Traumatic Lens Research Articles

Post-Traumatic Stress Across Color Lines: A History of Anti-Black Exclusion & PTSD.

Black Americans with Posttraumatic Stress Disorder have less access to mental healthcare compared to White Americans. Many factors contribute to thisinequity, including broader disparities within the healthcare system driven by systemic racism, and an underutilization of mental health services by Black Americans due to provider bias and stigma around mental healthcare. These disparities are rooted in a racist historical context of exclusion and abuse of the Black community by the White psychiatric establishment, and a perpetration of further trauma on Black clients, a context that is largely missing from traditional mental health education and literature on Black mental health today. This article aims to provide a necessary historical context of how the U.S. mental health care system has excluded Black Americans from trauma treatment. We use a contemporary trauma lens to demonstrate the ways in which Black trauma has existed throughout U.S. history, but how White psychiatryhas cast trauma symptoms as evidence of racial inferiority, hasexcluded Black individuals from treatment, and hasabused Black patients, thereby increasing Black trauma. The purpose of this review is to inform and educate mental health providers about our collective history, to counter a narrative of amnesia which identifies Black underutilization of services but forgets the exclusion from and abuse of Black people within the mental health system. We conclude with recommendations that providers can utilize to engage in antiracist practice and create an affirmative space for Black Americans to utilize trauma treatment and mental health care freely.

To remove or not to remove: Intraconal metallic foreign body following perforating ocular injury

Background: Foreign bodies (FB) are implicated in 17-30% of penetrating ocular injuries. We encountered 2 cases of perforating ocular trauma with metallic intra-orbital FB in 2 teenage males. Case report: A 17-year-old male presented with a nail-hammer injury 6 hours after trauma. Snellen’s acuity was 3/60 with a corneal laceration of 5mm with lens matter in the anterior chamber and vitreous hemorrhage. After primary repair by the anterior segment surgeon, posterior segment surgery was done following the diagnosis of retinal detachment (RD) and intra-ocular Foreign Body(FB) by ultrasound. No FB was noted intraoperatively. On Computerized Tomography (CT), metallic FB 5.2x3.5 mm was noted at the insertion of the inferior oblique muscle. Removal of IOFB was deferred by the oculoplasty department. Delayed oil removal was done with final Snellen’s acuity 6/12p. Another 16-year-old male attended the retina clinic 20 days after injury with a metal-on-metal hammering incident. Primary topical management was done elsewhere. Snellen’s acuity was 6/18p in the affected eye. The site of FB entry was scleral,1.4 mm from limbus at 9 o’clock with no associated lens trauma. CT scan of the brain and orbit showed intra-orbital FB medial to the medial rectus near the orbital apex. FB (4.4x4.3 mm) left a tract in subretinal space to enter intraconal space 1 disc diameter nasal to optic disc. Vitrectomy was done for tractional RD and postoperative Snellen’s vision was 6/12. Conclusion: A high degree of clinical suspicion is necessary to detect and localize IOFB. Non-toxic intra-orbital FB may be left in the context of good vision in the affected eye and possible iatrogenic optic nerve damage.

Using point of care ultrasonography to detect traumatic lens dislocation

Using point of care ultrasonography to detect traumatic lens dislocation

Application of modified Yamane technique in intrascleral intraocular lens fixation combined with or without iris reconstruction

