Presence Of Intraocular Foreign Body Research Articles

Prediction of late results of surgical treatment of traumatic retina detachment in eye injury of multiple origin

Purpose. To evaluate the possibility of predicting the anatomical and functional results of surgical treatment of traumatic retinal detachment (RD) in trauma of various geneses, taking into account the clinical picture and the severity of the proliferative syndrome based on large clinical data.Materials and methods. A comprehensive analysis of the clinical picture (using 22 features) and long-term results of surgical treatment of 427 patients with traction traumatic RD (TRD) after open and closed eye injury was carried out. The patients were divided into 7 groups depending on the mechanism of injury. The observation period was 5 years.Results. The most severe proliferative syndrome was observed in TRD after an open injury: OEI A (contusions with scleral rupture), OEI D (double puncture wound) and OEI E (explosive trauma with scleral rupture), when both the process of mooring and PVR are present, as well as with CEI A (contusion) in the event that after the first operation PVR continued to progress. We found a direct dependence of PVR activity in TRD on the area of the detached retina and the presence of a traumatic cataract, and the inverse dependence on the presence of intraocular foreign body (IFB), its size and the ability of IFB to cause metallosis. A direct dependence of long-term functional results of treatment on the PVR stage, the area of detached retina and the diagnosed retinal rupture during the first vitreoretinal surgical intervention was established.Conclusion. In order to make the surgical treatment of TRD more effective, it is worth using antiproliferative drugs intravitreally during vitreoretinal surgery, especially in OEI A, OEI D and OGI E, when the proliferative syndrome is caused both by PVR and mooring, as well as in CEI A in the case of a pronounced PVR stage.

Ultrasonography in ocular trauma: A pictorial description

Ultrasonography is an indispensable diagnostic tool for examination of the eye after ocular trauma, which can be quite challenging due to various reasons like lack of patient cooperation, hazy media, and injury to periocular structures. We have retrospectively analyzed the case records of 269 patients who had sustained ocular trauma over a span of 1 year and compiled the data of the findings that were obtained from ultrasound scan. The scan was found to be normal in most cases (27.63%) and the second most common finding was retinal detachment (24.36%). Other findings that were noted are vitreous hemorrhage, choroidal detachment, optic nerve avulsion, endophthalmitis, panophthalmitis, presence of intraocular foreign body, and phthisis bulbi.

Chinese expert consensus on the prophylaxis and management of traumatic infectious endophthalmitis (2023)

Traumatic infectious endophthalmitis refers to the inflammation of one or multiple layers of the eyeball wall and intraocular contents caused by pathogen invasion after open globe injury. Its incidence rate is about 4% to 16%. There are various factors related to the occurrence, development and prognosis of traumatic infectious endophthalmitis, including the types of ocular trauma, the properties of pathogens, the presence of intraocular foreign body and the treatment timing. Reasonable preventive measures, accurate diagnosis and timely and effective treatment are critical for the recovery of visual function and even the preservation of the eyeball in high-risk patients. In order to further clarify and standardize the prophylaxis and management of traumatic infectious endophthalmitis, the experts of the China Ocular Trauma Society have reached consensus opinions after discussions, thus providing reference for ophthalmologists in clinical practice.

Pediatric Open Globe Injuries Caused by Firecrackers in a Tertiary Eye Care Hospital in Iran.

