Penetrating Eye Injury Research Articles

Epidemiology of Penetrating Eye Injuries at Noor Hospital, Herat, Afghanistan: A Descriptive Study

Objectives: Ocular trauma is a major health issue globally, causing significant disability and vision loss. In Afghanistan, with its socioeconomic challenges and occupational risks, this study examined the incidence, demographics, causes, and visual outcomes of penetrating eye injuries among patients at Noor Hospital in Herat. Methods: This descriptive case series study included 98 patients with ocular trauma at Noor Hospital, Herat, from October 2020 to March 2021, using a universal sampling method. Inclusion criteria were patients confirmed to have ocular trauma after thorough evaluation, while those without ocular trauma were excluded. Data collection involved visual acuity assessments, patient histories, and follow-up visits, with variables such as age, sex, residence, occupation, and visual acuity. The data were analyzed using Excel based on patient records, register books, and direct interviews. Results: The study predominantly comprised male patients (83%), with the highest incidence observed among individuals aged 1-20 years (50%). Blunt objects were the primary cause of ocular trauma (24.5%), followed by penetrating trauma and physical conflict (16.3%). Visual impairment varied significantly, with normal or near-normal vision achieved in only a minority of cases (22.4%), whereas profound visual loss affected a substantial proportion (15.3%). Conclusion: Young males are most affected by blunt trauma, highlighting the need for targeted prevention, safety education, and better access to protective eyewear. This insight helps improve ocular trauma treatment and reduce preventable vision loss, especially in socio-economically challenged regions. Future efforts should address occupational hazards and promote early interventions.

Ocular trauma in badminton: A 5-year review of badminton-related eye injury emergency department presentations.

To examine the nature and severity of badminton-related ocular injuries in Melbourne, Australia. This is a retrospective chart review. A search of the medical records was conducted for patients presenting to the ED at The Royal Victorian Eye and Ear Hospital, with badminton-related eye injuries from June 2018 to May 2023. Data were extracted, focusing on injury mechanism, patient demographics and treatment outcomes. In total, 88 patients were included in the study, comprising 64 (73%) men and 24 (27%) women. The mean patient age was 36.13 years. The most common injury was hyphaema (73%), followed by commotio retinae (45%). One patient sustained a penetrating eye injury when a shuttlecock shattered the spectacles he was wearing during play. Medical intervention was required for 90% of patients. The most common interventions were steroid eye drops (80%) and cycloplegic eyedrops (76%). A total of six (7%) patients required surgical management. For those 69 patients followed up at The Royal Victorian Eye and Ear Hospital, 77% of patients had a final best-corrected visual acuity of 6/6 or greater. Hyphaema, commotio retinae and traumatic uveitis were the most commonly diagnosed injuries. The majority of patients with badminton-related eye injuries required medical treatment, and some necessitated surgical intervention. To mitigate these risks, there is a pressing need to develop an eye safety policy for Australian badminton players, and players should exercise caution when wearing spectacles during play to prevent potential penetrating eye injuries.

Three-year epidemiological analysis of penetrating ocular traumatic endophthalmitis.

The characteristics of patients with endophthalmitis due to penetrating ocular trauma are still limited. The aim of the study was to fill these gaps among Chinese population. This retrospective study included patients diagnosed as penetrating ocular traumatic endophthalmitis between January 2016 to December 2018. During the past 3-year period, a total of 201 patients with antecedent penetrating eye injuries were evaluated. Of which, 42 (20.9%) patients presented a clinical course compatible with acute infectious endophthalmitis. 39 (92.86%) patients were males, and 15 (35.71%) patients had mechanical injuries from intraocular foreign body (IOFB), the rate of endophthalmitis due to IOFB was 13.43%, higher to the rate among patients without IOFB (7.46%). The duration between injury occurrence and endophthalmitis onset was 1 day in 10 (23,80%) patients; 2 to 7 days in 31 (73.80%) patients, and 7 to 14 days in 1 (2.38%) patient. After 1 year follow-up, best corrected visual acuity (BCVA) better than 20/400 was observed in 15 (35.71%) patients, counting fingers and hand move in 17 (40.48%) patients, light perception in 5 (11.9%) patients and no light perception in 5 (11.9%) patients, respectively. Patients with promising outcomes had better initial BCVA at baseline (P < .001). Endophthalmitis is a severe ocular infectious condition that may lead to irreversible vision loss. A greater attention must be paid to penetrating eye injuries within males, who had poor BCVA at baseline, particularly with obvious IOFB.