AimsTo explore the application and long-term clinical effects of modified Yamane technique in intrascleral intraocular lens (IOL) fixation combined with or without iris reconstruction.Settings and designThe data of patients receiving IOL fixation with modified Yamane technique in an ophthalmology department between December 2021 and August 2023 were analyzed retrospectively. The longest follow-up duration was > 12 months.Methods and materialThe trailing haptic was fixed with the needle before the leading haptic. The silicone haptic stoppers were used to stabilize the IOL when iris reconstruction was combined. Preoperative and postoperative best-corrected visual acuity (BCVA), corneal endothelial cells (CECs), postoperative intraocular pressure (IOP), surgical indications and methods, and postoperative complications were recorded. Anterior segment optical coherence tomography (OCT) was used to evaluate IOL decentration and tilt. The paired sample t-test or Wilcoxon rank sum test were used to compare the results of the same index before and after the operation.ResultsTwelve patients (12 eyes) were included in this cohort. There were 1 case of IOL dislocation, eight cases of lens dislocation or subluxation, and three cases of aphakia. Traumatic lens dislocation was the main cause of aphakia. Primary lens extraction was performed in previous surgeries, and all three were combined with pars plana vitrectomy (PPV). Four of 12 patients underwent IOL fixation and iris reconstruction. The mean age of participants was 63 ± 10.61 years. The mean BCVA increased from 0.89 ± 0.72 logMAR to 0.39 ± 0.56 logMAR at the last visit (p < 0.05). The postoperative relative refractive error was − 0.13 ± 0.42 D (–0.60 D to + 0.57 D). The OCT showed that the IOLs were well centered, with a mean decentration of 0.20 ± 0.13 mm and a mean tilt of 2.31°±0.93°. Ten patients did not experience any complications.ConclusionsThe modified Yamane technique in IOL fixation surgery, especially combined with iris reconstruction, reduces operation difficulty, increases operational stability and safety, and improves postoperative visual acuity without serious intra- or postoperative complications. The long-term improvement effect was remarkable.

AN UNUSUAL WAY TO INDUCE THE CLOSURE OF A POSTERIOR POLE RETINAL TEAR IN A TRAUMATIC RETINAL DETACHMENT

Purpose. The authors present a case of both traumatic subluxated lens with zonular dialysis and a traumatic retinal detachment with posterior retinal tear. Methods. Some fragments have dropped into the vitreous chamber during phaco-emulsification and one of them has even passed through the retinal tear and has been removed from the subretinal space. A 3-piece intraocular lens with a tension ring supporting the capsular bag was implanted. Pars plana vitrectomy with accurate vitreous base shaving was approached by 23-gauge system. Subretinal fluid was removed by a complete fluid-air exchange. A large macular internal limiting membrane (ILM) peeling was performed and the posterior retinal tear was covered by multiple inverted ILM flaps. Results. Postoperatively, retinal reattachment was achieved, the retinal break was flat. The ILM flaps were well positioned within the retinal tear and covered the preoperatively bared RPE. Conclusions. The surgical treatment of injuries after a blunt ocular trauma are not standardizable. In this case surgical outcomes suggest the effectiveness of the surgeon’s intraoperative unusual maneuvers.

Clinical Presentations and Surgical Outcomes in Traumatic Iris and Lens-Related Injuries Due to Blunt Trauma

Purpose: The aim of this study was to evaluate the clinical presentation, treatment options, and surgical outcomes of patients admitted with traumatic iris and lens-related injuries due to blunt trauma. Methods: This retrospective study included 43 eyes of 43 patients who presented with traumatic iris and lens injuries between September 01, 2022 and July 01, 2023. Results: The mean age was 46.1±14.6 years and the mean ocular trauma score was 74.7±9.9. According to the cause of injury, the most common cause in males is assault, and the most common cause in females is fall. Nine (20.9%) patients underwent pars plana vitrectomy. Six (14%) patients underwent cataract surgery with phacoemulsification and intraocular lens implantation into “the bag.” Conclusions: In conclusion, other concomitant pathologies may make these surgeries difficult to perform. Early evaluation and timely management are essential to achieve the best possible outcomes in patients with traumatic iris and lens-related injuries.