The aim of the study is to determine characteristic features of open globe injuries caused by firecrackers among pediatric population. In this retrospective cross-sectional chart review, medical records of children with ocular trauma who were hospitalized in Isfahan, Iran, during 2013-2017 were reviewed. We analyzed the collected data before and after propensity score (PS) matching. Of 396 pediatric patients with open globe injury, 22 injuries (5.9%) were caused by firecrackers. Hyphema, iris prolapse, and lens rupture were noted in 15 (68.18%), 10 (45.45%), and 2 (9.09) eyes, respectively. None of patients had endophthalmitis. The mean age of patients in firecracker group was higher and significant (11.86 ± 4.05 in firecracker vs 7.80 ± 4.68 in nonfirecracker, P < 0.001). Furthermore, most boys were in firecracker group (95.5%, P = 0.005). Patients in firecracker group resided more in urban areas (86.4%, P = 0.054) and had more intraocular foreign body (IOFB) in the eyes (40.9%, P < 0.001). After PS matching, patients in firecracker group had higher IOFB ( P = 0.008). In logistic regression models, patients with corneal lacerations had lower odds for long-time admission (≥4 days) than patients with both corneal and scleral lacerations in crude model (odds ratio, 0.35; 95% confidence interval, 0.17-0.69) and adjusted model (odds ratio, 0.37; 95% CI, 0.18 to 0.74). After PS matching, there was no significant association between risk factors and outcomes. The present study showed several differences between the pediatric open globe injuries caused by firecrackers and other mechanisms of injuries, including the age, sex, living place, presence of IOFB, and length of hospital stay.

Epidemiological Characteristics and Outcome of Open Globe Injuries in Tabuk City, Kingdom of Saudi Arabia: Retrospective Cohort Study.

IntroductionThe objective of this study was to assess the epidemiological characteristics, clinical features and visual outcomes of open globe eye injury (OGI) in Tabuk, Saudi Arabia.MethodsA retrospective chart review of OGI patients who had undergone operative repair of their injuries in Tabuk, Saudi Arabia. The collected data included patients’ demographics, duration between trauma and presentation and the mechanism of trauma, wound location, extent of injury, presence of intraocular foreign body, and initial and final visual acuity data.ResultsSixty-three eyes of 63 patients who were admitted for traumatic globe rupture were included; 84.1% were males and 39.7% were of pediatric age. Delay in seeking medical care for > 24 h was recorded in 4.8% of patients. The most common (42.9%) mechanism was blunt trauma followed by sharp trauma (38.1%) and projectile trauma (9.5%); 55.6% had the injury in zone 1. Intraocular foreign body was reported in 9.5% of patients. Intraocular foreign bodies were significantly more common in adults (p = 0.018) compared to children. Poor visual acuity was noted in 77.8% of patients upon presentation and 60.3% on last visit.ConclusionThe incidence of OGI was more common in males. The most common cause of OGI was blunt injury, and half of the injuries were in zone 1. Visual outcomes are guarded for most patients with OGIs.

Основные аспекты травматических поражений глаз в условиях войн и военных конфликтов

Представленные в обзоре данные литературы свидетельствуют о том, что в связи с применением в современных войнах и военных конфликтах высокоразрушительных видов оружия частота и тяжесть повреждений глаз в историческом аспекте постоянно растет. Одной из самых частых причин травматического повреждения мозга и глаз, которые по сравнению с органами грудной и брюшной полостей ­обычно менее защищены, является взрывная волна. Травматическим повреждениям глаз присущи минно-взрывной двусторонний характер поражения одновременно нескольких структур глаза, наличие внутриглазных инородных тел, комбинированных и сопутствующих повреждений по сравнению с монокулярным поражением отдельных структур глаза без сопутствующих и комбинированных повреждений в мирное время. Среди оперативных вмешательств большой удельный вес составляют витреоретинальные вмешательства. Пострадавших при медицинской сортировке следует направлять непосредственно в лечебные учреждения, оснащенные соответствующим оборудованием и кадрами, владеющими методиками оперативных вмешательств на переднем и заднем сегментах глаза. Залогом успешных результатов лечения травматических повреждений глаз, полученных в боевых условиях, является своевременное проведение первичной хирургической обработки и витреоретинального вмешательства, плодотворное сотрудничество военных и гражданских медиков.

