Scleral Rupture Research Articles

Characterization of scleral rupture of canine globes following compression via mechanical testing unit.

To determine the load at failure of canine intact cadaveric eyes and to describe the anatomic location and length of the rupture following external compression. Sixty-six canine cadaveric globes. Globes were subjected to an axial force impacting the cornea or equator using a commercially available mechanical testing unit. Following rupture, eyes were inspected to document the anatomical site and length of rupture. The mean ± SD force necessary to induce scleral rupture was 310 ± 120 N OD and 294 ± 113 N OS. Increasing body weight (OD p = .000015, OS p = .0074) as well as cranial-to-caudal (OD p = .000045, OS p = .0075) and medial-to-lateral (OD p = .00027, OS p = .0083) globe diameter were associated with a higher force necessary to induce rupture. The median (25%, 75%) length of the scleral rupture was 8.5 (7.0, 11.0) mm OS and 10 (7.0, 12.5) mm OD. The median location was 8.0 (5.0, 10.0) mm posterior to the limbus at the most cranial extent OS and 6.5 (3.3, 10.0) mm OD. Rupture orientation in relation to the limbus was perpendicular (n = 35), parallel (n = 13), or other (n = 16). Globe laterality (i.e., OD or OS), sex, and age did not have a significant influence on the force necessary to induce rupture (p > .05). Following external compression, the canine globe frequently ruptures in a region approximating the equator extending 1 cm posteriorly, which may not be readily apparent on clinical examination.

Scleral Rupture during Scleral Buckle and Cryotherapy for Rhegmatogenous Retinal Detachment: A Case Report.

Scleral Rupture during Scleral Buckle and Cryotherapy for Rhegmatogenous Retinal Detachment: A Case Report.

PFCL nightmare: Scleral rupture and novel use of gelatin sponge in repair

We report a case of scleral rupture that occurred during perfluorocarbon liquid (PFCL) injection in a case of bullous rhegmatogenous retinal detachment (RD), which was managed uniquely using a gelatin sponge. So far, only two case reports of scleral rupture during PFCL injection have been reported. A 69-year-old gentleman presented with complaints of sudden-onset painless blurring of vision in his right eye and was diagnosed with pseudophakia with total bullous RD. During 23-G vitrectomy, PFCL was injected using a single-bore cannula. During FAE, the globe appeared hypotonous with choroidal folds. Scleral rupture with retinal incarceration was noted in the superotemporal quadrant. This case report illustrates further unique management.

Traumatic subconjunctival phacocele – Rare and sui generis

Blunt trauma to the globe can result in indirect scleral rupture with dislocation of crystalline lens into the subconjunctival or sub-tenon space and is known as phacocele. Here, we report a case of traumatic subconjunctival phacocele with history of blunt trauma to the globe 1 month back. The case presented with a mass in the inferonasal quadrant with no previous history of myopia, ocular surgery, or connective tissue disorder.

Simulation of Changes in Tensile Strain by Airbag Impact on Eyes After Trabeculectomy by Using Finite Element Analysis.

We studied the kinetic phenomenon of an airbag impact on eyes after trabeculectomy using finite element analysis (FEA), a computerized method for predicting how an object reacts to real-world physical effects and showing whether an object will break, to sequentially determine the responses at various airbag deployment velocities. A human eye model was used in the simulations using the FEA program PAM-GENERISTM (Nihon ESI, Tokyo, Japan). A half-thickness incised scleral flap was created on the limbus and the strength of its adhesion to the outer sclera was set at 30%, 50%, and 100%. The airbag was set to hit the surface of the post-trabeculectomy eye at various velocities in two directions: perpendicular to the corneal center or perpendicular to the scleral flap (30° gaze-down position), at initial velocities of 20, 30, 40, 50, and 60 m/s. When the airbag impacted at 20 m/s or 30 m/s, the strain on the cornea and sclera did not reach the mechanical threshold and globe rupture was not observed. Scleral flap lacerations were observed at 40 m/s or more in any eye position, and scleral rupture extending posteriorly from the scleral flap edge and rupture of the scleral flap resulting from extension of the corneal laceration through limbal damage were observed. Even in the case of 100% scleral flap adhesion strength, scleral flap rupture occurred at 50 m/s impact velocity in the 30° gaze-down position, whereas in eyes with 30% or 50% scleral flap adhesion strength, scleral rupture was observed at an impact velocity of 40 m/s or more in both eye positions. An airbag impact of ≥40 m/s might induce scleral flap rupture, indicating that current airbags may induce globe rupture in the eyes after trabeculectomy. The considerable damage caused by an airbag on the eyes of short-stature patients with glaucoma who have undergone trabeculectomy might indicate the necessity of ocular protection to avoid permanent eye damage.