Management of traumatic dislocated polymethyl methacrylate intraocular lens following globe rupture in a monocular patient: A case report

A 72-year-old monocular male with no light perception in the left eye and a history of cataract extraction with polymethyl methacrylate (PMMA) intraocular lens (IOL) implantation and retinal detachment repair with scleral buckling in the right eye presented after a forward fall and hitting his face with a large iris defect, irregular pupil, superior zone 2 globe rupture, dense vitreous hemorrhage, and a 1-piece PMMA IOL dislocated in the posterior chamber in the right eye. His visual acuity on presentation was hand motion with directionality, with no improvement on pinhole. PMMA IOLs are difficult to cut and require larger incisions for removal, which was difficult in our patient with open-globe rupture. His large iris defect and minimal capsular support ruled out other options such as the implantation of a new IOL. IOL repositioning with scleral suturing resulted in the successful salvation of his IOL and visual acuity.

Clinical evaluation of ophthalmic findings in active, amateur, adult, competitive male boxers in India.

Background: In the popular fighting sport of boxing, opponents strike each other above the belt line in the face, chest, and belly. The physical parts most exposed are therefore the nose and eyes. In amateur boxing, fights go only three rounds - three minutes for men and one minute for women - with a one-minute break in between. They wear gloves, but the head protection used in the men's game has been removed by AIBA due to the high likelihood of concussion when using head protection. Because chronic ocular changes may take longer than the expected short-term effects, this study included at least 3 years of competitive sports participation. Study design and setting: Institutional-based cross-sectional study. Materials and methods: To evaluate ophthalmic outcomes, 200 eyes of 100 active amateur, adult, and competitive male boxers were studied. Results: Of the 100 boxers, 51 had ophthalmic changes in at least one eye, and 49 had normal eyes. The average age of boxers was 24.98 years. The average duration of boxing training was 7.04 years. Healed eyelid scars, subconjunctival hemorrhages, conjunctival papillae, traumatic mydriasis, posterior synechiae, angulation abnormalities, traumatic cataracts, lens subluxation, increased intraocular pressure, and peripapillary atrophy were observed on the ocular side. None of these could be attributed to boxing. Conclusion: Boxing-related eye injuries are common in India and the most common vision-threatening eye abnormalities include traumatic cataracts, lens subluxation, and angle abnormalities. Surprisingly, no macular lesions were found on physical examination and OCT. Additional studies with a larger number of boxers will be needed to evaluate and prevent clinical symptoms. All boxers should have a complete eye exam regularly. Abbreviations: AIBA = Association Internationale de Boxe Amateur, OCT = Optical Coherence Tomography.

A retrospective analysis of surgical outcome in sutureless glueless scleral fixation of foldable intraocular lens.

Cataract surgery constitutes one of the highest volume surgeries performed worldwide approximating 10 million annually, varying from 100 to 6000 per million population. Implantation of scleral fixated intra-ocular lens (SFIOL) is getting popular in managing difficult situations like aphakia, subluxated lens, and dislocated cataracts. This retrospective series evaluated our experience with foldable 3-piece acrylic SFIOL implantation for various challenging surgical scenarios in a tertiary care ophthalmic institute in the southern part of India. The data from the first 150 patients, those operated in our hospital in the aforementioned technique, have been reviewed and analyzed. The mean age of the population was 46.43 years. The most common indication was found to be surgical aphakia (34.66%) followed by traumatic subluxated lens (8.33%). Postoperative BCVA at 3 months improved to 0.255 on the LogMAR scale from preoperative BCVA of 0.795 (P < 0.01). Intraocular pressure was found to stabilize over 3 months follow-up (P = 0.002). The various intraoperative and postoperative complications have been recorded. Ten patients required resurgery out of which eight had postoperative haptic dislocation. A detailed comparison of the role of a surgeon's experience in influencing outcomes has been evaluated. The technique offers physiological IOL placement using minimal surgical maneuvers. We strongly recommend this as a technique of choice for the surgical management of complicated scenarios with inadequate capsular bag support.