Risk factors and outcomes of post-traumatic endophthalmitis: a retrospective single-center study

BackgroundTo describe the epidemiology, characteristics, risk factors, and outcomes of post-traumatic endophthalmitis.Main bodyMedical records of consecutive open globe injury patients admitted and primarily treated between January 2006 and December 2016 were retrospectively reviewed. Patients were defined as having or not having associated endophthalmitis. Data of demographics, injury characteristics, clinical presentations, and visual outcomes were collected. The potential risks and significant factors for visual outcomes of post-traumatic endophthalmitis were determined. There were 591 patients included in this study. Among these, 118 patients were clinically diagnosed as having accompanied endophthalmitis. Higher proportions of intraocular foreign body (IOFB) (55.1% vs. 27.3%) and injury related to high-velocity objects (55.9% vs. 32.6%) were noted in patients with endophthalmitis compared to patients without endophthalmitis. Anterior wound location (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1 to 3.7; P = 0.020), presence of IOFB (OR, 1.9; 95% CI 1.2 to 3.0; P = 0.005), and delayed presentation of > 24 h (OR, 3.9; 95% CI 2.3 to 6.4; P < 0.001) were significant risk factors for associated endophthalmitis. Final visual acuity (VA) of the overall population improved significantly from 2.4 (0.6) logMAR to 1.4 (0.1) logMAR, P < 0.001, however, patients in the endophthalmitis group achieved a worse final VA than the non-endophthalmitis group (66.1% vs. 43.5%, P < 0.001).ConclusionHigh proportions of post-traumatic endophthalmitis patients had subsequent poor visual outcomes. Therefore, safety and protective measurements, especially when performing activities related to high-velocity objects, and the institution of prophylactic antibiotics in high-risk groups should be promptly considered to reduce the incidence.

Отдаленные результаты отсроченного удаления внутриглазного инородного тела при открытой травме глазного яблока с поражением заднего сегмента

Purpose. To study the clinical efficacy of the long-term results of a step-by-step method of surgical treatment of open eye trauma complicated by the presence of the intraocular foreign body (IFB) in the posterior segment, including primary surgical treatment (PST) and delayed vitreoretinal surgery with IFB extraction within 24 hours after PST. Material and methods. The clinical efficacy of delayed IFB removal within 2 years was studied in 32 eyes with open trauma of the eyeball complicated by the presence of IFB in the posterior segment. Concomitant traumatic complications included partial hemophthalmos (84.4%) and rhegmatogenous retinal detachment (RD) (59.4%). Results. By the end of 2 years of follow-up, the anatomical effect was observed in all examined 21 eyes, including 15 eyes (71.4%) with hemophthalmos and 13 eyes (61.9%) with traumatic retinal detachment. In this case, recurrence of RD occurred in 7 eyes, post-traumatic traction RD- in 3 eyes. Functional effect with improved visual acuity was in 12 eyes (57.1%). At the same time, the MCVA was 0.3±0.05 (0.15–0.5). Conclusion. The presented method made it possible to achieve a stable anatomical effect and stable functional results, even in the presence of severe trauma complicated by total hemophthalmos and retinal detachment, in the long term. Key words: open eyeball injury, intraocular foreign body, primary surgical treatment, transvitreal intraocular foreign body extraction, post-traumatic traction retinal detachment.

Проблемы локализации внутриглазного вколоченного инородного тела. Клинический случай

The article describes a clinical case of an eye injury with presence an intraocular foreign body (IFB), the localization of which was problematic. Patient T was 28 years old, was admitted with complaints of lack of vision, redness and lacrimation from the left eye. From the anamnesis – while working, he hit metal with a hammer, and the scale flew off into the left eye. In addition to the standard ophthalmologic examination, electrophysiological examination, B-scan and UBM were performed. According to the B-scan data, high optical density IFB was detected in the shells 9 mm from the upper border of the optic disc, in the 1-hour meridian, approximately 3.5 mm long. According to the X-ray data of the orbit in 2 projections, an X-ray contrast shadow, metal density, up to 3.0 mm in size was revealed. Radiography of Baltin–Comberg was not performed due to the lack of technical capability. During a standard three-port vitrectomy in the area of possible foreign body occurrence, the retina was damaged, there was a local detachment, but the foreign body itself was not visualized. In addition, during a thorough, detailed examination using a sclerocompressor, no visible defects of the sclera were found transvitreally. In the early postoperative period, the patient was performed with a computed tomogram, where the presence of a foreign body was confirmed, which was adjacent to the posterior wall of the eyeball for 1 hour with clear contours, measuring 3х3 mm. Taking into account the non-standard situation, the absence of a foreign body in the vitreous cavity, it was decided to re-search and remove the foreign body by using of the diascleral method. For a clearer contrast, diaphanoscopy was used, which made it possible to visualize and accurately localize a foreign body in the layers of the sclera. Conclusion. In the presence of IFB for search and precise localization, it is first of all necessary to perform the radiological Baltin-Comberg method. In cases when FB is not visualized intraoperatively, is impaled into the layers of the eye and the radiological Baltin-Comberg method has not been performed, diaphanoscopy of the eye is the optimal auxiliary method for searching for «hidden» foreign bodies. Key words: intraocular foreign body, radiological method of Baltin-Comberg, diaphanoscopy of the eye.