Penetrating eye injuries caused by animal inoculation needle sticks: Two case reports

We present two cases of ocular injuries caused by animal inoculation needles associated with full-thickness corneal lacerations and traumatic cataracts. Total vitrectomy was performed on the days of the incidents; both retinal holes and retinal hemorrhages were observed. The patients achieved final visual acuities of 20/25 and 20/16, respectively. This report seeks to share treatments that ensure successful outcomes when ocular injuries are caused by animal inoculation needles. We recommend early vitrectomy to prevent endophthalmitis while monitoring any retinal damage.

Aetiology and epidemiology of surgical vitreoretinal presentations in an Australian paediatric population: A seven-year retrospective study.

Paediatric vitreoretinal pathology is distinct from adult cases in both presentation and surgical planning. Here we aim to report the aetiology and epidemiology in children 0-18 years requiring vitreoretinal surgery at a major tertiary paediatric hospital in Queensland, Australia. Retrospective review of cases requiring vitreoretinal surgery between May 2015 and October 2022 was conducted. Demographics, ocular and medical history, surgical pathology, procedures performed, and epidemiology data were retrieved. Patients were grouped into three main aetiologies: traumatic, syndromic, or secondary. A total of 124 patients, the majority male (87, 70.2%) with a mean age of 10.3 years underwent vitreoretinal surgery. Trauma accounted for 32.3% of cases requiring surgery of which 47% were due to a penetrating eye injury. 35.5% were associated with a syndromic cause with common aetiology including coats, congenital cataract, sticklers, and retinopathy of prematurity. 32.3% developed secondary pathology and retinal detachment was the primary cause for surgery (55%). The average time from symptom onset to presentation was 30 days (SD 56.88) with patients living an average of 306.2 km (SD 558.9) away from the Queensland Children's Hospital. Older age was significantly associated with increased days to presentation in the traumatic group (p < 0.05). This study provides an insight into the aetiology and epidemiology of paediatric vitreoretinal presentations in Queensland, Australia.

Comparison of the effectiveness of different corneal curvature measurement methods for IOL implantation in traumatic aphakic eyes with corneal injury.

To assess the refractive outcomes of secondary intraocular lenses (IOL) in patients with traumatic aphakic eyes with corneal penetrating injury and compare different corneal curvature measurement methods. Patients with unilateral penetrating eye injuries underwent corneal wound repair and cataract extraction, followed by secondary IOL implantation. Corneal curvature measurements were taken on the contralateral healthy eye (Group A), from the affected eye before removing corneal sutures (Group B), or after suture removal (Group C). The refractive outcomes were compared among the three groups. The study included 261 eyes. The Mean Absolute Error (MAE) in Group C (0.99 ± 0.85 D) was significantly smaller than that in Group A (1.87 ± 1.71 D) and Group B (1.37 ± 1.20 D) (both P < 0.001). Moreover, the percentage of eyes with IOL prediction errors within ± 0.50 D in Group C (40%) was higher than that in group A (21.7%) (OR = 2.364, 95%CI: 1.272-4.392, P = 0.006) and group B (28.0%) (OR = 1.714, 95%CI: 0.948-3.099, P = 0.073), and the percentage of eyes with IOL prediction errors within ± 1.0 D in Group C (90.9%) was higher than that in group A (67.9%) (OR = 4.758, 95%CI: 2.131-10.626, P < 0.001) and group B (75.0%) (OR = 3.370, 95%CI: 1.483-7.660, P = 0.003) as well. In traumatic aphakic eyes with corneal sutures, IOL power calculation based on the corneal curvature of the injured eye after removing the corneal sutures yields the best refractive outcomes.