A Modified Four-point Scleral Fixation of Intraocular Lens in Aphakic Eyes without Adequate Capsular Support

Abstract Background: Polypropylene is a commonly used suturing material for intraocular lens (IOL) scleral fixation, but a high breakage rate after several years of follow-up is reported. Meanwhile, Gore-Tex has been a popular artificial material in ophthalmic surgery. Aim: This pilot study investigated the safety and efficacy of a modified surgical technique for scleral fixation of a four-point, close-loop haptic IOL using Gore-Tex as the suture material for aphakic patients without adequate capsular support. Methods: A modified IOL scleral fixation technique was developed using a four-point, close-loop haptic IOL and Gore-Tex as the suture material. Patients undergoing the operation between March 2018 and May 2019 at one center were included in the study. The preoperative uncorrected distance visual acuity (UDVA) with spectacles and postoperative UDVA with an IOL were compared as the main outcome. Follow-up time was 17–43 months. Results: A total of 10 eyes of 10 patients were enrolled, including 3 with iatrogenic IOL dislocation, 3 with iatrogenic lens drop, 2 with traumatic lens dislocation, and 2 with late in-the-bag IOL dislocation. The mean age was 70.8 ± 12.11 years. The mean UDVA, evaluated by the logarithm of the minimum angle of resolution, was decreased from preoperative 1.89 ± 0.28 to postoperative 0.58 ± 0.70 (P &lt; 0.001). No complications were reported except in one case with a postoperative corneal ulcer which healed after antibiotic treatment. Conclusions: The favorable outcome suggests Gore-Tex sutures as a safe and stable material for IOL scleral fixation. Prospective studies with a larger sample size would be necessary for more details on the safety and efficacy of the Gore-Tex suture in IOL scleral fixation.

Lens injury as acomplication of intravitreal medication injection

Intravitreal medication injections are an efficient and low-risk delivery technique for treating various retinal diseases. Rare serious complications include increased intraocular pressure, vitreous hemorrhage, retinal tears and detachment, intraocular inflammation and endophthalmitis. In the case series presented here, we report iatrogenic lens injuries caused by inadequate performance of intravitreal injections. Amulticenter data collection of patients treated with intravitreal injections with visible iatrogenic lens defects from 2016 to 2023 was retrospectively performed. Lens trauma after intravitreal injections was identified in six cases (69.3±6.5 years). While five cases were observed after anti-VEGF therapy, we identified lens injury after dexamethasone implantation in one patient. Iatrogenic lens injury during intravitreal injection is preventable with the correct injection technique. Knowledge of individual axis length and lens status also helps to avoid this complication.

Cataract due to iatrogenic lens trauma during an intravitreal injection-imaging using (intraoperative) optical coherence tomography

Cataract due to iatrogenic lens trauma during an intravitreal injection-imaging using (intraoperative) optical coherence tomography

Betrayal Trauma Anger: Clinical Implications for Therapeutic Treatment based on the Sexually Betrayed Partner’s Experience Related to Anger after Intimate Betrayal

This article provides insight into the complex anger often following the discovery of broken trust and attachment in a relationship as a result of sexual betrayal. In the past, the helping profession viewed angry betrayed partners from a pathological lens. Through research and progression in the mental health field, betrayed partners are now viewed from a trauma lens as traumatized individuals, and a greater understanding exists of why partners will most likely experience complex anger after betrayal. This article aims to add to the existing literature on the topic of betrayal trauma and provide clinical considerations for assessment and treatment of those seeking therapeutic help to manage and reduce anger. 297 sexually betrayed partners participated in a Betrayal Trauma Anger Survey. Results revealed 83.5% of participants remain in the relationships with their betrayers. 39% of betrayed partners reported not being provided specific help to manage anger from their helping professional. 87% reported self-blame and 43% considered harming themselves. Results clearly indicate that betrayed partners are significantly impacted physiologically, psychologically, behaviorally, and spiritually, and they experience feelings of intense anger with 84% reporting their experienced anger is more intense than at any other time they experienced anger prior to discovering betrayal.