Anterior segment optical coherence tomography aided delineation of metallic intraocular foreign body

Penetrating ocular injury is an important cause of loss of vision and may be associated with the presence of intraocular foreign body (IOFB). Missed IOFB may present with non-specific clinical features which may delay accurate diagnosis and proper management. We are presenting a case of unusual retained intraocular foreign body in a 38-year-old woman which emphasizes the need of careful review of patient's traumatic history and need of investigation like anterior segment optical coherence tomography (ASOCT) in diagnosis, localization of foreign body and follow-up after foreign body removal.

Poor prognostic factors in post-traumatic endophthalmitis following open globe injury.

To demonstrate prognostic factors for poor visual outcome in patients with post-traumatic endophthalmitis (PTE) following open globe injury. A retrospective study was conducted on 66 patients (66 eyes) with PTE following open globe injury from 2005 to 2015. Potential factors accounting for good and poor visual outcome were statistically analyzed by Chi-square test and Logistic regression model. In 66 cases, 39 cases (59%) had a poor visual outcome. Univariate and multivariate Logistic regression analysis identified retained intraocular foreign body (IOFB) as the only factor significantly associated with poor visual outcome [adjusted odds ratio, 4.62; 95% confidence interval (1.04-20.53); P=0.04]. The most common causative agents were gram-positive organisms (83%), of which Bacillus cereus (33%), was the most common pathogen. All cases received intravitreal antibiotic injections. Oral ciprofloxacin was the most used systemic antibiotic (33%). Pars plana vitrectomy was performed in 83% (55/66) of cases. At 6mo follow-up, mean BCVA was 1.74±0.72 logMAR units. In patients with PTE following open globe injury, the only predictor of poor visual outcome is the presence of IOFB. Bacillus cereus is the most isolated microorganism.

Six-year epidemiological analysis of post traumatic endophthalmitis in a Brazilian hospital

BackgroundTo evaluate the epidemiology of endophthalmitis cases related to ocular trauma, including visual acuity during and 1 year after trauma, source of trauma and method of treatment.MethodsA retrospective study analyzed the epidemiological data of patients with a clinical presentation of endophthalmitis after ocular penetrating trauma between January 2012 and January 2017 at Escola Paulista de Medicina/UNIFESP, a hospital in São Paulo, SP, Brazil.ResultsA total of 453 patients with antecedent open globe trauma were evaluated, among these, 30 patients with suspected endophthalmitis. All patients were male. The time interval between trauma and ophthalmological evaluation and collection of vitreous and aqueous material was 1 day in 36.66%, 2–7 days in 43.44%, 7–14 days in 10% and more than 15 days in 10% of patients; 66.66% had positive cultures. 11 patients had intraocular foreign body. One year after trauma, visual acuity was classified as no light perception (NLP) in 33.33%, light perception in 6.66%, hand motion in 13.33%, counting fingers in 13.33%, and better than 20/400 in 20% of patients. Considering presence of intraocular foreign body, initial visual acuity and symptoms onset time, only initial visual acuity showed as better prognostic factor in final visual acuity.ConclusionEndophthalmitis is a severe ocular inflammatory condition that may lead to irreversible vision loss. Initially only one patient had visual acuity of NLP, but after 1 year, 33% showed visual acuity of NLP, and only 20% had visual acuity better than 20/400, what is consistent with a severe infection with a guarded prognosis. The high incidence of endophthalmitis after ocular penetrant trauma justifies distinct treatment and greater attention.