Clinical Features of Patients with Penetrating Eye Injury and Foreign Body Complicated by Endophthalmitis

Purpose: to study the clinical features of patients with penetrating eye injury and foreign body, complicated by endophthalmitis.Methods. 68 patients (68 eyes) with penetrating injury and ocular foreign body were included in the retrospective study, including 91.2 % males and 8.8 % females. The mean age was 50.00 [32.00; 60.00] years. The patients were divided into 2 groups: with endophthalmitis — 24 patients, without inflammation — 44 patients. All patients underwent standard ophthalmologic methods of examination.Results. The age of patients with endophthalmitis was significantly greater compared to patients without inflammation — 51.50 [46.25; 63.25] years and 36.50 [31.25; 58.50] years, respectively (p = 0.0446). In the first day after injury, only 25 % of patients asked for medical care (p = 0.0071). In patients with endophthalmitis according to biomicroscopy data on admission the following were significantly more frequent: eyelid edema (p &lt; 0.0001), purulent discharge (p &lt; 0.0001), total hyphema (p = 0.029), hypopyon (p &lt; 0.0001), iris edema (p &lt; 0.0001), fibrin in vitreous body (p = 0.0014), as well as its destruction (p = 0.0005). 87.5 % of patients with endophthalmitis showed absence of fundus reflex (p = 0.0105), and 25 % of patients with inflammation showed increased intraocular pressure (p = 0.0019). In patients with endophthalmitis, surgical treatment was performed: cataract phacoemulsification in 91.7 % of patients (p &lt; 0.0001), vitreoectomy in 87.5 % (p = 0.0098), enucleation of the eye in 12.5 % (p = 0.0165) and evisceration in 12.5 % (p = 0.0165). Bacterial culture in patients with endophthalmitis revealed Gram-positive microflora in 100 % of cases. There were also significant differences between the groups in the intravitreal, systemic and subconjunctival antibiotic therapy used.Conclusion. Patients with penetrating eye injury and foreign body, complicated by endophthalmitis, are characterized by more signs of inflammation, pronounced damage to the eye and its structures.

Penetrating Fishhook Ocular Injury: Challenging management in low- resource country

Introduction : Fishing is a common income source in rural areas, but fishhook eye injuries are rare. This report describes a case of a rare penetrating fishhook ocular injury, which resulted in endophthalmitis and eye evisceration, and highlights the challenges caused by delayed referral and limited options for intravitreal antibiotics due to inadequate consumable availability.&#x0D; Case Illustration : A 13-year-old boy from Vanuatu had a fishhook in his right eye and was referred to an Ophthalmologist one day later due to unavailability of flights. Upon arrival, endophthalmitis signs were noted, with the left eye having a visual acuity of 6/7.5 and the right eye showing only hand movement. The right eye showed corneal edema and a blood stain around the fishhook, fresh keratic precipitates, discharge and conjunctival edema. The fishhook was removed, and the cornea repaired under local anesthesia. On Day 1 post-operation, Intravitreal vancomycin and moxifloxacin were administered after procuring privately from pharmacies outside the hospital. However, the patient's condition worsened, requiring evisceration of the right eye.&#x0D; Discussion : Prompt management of penetrating eye injuries is crucial, with patients requiring broad spectrum antibiotics, tetanus shots, and an eye shield during referral. However, challenges such as lack of an eye shield and transportation delays worsened the patient's condition before arrival. This case also highlights the challenges faced in treating the patient effectively by the ophthalmologist due to limited options intravitreal antibiotics.&#x0D; Conclusion Timely management and urgent referral are crucial in low-resource areas to prevent complications. Essential consumables are necessary for effective treatment by an ophthalmologist.