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.

Numerical and clinical analysis of an eyeball injuries under direct impact.

The objective of this study was to develop a numerical model of the eyeball and orbit to simulate a blunt injury to the eyeball leading to its rupture, as well as to conduct a comparative analysis of the results obtained using the finite element method against the clinical material concerning patients who had suffered an eyeball rupture due to a blunt force trauma. Using available sclera biometric and strength data, a numerical model of the eyeball, the orbital contents, and the bony walls were developed from the ground up. Then, 8 different blunt force injury scenarios were simulated. The results of numerical analyses made it possible to identify possible locations and configurations of scleral rupture. The obtained results were compared against the clinical picture of patients hospitalized at the Department of Ophtalmology, Medical University of Gdańsk in 2010-2016 due to isolated blunt force trauma to the eyeball. It has been demonstrated that the extent of damage observed on the numerical model that indicated a possible location of eyeball rupture did not differ from the clinically observed configurations of the scleral injuries. It has been found that the direction of the impact applied determines the location of eyeball rupture. Most often the rupture occurs at the point opposite to the clock-hour/positions of the impact application. The eyeball rupture occurs in the first 7-8 ms after the contact with the striking rigid object. It has been established that the injuries most often affected the upper sectors of the eyeball. Men are definitely more likely to sustain such injuries. Eyeball ruptures lead to significant impairment of visual acuity. This study may contribute to a better understanding of injury mechanisms and better treatment planning. It may also contribute to the development of eyeball protection methods for employees exposed to ocular injuries. Int J Occup Med Environ Health. 2023;36(2):263-73.

Clinical efficacy of early vitrectomy in patients with severe blunt ocular trauma

BACKGROUND: Eye injury is an actual problem, occupying a leading position among the main causes of blindness and low vision, accounting for 22.8% in the structure of primary visual disability, of which 53% of cases are due to closed eye injury. Despite the development and widespread introduction into practice of methods of high-tech care for patients of this profile, there are a number of complications that poorly respond to treatment, ultimately leading to the loss of visual function of the injured eye.
 AIM: Evaluation of the effectiveness of early vitrectomy in patients with severe blunt ocular trauma, based on clinical results obtained during treatment and postoperative follow-up.
 MATERIALS AND METHODS: The study included 34 patients (34 eyes) with contusion-type eye injury. The mean age of patients was 39 years, among them 30 were men (88.24%) and 4 (11.76%) women. Patients were divided into 2 groups. Group 1 included 11 patients (10 men, 1 woman) with an open-type eye injury with a subconjunctival scleral rupture; upon admission, visual acuity varied from incorrect light projection to 0.01. In group 2, there were 23 patients (20 men, 3 women) with severe closed eye injury, upon admission to the hospital, visual acuity ranged from incorrect light projection to 0.06. In all cases, patients underwent subtotal three-port vitrectomy at an early date (up to 3 days) after injury.
 RESULTS: On the 1st day after surgery, there was an improvement in visual acuity in all patients. The follow-up period for patients was 6 months. All included patients had a stable anatomical result, no cases of subatrophy were noted, satisfactory functional results were achieved - visual acuity varied from 0.02 to 0.8. After 6 months, 32 out of 34 eyes (94.12%) showed no signs of proliferative vitreoretinopathy. In 2 patients (18.18%) from group 1, the development of proliferative vitreoretinopathy under silicone oil was revealed. Epiretinal membrane was diagnosed in 2 patients (8.7%) from group 2 and in 1 patient (9.09%) from group 1.
 CONCLUSIONS: Obtained clinical results of treatment of patients with severe blunt ocular trauma indicate the expediency of vitrectomy in early stages after injury, which is an effective treatment method. Long-term results demonstrate stable functional results for 6 months. Vitrectomy performed early after injury serves for prevention of proliferative vitreoretinopathy, but does not completely exclude its development. Performing surgery early after injury increases the prospects for preserving visual functions of the eye and is a positive prognostic factor.