Prognostic factors associated with visual outcome of salvageable eyes with posttraumatic endophthalmitis

The purpose of this study is to evaluate the prognostic factors associated with visual outcomes in the salvageable eyes with posttraumatic endophthalmitis. We retrospectively reviewed the medical records of all patients diagnosed with posttraumatic endophthalmitis in our hospital between 2008 and 2015. The following information was collected: age, sex, etiology, past medical history, clinical manifestations, wound location, microbiology, blood leukocyte counts, types of interventions, initial visual acuities and final visual acuities. Univariate and multivariate analyses were used to explore the factors associated with final best-corrected visual acuity. In total, 98 eyes of 98 patients were included in our study. Fifty-seven eyes underwent vitrectomy, 27 of them had silicone oil tamponade, 38 eyes received intravitreal ceftazidime only and 3 eyes received intracameral ceftazidime. In univariate analysis, poor initial visual acuity, presence of intraocular foreign body, number of intravitreal injections, retinal detachment and Zone 3 injury were associated with poor visual outcome. In multivariable analysis, poor initial visual acuity, presence of intraocular foreign body and number of intravitreal injections were independently associated with poor visual outcome. The silicone oil group had fewer repeated intravitreal injections than the group without oil tamponade. We concluded that the visual outcome of salvageable eyes with posttraumatic endophthalmitis is associated with initial visual acuity, presence of intraocular foreign body and number of intravitreal antibiotic injections.

Visual outcomes and prognostic factors in open-globe injuries

BackgroundOcular trauma is an important cause of visual loss worldwide. Improvements in our knowledge of the pathophysiology and management of ocular trauma during the past 30 years, in conjunction with advances in the instrumentation and techniques of ocular surgery, have improved the efficacy of vitreoretinal surgery in injured eyes. The aim of the current study was to determine the visual outcomes and prognostic factors of open-globe injuries in the Japanese population.MethodsRetrospective study of 59 eyes of 59 patients presented with open globe injuries between September 2008 and March 2014 at Nagasaki University Hospital was conducted.Demographic factors including age, gender, and clinical data such as cause of injury, presenting visual acuity (VA), location of injury, type of injury, lens status, presence of intraocular foreign body, types of required surgeries, and final VA were recorded. According to the classification of Ocular Trauma Classification Group, wound location was classified into three zones. Chi-square test was used to compare presented data.ResultsOut of the 59 patients, 46 were placed in the Light Perception (LP) group, and 13 were placed in the No Light Perception (NLP) group. Work-related trauma was the most common cause (27 eyes) followed by falls (19eyes). Work-related trauma was common in males (P = 0.004), while falls was significantly common in females (P = 0.00001). Zone III injuries had statistically significantly poor prognostic factor compared to other zones (P = 0.04). All cases of NLP group (100%) presented with rupture globe. Poor VA at first visit (P = 0.00001), rupture globe (P = 0.026), history of penetrating keratoplasty (PK) (P = 0.017), retinal detachment (RD) (P = 0.0001), vitreous hemorrhage (VH) (P = 0.044), and dislocation of crystalline lens (P = 0.0003) were considered as poor prognostic factors.ConclusionPoor VA at first visit, rupture globe, zone III injuries, history of penetrating keratoplasty, RD, VH, and dislocation of crystalline lens were found to be poor prognostic factors. PPV had a good prognostic value in open globe injuries associated with posterior segment involvement.

POSTTRAUMATIC ENDOPHTHALMITIS: An 18-Year Case Series.