Management of Iatrogenic Iridodialysis with Single-pass Four-Throw (SFT) Pupilloplasty : A Case Report

Introduction : Iridodialysis is a localized separation or tearing away of the iris from its attachment to the ciliary body. It occurs most commonly secondary to trauma, and it is more frequently associated with blunt traumas compared to penetrating eye injuries. Iridodialysis can also occur due to intraocular surgeries. The prevalence of iridodialysis secondary to blunt trauma was reported to be 9.3-14% as compared to 0.2% caused by cataract surgeries. Small and superiorly located iridodialysis may be left untreated. However, a more inferiorly placed, larger, or symptomatic iridodialysis warrants surgical repair.&#x0D; Case Illustration : A Male 62 years old came with chief complaint Glare on right eye after complicated cataract surgery 2 months before.Patient also complained blurry vison without redness. Examination found visual acuity 6/60 UCVA RE, iridodialysis at superior region from 10 o’clock until 1 o’clock, IOL (+) with good central, Normal Posterior Segment. Patient was treated with Single-pass Four-Throw (SFT) Pupilloplasty with local anesthesia and 1-month after Pupilloplasty we found visual acuity 6/30 UCVA RE and without any glare complaint anymore.&#x0D; Discussion : Management of this patient is a challenging case. The treatment og Single-pass Four-Throw (SFT) Pupilloplasty can give great outcome for visual acuity and glare symptom. SFT Pupilloplasty is also great and easy technique for beginner eye surgeon but for anesthesia, general anesthesia is more convenience than local ones.&#x0D; Conclusion : SFT Pupilloplasty is also great and easy techinique for iatrogenic iridodialysis.

Наш опыт эндовитреального удаления внутриглазных инородных тел при выполнении хирургии тяжелых проникающих ранений глаз

Purpose. To evaluate efficiency and safety of transvitreal removal of intraocular foreign bodies (IOFB) when performing vitrectomy after penetrating eye injuries. Material and methods. 12 patients (12 eyes) with penetrating ocular trauma with IOFB were included in this study. In 2 eyes, IOFB was removed in our clinic on the same day during an emergency surgical treatment, immediately upon admission of patients: in 10 eyes – delayed. At the time of admission to the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution, we registered low visual acuity or blindness in all 12 eyes: in 8 eyes – from 0.001 to 0.4; in 4 eyes – from LP to NLP. A standard three-port 25-gauge vitrectomy was performed in all patients, during which IOFB was localized. Results. In all eyes IOFB was correctly removed; in 3 eyes with retinal detachment, it was possible to achieve its total reattachment. In 7 eyes, IOFB removal was performed using intraocular forceps: 5 eyes – through the corneal tunnel – the pupillary zone – posterior capsulorhexis at the stage of phacoaspiration, 2 eyes – through the port; in 3 eyes – with the help of a vitreotom; in one eye – with the help of an magnet through the pupillary zone before implantation of the IOL RSP-3 (Russia), and in one eye – with the help of scleral forceps. Conclusion. The IOFB entry wound in 12 eyes were: corneal – 5 eyes, scleral – 5 eyes, corneoscleral – 2 eyes. In 11 eyes IOFB were metallic (9 magnetic and 2 non-magnetic), in 1 eye – non-metallic. The volume and tactics of vitreoretinal surgery in each case of IOFB removal was determined by the initial severity of eye injuries, size, and location of the IOFB, the degree of secondary trauma to the intraocular structures after their removal during the primary wound repair. Key words: ocular trauma, intraocular foreign body, penetrating eye injury, vitrectomy