Traumatic lenticele – A rare case report

Traumatic subconjunctival dislocation of the lens (phacocele or lenticele) is of relatively rare occurrence. We report an unusual case of subconjunctival dislocation of the cataractous lens following blunt ocular trauma by cow horn in an elderly patient without having any previous ocular surgery or trauma. Blunt trauma resulted in indirect scleral rupture with subsequent dislocation of the crystalline lens in the subconjunctival space. The pathophysiological mechanism, clinical presentation, and management are discussed in this case report.

Outcome of Primary Management of Scleral Rupture without Vitrectomy Jakarta Eye Trauma Study

Introduction: To report the outcome of primary management of scleral rupture without vitrectomy. Methods: Descriptive retrospective study of primary surgical management of scleral rupture located anterior to the equator. Initial and final visual acuity (FVA, intra ocular pressure, type of injury (sharp/blunt/projectile), wound length, time interval between the incident and primary repair and cause of injury were recorded. Encircling scleral buckle was placed in case of scleral laceration reaching muscle insertion. Patients who had a follow up of 3 months after the primary repair were included in the study . Results: There were 41 patients out of 78 who had scleral rupture anterior to the equator. The average age was 21.27 + 9.73 years (range 3-50 years). Thirty-three (80.4%) were males and eight (19.6%) were females. Rupture was located superiorly) in 28 (68.3%) patients, and inferiorly in 13 (31.7%) patients. Eight patients underwent encircling buckle. The time interval from the injury till the primary repair less than 8 hours (p 0.000) and 8-24 hours (p 0.000) were associated significantly with FVA improvements. Initial VA correlated with FVA improvement significantly (p 0.001). Two patients with initial VA of LP became NLP, and they had a wound length 11 mm and 12 mm respectively. Conclusion: The primary management of scleral rupture anterior to the equator, without vitrectomy, improves VA significantly. Time interval less than 24 hours and shorter wound length correlated with significant improvement of final VA.

Sports ball projectile ocular trauma in dogs

To describe the clinical features, management, and outcome of dogs presenting with sports ball projectile ocular injuries. Eighteen dogs. A retrospective study reviewing cases of ocular injury due to a sports ball projectile that presented to the Cornell University ophthalmology service between 2004 and 2021. Dog age, type of sports ball, initial ocular lesions, eye affected, clinical management, and visual outcome were recorded. Sports ball projectile ocular injuries were identified in 18 eyes of 18 dogs. The median age of the dogs was 1.0 years old, ranging from 0.3- to 9-years- old. Nine dogs were male, and 9 were female. Ocular injuries were caused by small, dense balls (e.g., golf balls, baseballs) in 11 dogs; small, light balls (e.g., tennis balls, toy balls) in 5 dogs; and large, soft balls (e.g., soccer ball, football) in 2 dogs. Closed-globe injuries (12 of 18 eyes) presented with traumatic uveitis (91%), hyphema (45%), and subconjunctival hemorrhage (18%). All 12 closed-globe injury cases were medically managed, eight dogs remained visual. Open-globe injuries (6 of 18 dogs) presented with three corneal lacerations and three scleral ruptures. Five open-globe injuries required enucleation, and one was medically managed and maintained vision. Sports ball projectile ocular injuries in dogs can result in substantial ocular morbidity and in loss of vision. Small, dense balls were associated with injuries that carried the most guarded prognosis and required more aggressive management. Small and large lighter projectiles were associated with less serious ocular injuries and visual outcomes.

Ocular trauma: Occult scleral rupture with macular avulsion

Ocular trauma: Occult scleral rupture with macular avulsion

Uveal Malignant Melanoma in a Hybrid Macaw Parrot (Ara chloropterus × Ara militaris).