To describe the demographics, characteristics, management, and visual outcomes of eyes diagnosed with endophthalmitis after open globe injury. Retrospective cohort analysis of all patients diagnosed with endophthalmitis after open globe injury from 1997 to 2015 at University Hospital, Newark, NJ. Twenty-six eyes were identified (all male patients; mean age: 37 ± 15 years). Cultures were positive in 16 eyes (62%), with Staphylococcus species (7 eyes, 44%) being the most common organism. Twelve eyes (46%) presented with open globe injury and concurrent endophthalmitis; 14 eyes (54%) developed endophthalmitis a mean of 14 days after open globe repair (OGR; 1 outlier of 98 days excluded). All eyes were managed with systemic and intravitreal antibiotics. The presence of intraocular foreign body (P < 0.05) and delayed primary OGR (P < 0.03) were significantly more common with concurrent versus post-OGR endophthalmitis. Four (29%) eyes in the post-OGR endophthalmitis group had corneal wound leak after OGR. Four (15%) eyes with no light perception vision were enucleated. Ten (40%) of 25 eyes with documented best-corrected visual acuity had final best-corrected visual acuity ≥20/200; final best-corrected visual acuity ranged from no light perception to 20/20. The presence of intraocular foreign body and delayed presentation were significantly more common with concurrent endophthalmitis. Twenty-nine percent of eyes that presented with endophthalmitis after OGR had a wound leak. Final best-corrected visual acuity ≥20/200 was achieved in 40% of cases.

Surgical Management of Traumatic Retinal Detachment with Primary Vitrectomy in Adult Patients.

Purpose. To evaluate functional and anatomical results of pars plana vitrectomy (PPV) in the retinal detachment (RD) followed by severe eye trauma. Methods. Retrospective analysis of medical records of forty-one consecutive patients treated with 23-gauge PPV due to traumatic RD. Age, gender, timing of PPV, visual acuity, and presence of intraocular foreign body (IOFB) and proliferative vitreoretinopathy (PVR) were included in the analysis. Results. Mean age of patients was 47 years; the majority of patients were men (88%). Closed globe injury was present in 21 eyes and open globe injury in 20 eyes (IOFB in 13 eyes, penetration injury in 4 eyes, and eye rupture in 3 eyes). Mean follow-up period was 14 months; mean timing of PPV was 67 days. Twenty-seven (66%) eyes had a functional success; 32 eyes (78%) had anatomical success. As a tamponade silicone oil was used in 33 cases and SF6 gas in 8 cases. Conclusions. Severe eye injuries are potentially devastating for vision, but vitreoretinal surgery can improve anatomical and functional outcomes. Among analysed pre- and intra- and postoperative factors, absence of PVR, postoperative retinal attachment, and silicone oil as a tamponade were related to significantly improved visual acuity.

Use of Intravenous Vancomycin and Cefepime in Preventing Endophthalmitis After Open Globe Injury.

The choice and route of antibiotic prophylaxis in the setting of open globe injury remains controversial. We investigated the utility of intravenous vancomycin and cefepime prophylaxis in preventing endopthalmitis after open globe injury. The charts of 224 patients who presented to Parkland Memorial Hospital and Children's Medical Center in Dallas, Texas, between June 1, 2009 and June 30, 2013, with open globe injury and who were treated with prophylactic intravenous vancomycin and cefepime were retrospectively reviewed. Data collection included time from injury to presentation, mechanism of injury, details of ophthalmological examination, timing of open globe repair, and length of follow-up. All patients were treated with intravenous vancomycin and cefepime for 48 h after presentation. The primary outcome measure was rate of endophthalmitis, and the secondary outcome measure was identification of risk factors for developing endophthalmitis. Out of 224 patients who presented after open globe injury, 3 patients had signs of endophthalmitis on initial exam before starting antibiotics, and 2 patients developed endophthalmitis after initiation of vancomycin and cefepime (0.9%). Delayed time from injury to presentation was a risk factor for post-traumatic endophthalmitis (P = 0.0002). The association between presence of intraocular foreign body and post-traumatic endophthalmitis was approaching significance (P = 0.064). When intravenous vancomycin and cefepime are used prophylactically after open globe injury, the rate of endophthalmitis is low.

Post traumatic endophthalmitis: incidence and risk factors.