INCIDENCE AND DEPENDENCE OF FUNCTIONAL RETINAL CHANGES IN RHEGMATOGENOUS DETACHMENT IN PATIENTS OF DIFFERENT AGE GROUPS

Introduction. Rhegmatogenous retinal detachment results from retinal rupture causing the accumulation of fluid with the separation of the neurosensory retina from the main pigment epithelium. This condition is known as the most common type of retinal detachment. Patients with newly developed retinal detachment typically experience a sudden loss of vision, accompanied by floating opacities and metamorphopsia, or a "dark veil," that interferes with vision. The annual incidence of retinal detachment has been estimated in different countries and regions for a long time and ranged from 6.9 to 26.2 cases per 100,000.&#x0D; Aim of this study is to investigate the incidence rate of rhegmatogenous retinal detachment among individuals of different age groups.&#x0D; Materials and methods. 240 patients with rhegmatogenous retinal detachment operated during 2022-2023 were included in this retrospective study. The criteria for inclusion were the following: a case of retinal detachment with onset between January 2022 and October 2023. Exclusion criteria include: 1) traction-induced retinal detachment (eg, proliferative diabetic retinopathy), iatrogenic injury, or eye tumor; 2) subclinical RBS, which could be cured by one laser treatment of the retina; 4) a history of penetrating eye injury; 5) retinal detachment caused by a macular tear.&#x0D; Results and conclusions. Following the analysis of the incidence of rhegmatogenous retinal detachment, it was observed that this condition predominantly occurs in men (62.5% of cases), particularly in the older age group (60-70 years). The average duration of detachment before surgical intervention is 18.4±2.4 days. Early detection of rhegmatogenous retinal detachment leads to a reduced risk of total retinal detachment with macular involvement, as evidenced in our study (63.3% macula-off in men compared to only 28.8% macula-off in women).

The first experience in the treatment of large penetrating wounds of the sclera using expanded primary microsurgical treatment

BACKGROUND: According to the literature, the absence of pattern vision in the outcome of open wounds of the eyeball is observed in 2530% of cases, and in the presence of large wounds with multiple injuries of intraocular structures, it is 6180%.&#x0D; AIM: to present the results of expanded microsurgical treatment of large penetrating corneoscleral and scleral wounds involving the zone III, to evaluate the results of the given algorithm for severe penetrating injury care.&#x0D; MATERIALS AND METHODS: Presented are the results of treatment of 24 patients with large penetrating corneoscleral and scleral wounds, massive hemophthalmos, and other injuries. All patients underwent primary microsurgical treatment according to a modified, expanded algorithm, which, in addition to suturing the fibrous capsule of the eye, included subtotal vitrectomy, primary treatment of retinal and choroidal wounds, the use of autologous conditioned plasma (P-PRP) , tamponade with silicone oil or a gas-air mixture.&#x0D; RESULTS: Evaluation of treatment results was carried out on day 3, after 1 and 6 months. Special attention was paid to the identification of signs of proliferative vitreoretinopathy as most important in terms of prognosis. After 6 months, visual acuity above 0.1 was noted in 10 patients, 0.020.09 in 12, absence of pattern vision in 2. Signs of development and progression of PVR during 6 months were noted in 7 patients (29.2%), of which repeated surgeries were performed in 5 cases.&#x0D; CONCLUSIONS: The new advanced algorithm of primary microsurgical treatment allows to improve functional results in severe cases of penetrating eye injury.

A Prospective Study on Clinical Features and Visual Outcome of Penetrating Eye Injury at Preah Ang Duong Hospital, Cambodia

A Prospective Study on Clinical Features and Visual Outcome of Penetrating Eye Injury at Preah Ang Duong Hospital, Cambodia