An adult male green-winged (Ara chloropterus) × military (Ara militaris) hybrid macaw of unknown age was presented to the Texas A&M Veterinary Medical Teaching Hospital for evaluation of left periocular swelling, blepharospasm, and ocular discharge. Complete ophthalmic examination and B mode ocular ultrasonography were performed to evaluate the affected eye. Ocular examination revealed a blind left globe with exophthalmos, periocular swelling, diffuse corneal edema, and severe anterior fibrinous uveitis obscuring visualization of the intraocular structures. An ultrasound examination revealed a hyperechoic mass that filled the posterior segment of the globe. Focal discontinuity of the posterior sclera suggested scleral rupture. Enucleation with histopathology was recommended and performed 1.5 months later. Intraoperatively, a heavily pigmented and friable soft tissue mass extruded through the posterior sclera and extended into the orbit. Histologically, the mass was consistent with a malignant melanoma. The patient died 18 hours after the surgical procedure because of unknown complications. Postmortem examination did not identify evidence of metastasis. This study described the clinical appearance and histopathologic findings of a rare ocular neoplasm with extrascleral extension in a hybrid macaw. Although uncommon in psittacine birds, primary ocular melanocytic neoplasms may display features of malignancy with scleral or orbital invasion, or both.

Clinical and pathologic evaluation of chorioretinal lesions in wild owl species.

Investigate histopathology and spectral-domain optical coherence tomography (OCT) imaging of wild owls with chorioretinitis and identify any potential correlation with an infectious etiology. Ophthalmic examination and retinal OCT imaging were performed on fifteen great horned (Strix varia) and barred (Bubo virginianus) owls (30 eyes) with chorioretinitis and five owls with normal eyes (10 eyes). Testing to investigate the presence of potential infectious diseases included a complete blood count, biochemistry, protein electrophoresis, West Nile virus (WNV) plaque reduction neutralization test, Toxoplasma gondii modified direct agglutination test, WNV RT-PCR, and Avian Influenza RT-PCR. A necropsy was performed on all owls, including ocular histopathology. Fundus lesions included retinal detachment (7/15 owls), depigmented lesions (12/15), pigment clumping (8/15), and retinal tear (4/15). All birds were negative for WNV and Avian Influenza on RT-PCR. Of the owls with chorioretinitis, 3/15 were seropositive for WNV and 7/15 for T.gondii. Optical coherence tomography of 25/30 affected eyes revealed outer retinal lesions (19/25 eyes), retinal detachment (16/25), and retinal tears (3/25). Histopathological examination revealed outer nuclear layer atrophy (19/30 eyes), retinal detachment (18/30), retinal tears (7/30), suprachoroidal hemorrhage (12/30), scleral rupture (3/30), and ossicle fracture (3/30). Although 20% of birds were seropositive for WNV and 46.6% for T.gondii, histopathologic findings supported that the posterior segment lesions in the study group were likely due to blunt ocular trauma rather than an infectious etiology. The results of OCT imaging and histopathology documented retinal changes most consistent with blunt ocular trauma.

Scleral rupture during micro-incision vitrectomy surgery for primary rhegmatogenous retinal detachment - A case report

Scleral rupture during 23-gauge pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment, without known predisposing factors, is a rare but catastrophic complication. Scleral rupture in our patient developed in superotemporal quadrant corresponding to the area of chorioretinal atrophy in retina. Prompt suturing of scleral rupture, usage of perfluoro-N-octane (PFO) as short-term endo-tamponade, and removal of epiretinal membrane (ERM) under silicone oil (SO) were the major contributing factors leading to successful outcome. High index of suspicion should be kept for any chorioretinal atrophic patches and sclera corresponding to these areas should be carefully examined for any pathosis.

A rare orbital cyst due to traumatic lens dislocation

Lens dislocation into the subconjunctival or subtenon's space is a rare but known complication of blunt eye trauma. However, lens dislocation into the orbital space has never been reported. Here, we describe a case of orbital cyst caused by traumatic lens dislocation. A 55-year-old man complained of persistent orbital edema and pain in the right eye after ocular evisceration and orbital implant surgery for severe scleral rupture. Computed tomography showed increased soft-tissue density in the infero-temporal orbital space. An orbitotomy and histological examination confirmed that the mass in the orbit was a cyst that formed from the dislocated lens.