Post traumatic endophthalmitis is an uncommon but severe complication of ocular trauma. We aimed to identify the incidence of post traumatic endophthalmitis and its contributing risk factors in Feiz hospital (Isfahan, Iran) from 2006 until 2010. Medical records of 1042 patients with open globe injury were analyzed and data were collected including age, sex, location of being injured, visual acuity (VA), time from injury to hospitalization and to repair, site of ophthalmic injury and the presence of foreign body. The frequency of post-traumatic endophthalmitis was about 2.1% (N = 22) of all patients. Nine of 22 cases with endophthalmitis were under 8 years. The visual acuity at the time of admission was seen to be contributed to high rate of endophthalmitis. Intraocular foreign body was detected in 139 patients; and the rate of endophthalmitis was 5% among these patients. Statistical analysis showed significant relationship between presence of foreign body and higher rate of endophthalmitis. Also, duration of hospitalization was significantly different between two study groups (P = 0.019). There were no significant differences between two groups in terms of other studied variables. Patients with low age, low visual acuity at admission, presence of intraocular foreign body and long duration of hospital stay had a higher risk of endophthalmitis after the repair of the globe. Compared to the reports of other large institutions, we can attribute the low incidence rate of endophthalmitis in our institution to the early use of systemic antibiotics such as gentamycin and cephalosporins in the first hour of hospitalization until discharge.

Infectious endophthalmitis: review of 420 cases

BackgroundTo characterize the causative pathogens and the visual outcomes among patients with endophthalmitis at a large referral center in northeastern Thailand.MethodsAll cases of infectious endophthalmitis treated between 1983 and 2007 were reviewed retrospectively. The patient data – including age, sex, history of ocular injuries, previous treatment and duration of the symptoms – were recorded. The ocular examination included affected side, anterior chamber reaction, vitreous haze, and presence of intraocular foreign bodies. Smears and cultures were prepared from anterior chamber paracentesis and/or vitreous tapping. Intraocular antibiotics were administered at the time of anterior chamber paracentesis and/or vitreous tapping. Vitrectomy and/or lensectomy were performed when indicated. Initial visual acuity before treatment and the final best-corrected vision were compared.ResultsA total of 420 cases of endophthalmitis were reviewed: 181 cases (43.1%) had ocular trauma before the infection; 135 (32.2%) developed endophthalmitis after intraocular surgery; and, 122 (29.1%) had a positive culture. Bacteria were isolated in 114 cases (93.4%) and fungi were noted in eight (6.6%). The common causative bacterium was Staphylococcus epidermidis. Combined vitrectomy and intraocular antibiotics were performed in 189 cases (45.0%), whereas 69 cases (16.4%) were treated with intraocular antibiotics alone.ConclusionMost of the reviewed cases were associated with trauma and intraocular surgery. The most frequently encountered bacterium causing infectious endophthalmitis was S. epidermidis. Most cases were treated with combined vitrectomy and intraocular antibiotics. The final visual outcomes seem to vary according to the type of endophthalmitis.

Clinical and epidemiologic characteristics of severe childhood ocular injuries in Southern Iran

Purpose:To evaluate the clinical and epidemiological characteristics of children with ocular trauma.Materials and Methods:We retrospectively reviewed the medical records of 278 children (aged 15 years or less) hospitalized with ocular injuries and treated as inpatients at a tertiary referral center in Shiraz, Iran, from 2005 to 2008. Nominal variables were evaluated with a Chi-square test. A P-value less than 0.05 indicated statistical significance.Results:The cohort was comprised of 205 (74%) males, outnumbering females by a ratio of 2.81/1. The mean age was 7.6 ± 3.96 years. Rural residents comprised 125 (45%) of the cohort. Sharp objects caused ocular injury in 211 (76%) cases, and 207 (74%) cases had open-globe injuries. The lens was injured in 62 (30%) cases at initial examination and 89 (43%) patients according to ultrasound examination (P = 0.006). Twenty-eight cases (10%) developed post-traumatic endophthalmitis. Endophthalmitis was associated with needle injury [odd ratio (OR) = 19.25] and presence of intraocular foreign body (OR = 3.48). Visual acuity of patients with closed-globe injuries was 20/200 or better on both initial and final examinations. Visual acuity of patients with open-globe injuries were in the range of light perception to 20/200.Conclusions:Trauma is an important cause of childhood ocular morbidity in southern Iran. Playing with sharp objects is an important cause of ocular trauma in children, and most injuries can be prevented by careful supervision.