Explosives-based vole traps-A novel injury pattern in the eye region

Anovel method for trapping voles is the use of pistol-like explosive tools loaded with bolt-action ammunition. When triggered the vole is killed by the very high gas pressure created. Accidental releases can result in facial and/or eye injuries. The aim of this work was to describe the injury pattern in the patient and to experimentally verify whether there is arisk of penetrating eye injuries. Two emergency patients presented to our eye clinic with eye injuries after unintentional triggering of the explosive trap. Based on the new pattern of injury noted, experiments were performed on enucleated porcine eyes to determine the possible severity. For this purpose, avole trap was clamped in aholder and loaded with aCal. 9 × 17 mm cartridge in each case. In front of the muzzle opening, 3pig eyes each were fixed on Styrofoam at adistance of 20, 40, 60 and 80 cm. The foreign body indentations in the cornea were visualized and measured by spectral domain optical coherence tomography (SD-OCT). The pig eyes were then dissected and searched for foreign bodies using microscopy. The SD-OCT images of an injured patient were also included for human comparison. On patient examination, in addition to the usual fine gunshot marks on the face and conjunctiva/eye area, wax-like, larger and heavier particles of approximately 0.1-0.2 mm in size were found, which originated from the cartridge end cap. Removal of these foreign bodies, some of which were injected more deeply into the cornea, conjunctiva, and tenon, is much more difficult and extensive than in usual blast trauma. There was no evidence of intraocular foreign bodies in either patient. Likewise, no intraocular foreign bodies could be detected experimentally in any pig eyeball (n = 12). Remnants of the wax-like cartridge end were found deeply penetrating into the corneal stroma. The maximum penetration depth measured against the total corneal thickness was 46% at 20 cm device distance and decreased with greater distance to the vole trap (penetration depth at 40 cm at 37%, at 60 cm at 28% and at 80 cm at 19%). For comparisons on the human eye, apenetration depth of 54% was measured at adistance of about 40 cm. In pig eyes the number of foreign bodies per cm2 decreased with increasing distance from the vole trap (mean: n = 174 foreign bodies, FB, at 20 cm distance, n = 46FB at 40 cm, n = 23FB at 60 cm, and n = 9FB at 80 cm). The largest penetrating foreign bodies measured amean of 383 ± 43 μm with amaximum of 451 μm. New vole traps with gas-powered mechanisms result in larger deeply penetrating wax-like foreign bodies in the cornea, conjunctiva, and tenon of the eye, which are difficult to remove and only surgically possible. Despite the significant explosion during triggering, there was no evidence of penetrating ocular injury from the foreign bodies either in the patient or experimentally in the pig eyes. Safety goggles should be worn when handling the traps to avoid penetration of foreign bodies into the eye.

Intraocular Axon Regeneration in a Model of Penetrating Eye Injury.

Purpose: Penetrating eye injuries commonly cause permanent loss of vision in patients. Unlike mammals, zebrafish can regenerate both damaged tissue and severed axons in the central nervous system. Here, we present a tractable adult zebrafish model to study intraocular axon regeneration after penetrating eye injury. Methods: To create consistent penetrating intraocular injuries, pins of standardized diameters were inserted into the eye through the cornea and penetrating the retina but not the underlying sclera. Transgenic gap43:GFP reporter fish were used to preferentially label retinal ganglion cells (RGCs) that respond to injury with regenerating axons. Retinas were fixed and flat mounted at various times postinjury to examine injury size, number of green fluorescent protein (GFP)-positive cells and axons, axonal varicosities, and rate of regeneration to the optic nerve head. Intraocular injection of colchicine was used to inhibit axon outgrow as a proof of principle that this method can be used to screen effects of pharmacological agents on intraocular axon regeneration. Results: Penetrating injury to the zebrafish retina results in robust axon regeneration by RGCs around and beyond the site of injury. The gap43:GFP transgene allows visualization of individual or small bundles of axons with varicosities and growth cones easily observable. Regeneration proceeded with most, if not all, axons reaching the optic nerve head by 3-day postinjury. A single intraocular injection of colchicine a day after injury was sufficient to delay axon regeneration at 2-days postinjury. Surprisingly, we identified a stereotypically located population of circumferential projecting neurons within the retina that upregulate gap43:GFP expression after injury. Conclusions: Penetrating injury to the adult gap43:GFP transgenic zebrafish eye is a model of successful intraocular axon regeneration. The pharmacological and genetic tools available for this organism should make it a powerful tool for dissecting the cellular, molecular, and genetic mechanisms of axon regeneration in the intraocular environment.

Method of Extended Primary Microsurgical Treatment of Extensive Penetrating Scleral Wounds