Creative arts as self-care: vicarious trauma, resilience and the trainee art therapist

This article has been removed in accordance with the journal's editorial policies. Article title: Creative arts as self-care: vicarious trauma, resilience and the trainee art therapist Authors: Dayna Ortner Journal: International Journal of Art Therapy Citation information: Volume 29, Number 01, pages 45 - 56 Version of Record Published Online: 15 March 2024 DOI: http://dx.doi.org/10.1080/17454832.2024.2317941

In-Office Lens Repositioning for Anterior Crystalline Lens Dislocation.

We describe an in-office lens repositioning technique for anterior crystalline lens dislocation. We present a case series of four patients with spontaneous or traumatic anterior crystalline lens dislocation. The technique included supine patient positioning, gentle pressure with a cotton swab on the peripheral cornea to guide the lens into the posterior chamber, and the use of a miotic agent afterward to prevent subsequent subluxation. In the four cases described, the in-office technique successfully restored the lens to the posterior chamber, improved vision, and decreased intraocular pressure in most instances by resolving the angle closure secondary to pupillary block. The in-office lens repositioning technique is appropriate as an acute non-surgical intervention or temporizing measure for anterior crystalline lens dislocation. [Ophthalmic Surg Lasers Imaging Retina 2024;55:293-298.].

TRAUMATIC LENS SUBLUXATION FROM PICKLEBALL INJURY: A CASE SERIES

Purpose: The purpose of this study was to describe two cases of traumatic lens subluxation resulting from pickleball injury. Methods: This is a case series. Results: A 77-year-old man presented with worsening vision and was noted to have subluxation of his intraocular lens 10 days after being struck in the eye with a pickleball. The patient underwent a lens exchange with scleral fixation. A 76-year-old woman presented with blurry vision on the same day as her injury and was noted to have subluxation of her crystalline lens. She also underwent a lens insertion with scleral fixation. However, she experienced additional complications of postoperative cystoid macular edema and traumatic glaucoma. Conclusion: We recommend increased use of eye protection in pickleball.

Visual Outcomes of Traumatic Lens Dislocations and Subluxations Managed by Pars Plana Vitrectomy and Lensectomy.

The aim of this study was to evaluate the visual outcome of lens dislocation and subluxation managed by pars plana vitrectomy (PPV) and lensectomy in patients with open (OGIs) or closed globe injuries (CGIs). Medical records of 70 consecutive patients treated by PPV and lensectomy over a period of 11 years (1 January 2010-31 December 2020) were retrospectively reviewed. We collected demographic data, best corrected visual acuity (BCVA) using a Snellen Chart pre- and postoperatively, associated ocular injuries and treatment strategy. Visual outcome was evaluated according to the final BCVA which was defined as poor <0.1 or good ≥0.1. The mean age was 57.9 ± 17.6 years. CGIs were present in 49 (70.0%) cases and open OGIs in 21 (30.0%) cases. The dislocation mechanism was zonular lysis in 59 cases (84.3%) and capsular rupture in 11 cases (15.7%). The intraocular lens implant (IOL) was sutured to the sclera in 51 (72.9%) cases or positioned in the capsular bag or in the sulcus in 3 (4.3%) cases and 1 (1.4%) case, respectively, whereas 15 (21.4%) patients remained aphakic. A good BCVA ≥ 0.1 was achieved in 45.71% of the eyes. The presence of retinal detachment (RD) (p = 0.014), iridodonesis (p = 0.011) and initial BCVA (p = 0.000) achieved statistical significance in predicting visual outcome. After treatment, 45.71% of patients achieved a final BCVA ≥ 0.1. RD, iridodonesis and initial BCVA were risk factors for poor visual outcome in our series.