Intra-operative scleral rupture during 23 gauge pars plana vitrectomy: a case report

BackgroundUse of perfluorocarbon liquid (PFCL) has been increasingly growing as an adjuvant in vitreo-retina surgeries. Some commonly encountered complications with its use include subretinal migration, formation of sticky silicone oil or retained PFCL in vitreous cavity and anterior chamber. Scleral rupture during PFCL injection has a rare occurrence. We report an unexpected event of scleral rupture during PFCL injection and discuss the management challenges faced by the surgeon.Case presentationA 66 year indo-aryan male was undergoing pars-plana vitrectomy (PPV) with diagnosis of subtotal rhegmatogenous retinal detachment (RD) with Proliferative Vitreo-retonipathy (PVR)-B. After near total vitrectomy PFCL was being injected and then there was sudden poor visualization of fundus with development of bullous RD and globe hypotony. The surgeon was not able to figure out the cause of hypotony and air was switched on in the infusion cannula. This further complicated the situation resulting in migration of air in the anterior chamber, posterior dislocation of intraocular lens complex, 180° inferior retinal dialysis and ballooning of the conjunctiva which gave a clue of probable scleral rupture. Conjunctival peritomy was performed superiorly and scleral defect was noted. Intraocular tissue incarceration and air leak was visible from the wound. This confirmed scleral rupture during PFCL injection. Repositioning of incarcerated retina was not possible and retinectomy was performed followed by repair of scleral rupture with lots of difficulty in a vitrectomised eye.ConclusionPFCL injection, a crucial step of vitreoretina surgery, should be performed slowly with extreme caution maintaining an optimal intraocular pressure to prevent devastating complications like scleral rupture.

A Non-expected and Extreme Complication of Phacoemulsification: Scleral Wall Rupture

Rupture of the scleral wall during intraocular surgeries is extremely rare even in patients with a history of trauma, underlying ocular or systemic autoimmune disease. In this report, we describe a single case of a partial scleral wall rupture during phacoemulsification. We aim to discuss this extreme complication and to highlight the importance of a trauma history before phacoemulsification. An 84-year-old patient was hospitalized with the plan of phacoemulsification surgery. During phacoemulsification, conjunctival chemosis appeared all around the limbus and subconjunctival hemorrhage at nasal side. After conjunctival dissection, partial scleral rupture was detected. Iris-choroid were expelled from the wound. Phacoemulsification was immediately stopped and wound was closed primarily. There were no signs or symptoms of prior inflammation, and rheumatologic workup was negative. Nevertheless, the patient had an old ocular blunt trauma history. During the examination of a patient with a trauma history, scleral wall structure should not be overlooked. Weakness in scleral wall could lead to detrimental complications during intraocular surgeries.

Orbital Leakage of Intraocular Silicone Oil: Case Reports and Literature Review

Silicone oil migration into the periorbital tissues occurs rarely after vitreo-retinal surgery and two cases are reported. The first case was a 48-year-old woman who presented with a blind painful right eye, upper eyelid swelling, and ptosis after multiple vitreo-retinal surgeries. Diffuse infiltration of silicone oil in the upper eyelid and anterior orbit was found during evisceration, mainly around the plate of a Baerveldt glaucoma valve. In the second case, a 69-year-old man with prior right scleral rupture underwent silicone oil tamponade for retinal detachment and presented with right upper eyelid swelling due to multiple silicone oil granulomas within the orbit. Open globe injury and glaucoma drainage devices both appear to facilitate extraocular migration of silicone oil that results in marked orbital infiltration and inflammatory response.

Traumatic Suprachoroidal Dislocation of Crystalline Lens

ABSTRACT We report a patient with traumatic suprachoroidal dislocation of crystalline lens in the absence of scleral rupture, retinal tear or detachment. Histopathological confirmation of diagnosis is provided, as well as the surgical approach for removal of dislocated lens from the suprachoroidal space.