Purpose: to expand and modernize the technology of primary microsurgical treatment of extensive scleral wounds due to simultaneous subtotal vitrectomy, primary treatment of retinal and choroid wounds, filling of tissue defects with autologous conditioned plasma (ACP), tamponade with silicone oil or C3F8 gas.Methods. 15 patients (15 eyes) with extensive penetrating scleral and corneoscleral wounds ranging from 8 to 15 mm in length, with concomitant complex injuries of various structures of the eye: traumatic cataract, wound of the ciliary body, injury or loss of the iris, subtotal/total hemophthalmos, retinal detachment were monitored. All patients underwent primary surgery according to the original extended technique.Results. The functional results of surgical treatment in patients, taking into account the severity of the injury, were high: in the early postoperative period, 1 month after primary surgery, visual acuity with correction ranged from 0.02 to 0.5. Signs of proliferative vitreoretinopathy were not observed in any case.Conclusion. The proposed method of extended primary microsurgical treatment for extensive penetrating scleral and corneoscleral wounds with severe concomitant damage to intraocular structures is effective and has a number of advantages: early prevention of severe complications in the form of proliferative vitreoretinopathy, shortening the rehabilitation period. The method allows to achieve high functional results in the most severe cases of penetrating eye injury.

Material risk: vitreoretinal surgery, evisceration, enucleation and sympathetic ophthalmia-where are we currently?

Sympathetic ophthalmia (SO) is known to occur after severe penetrating eye injury, evisceration and even enucleation surgery. Recent evidence suggests that a greater risk lies after multiple vitreoretinal procedures. The risk of SO following evisceration is only minimally greater than that following enucleation surgery. This review evaluates literature on SO to date and provides figures for the risk of developing SO for the purposes of the consent process. The issue of SO and Material Risk following vitreoretinal surgery is reviewed and figures for the purposes of consent are outlined. This is of particular relevance for patients in whom the contralateral eye is and will likely remain the better seeing eye. Sympathetic ophthalmitis is known to occur after severe penetrating eye injury, after evisceration and enucleation. More recently, sympathetic ophthalmitis has been recognised to occur after vitreoretinal surgery. This article reviews the evidence on material risk when consenting patients for elective and emergency eye procedures after ocular trauma or surgery. When a globe needs to be removed because of irreparable ocular injury, previous publications dictated the procedure to be an enucleation because of the fear of an increased risk of SO after an evisceration. Perhaps the issue of material risk of sympathetic ophthalmia (SO) remains over-emphasised by ophthalmic plastic surgeons and under-recognised by vitreoretinal surgeons during the consent process for evisceration, enucleation and vitreoretinal surgery. Antecedent trauma and number of previous surgeries may actually be a more significant risk factor than the type of eye removal. Recent medicolegal cases also help us understand the importance of the discussion of this risk. We present our current understanding of the risk of SO after different procedures and suggest how this information may be included in a patient consent.

Первичная отсроченная хирургическая помощь пациенту с боевым ранением глаза

Currently, injuries to the visual organ are one of the most important causes of blindness and disability due to the complicated course of the post-traumatic process and an unfavorable functional outcome, in the vast majority of cases of the able-bodied population. The timeliness of providing highly specialized ophthalmic surgical care is a fundamental factor that allows for the medical and social rehabilitation of patients with various visual organ injuries in the shortest possible time. In turn, the prolongation of the terms of primary surgical treatment dictates slightly different approaches to the conservative and surgical treatment of such patients. Objective. To evaluate the effectiveness of primary delayed simultaneous surgical care for a patient with a penetrating comminuted battle wound of the eye. Material and metods. Patient K., 35 years old, was admitted to the ophthalmological department of the State Medical Institution «OOKB» of Orenburg with complaints of decreased visual acuity of the left eye with the diagnosis: OS – Multiple military trauma. Consequences of penetrating eye injury. Corneal scar. Traumatic cataract. Partial hemophthalmos. Local retinal detachment. Intraocular foreign bodies. From anamnesis: a month ago, during military operations, he received a shrapnel wound to the head. An open penetrating comminuted fracture of the left temporal bone was performed in a military hospital. I did not receive surgical ophthalmological care. Ophthalmological status: Vis OD = 1,0: OS = movement of the shadow at the face. The IOP of both eyes is normal. OS – conjunctiva is injected, a metallic foreign body is embedded in the sclera at the meridian of 7 hours, 5 mm from the limb, the cornea is transparent, the corneal scar, the anterior chamber is shallow, the moisture is transparent, the iris is edematous, the pupil in the center is deformed, tightened for 7 hours, the pupil reaction is slowed down, inhomogeneous opacities in the lens. The reflex is dim, the details of the fundus and vitreous are not ophthalmoscoped. Preparatory measures were carried out before the surgical intervention: antibacterial and anti-inflammatory therapy. At the first stage, phacoemulsification of traumatic cataract with posterior continuous capsulorexis was performed in the conditions of medical mydriasis. The second stage was a standard three-port vitrectomy of 25 G with the removal of organized vitreous blood clots and the removal of the posterior hyaloid membrane. During the revision, a parietal foreign body with local retinal detachment is visualized in the middle outer part. A 23 G tweezers were used to remove the foreign body, which required the replacement of one of the ports. Delimitative endolasercoagulation was performed. The foreign body was removed through the posterior capsulorexis: brought to the iris in the anterior chamber of the eye, then evacuated through a tunnel incision of 2.75 mm. Then a perfluoroorganic compound (PFOS) was introduced, the retina was attached, additional retinal endolasercoagulation was performed. At the third stage, a simultaneous replacement of PFOS with silicone oil was carried out. The Miol-soft intraocular lens was implanted. At the last stage, the embedded foreign body of the sclera was removed, the conjunctival wound was sutured. On the fifth day after surgical treatment, the patient was discharged for outpatient follow-up with the functions of vis OS = 0.2 sph (+) 4.0 = 0.4 with recommendations. Conclusions. As a result of simultaneous high-tech vitreoretinal surgical treatment against the background of anti-inflammatory and antibacterial therapy, high functional results were achieved. Keywords: injury, penetrating wound of the eye, foreign body of the eye, local retinal detachment