Frozen in trauma on a warming planet: a relational reckoning with climate distress

"As awareness of the destabilising impacts of the climate crisis and its multiple layers of connected injustices increase, individuals struggling with climate distress have begun to arrive at our clinical doorsteps. This article details some of the questions and challenges of climate-informed clinical work, including aspects of what both clinician and client experience emotionally and ways we may turn away from the reality of harms and injustices. Utilising a trauma lens, a detailed case description is presented of a man ‘frozen in trauma’ in response to the climate and environmental crisis. Since clinicians are embedded in the climate emergency along with their clients, the author shares her personal trajectory of climate awareness (Hoggett and Randall, 2018), along with countertransferential responses that occurred in the therapy. The clinical description includes an understanding of the client’s history of a transgenerational trauma that echoed with and amplified his responses to the planetary crisis. Ways of processing and holding the difficult emotions within the clinical work are outlined, along with how the client was usefully able to enlarge his focus to helping others. Recognizing multiple forms of interconnection, including with the more-than-human world, are described as a way to move forward. Keywords climate distress, environmental injustice, trauma, grief, psychoanalysis, transgenerational, interconnection"

FIL SSF intraocular lens opacification after pars plana vitrectomy with gas tamponade for traumatic lens luxation and retinal detachment: a case report and literature review

BackgroundTo report a case of sutureless scleral-fixated hydrophilic intraocular lens (FIL SSF IOL, Soleko, Italy) opacification following pars plana vitrectomy surgery using sulfur hexafluoride (SF6) for traumatic lens luxation associated with retinal detachment.Case presentationA 77-year-old woman was referred to our emergency department after blunt trauma in her right eye. At the ophthalmic evaluation, visual acuity was hand movement, biomicroscopy showed pseudoexfoliation syndrome and a traumatic lens luxation in the vitreous chamber. The patient underwent pars plana vitrectomy, subluxated cataract explantation, and FIL SSF IOL implant. During surgery, an inferior retinal detachment was encountered, requiring 20% SF6 gas tamponade. No adverse events were encountered. One month postoperatively, visual acuity (BCVA) improved to 0,3 logMAR. At the 3-month follow-up, the patient presented with BCVA of 0,5 logMAR, and biomicroscopy showed a minimal IOL opacification. Six months postoperatively, BCVA decreased to 1.0 logMAR, and diffuse, IOL opacification was noted at slit lamp examination. The patient refused any other surgical intervention for IOL exchange.ConclusionsAlthough hydrophilic IOL opacification gas related is known, to the best of our knowledge, this is the first case reported in the literature of FIL SSF IOL opacification after pars plana vitrectomy with gas tamponade for retinal detachment.

Technique of using Cionni-modified capsular tension ring in the management of severely traumatic lens subluxation.

To investigate the effect of Cionni-modified capsular tension ring (CTR) implantation in patients with severely traumatic subluxated cataracts. All patients who totally had traumatic cataracts and lost zonule support and underwent cataract surgery were retrospectively analyzed. Corrected distance visual acuity (CDVA), extent of zonulysis, intraocular lens (IOL) position, intraoperative presentation, and complications were assessed. The primary outcomes included IOL centration stability and other postoperative complications. Twenty patients (20 eyes) were included in this study. The mean age in this study was 58.0±11.3y, and the average follow-up time was 17.3±12.8mo. Capsule bags were saved by Cionni-modified CTR. Nine eyes (45%) underwent simultaneously anterior vitrectomy due to the presence of vitreous in the anterior chamber. The preoperative mean CDVA was 0.83±0.24 logMAR, and the postoperative average CDVA was 0.23±0.30 logMAR (P<0.05). The horizontal and vertical IOL decentration after surgery was 0.27±0.12 mm and 0.41±0.19 mm, respectively; the vertical and horizontal IOL tilt after surgery was 5.5°±2.5° and 6.1°±2.2°, respectively. None of the eyes had obvious IOL decentration during the follow-up time. Eight eyes (40%) had posterior capsule opacification (PCO) that was severe enough to cause poor vision. Neodymium: YAG laser capsulotomy were performed on these eyes when the CTR was stabilized. With the help of Cionni-modified CTR, capsular bag preservation and better IOL concentration can be achieved without major complications in patients with severely traumatic subluxated cataracts.