Primary vitrectomy in total and subtotal hemophthalmos of traumatic etiology

Purpose: to present the functional results of primary early vitrectomy in patients with subtotal and total hemophthalmos with penetrating wounds and severe contusions of the eye. Material and methods. 41 patients were observed, including 24 patients (24 eyes) with a penetrating eye injury and 17 patients (17 eyes) with a severe eye contusion. All patients had subtotal or total hemophthalmos. All patients underwent a 25G three-port vitrectomy no later than 3 days after the injury. 33 patients received a tamponade with silicone oil 5700, and 8 patients received gas-air mixture C3F8. The follow-up period was 6 months. Results. On the first day after surgery, 31 patients treated with silicone oil tamponade showed an improvement in visual acuity. With gas-air tamponade, visual acuity as light perception was obtained for 1 day; as the gas resorbed, objective vision appeared in all 8 cases. Six months after the surgery, a good anatomical result was achieved: no signs of subatrophy were detected in any of the presented patients. An unfavorable outcome (lacking or incorrect light perception) was observed in 4 cases (9.75%), a relatively favorable functional outcome in the form of objective vision less than 0.1, in 17 cases (41.5%), a favorable outcome with visual acuity above 0.15 in 20 cases (49%). Signs of proliferative vitreoretinopathy were noted in 8 patients (19.5%), which in cases of severe penetrating wounds and contusions and a number of complicating factors is a good result as compared to the available literature statistics. Conclusion. Our study shows that in patients with total and subtotal hemophthalmos with penetrating eye wounds and severe contusions, primary vitrectomy should be performed at an early stage. After the surgery the patients receive a statistically significant increase in visual acuity, have a stable anatomical result and, in the long term, obtain a good functional result.

Intrastromal Corneal Glass Foreign Body in a Case of Spectacle Glass Injury

Spectacle-related glass foreign body eye injury is commonly associated with sports activities and a significant contributor to penetrating eye injury. Optically clear glass particles may easily be missed during the examination. We present a case of intrastromal glass foreign body embedded in superficial layers of corneal stroma associated with sports-related spectacle injury in a 21-year male. There were multiple superficial lacerations and multiple small glass fragments on the surface of the cornea. After the removal of glass fragments under a slit lamp, the eye was washed thoroughly and patched with antibiotic and cycloplegic eye drops for twenty-four hours. However, the next day we could detect a small intrastromal glass fragment in the superficial layers of the corneal stroma under slit-lamp examination with high magnification. A small piece of glass (1mm in length) was removed under topical anaesthesia.