A new classification for epidemiological study of mechanical eye injuries / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Considering the difficulty in classifying some cases with eye trauma by Birmingham Eye Trauma Terminology (BETT) in our epidemiological study, we introduce a new classification for epidemiological study of mechanical eye injuries based on BETT.</p><p><b>METHODS</b>A retrospective investigation was carried out in 31 hospitals from January 2005 to December 2010. All medical records of inpatients with eye injuries were reviewed. A total of 10 718 patients (11 227 eyes) were diagnosed as mechanical eye injuries. All mechanical eye injuries were tried to be classified using BETT. While some eye injuries were difficult to categorize. We recorded the injury type and case number. A new classification based on BETT was also used for the same project.</p><p><b>RESULTS</b>Of 10 718 patients (11 227 eyes) with mechanical eye injuries, the following cases cannot be classified by BETT: 1 488 patients (1 559 eyes) with merely orbital or ocular adnexa injury, 1 961 (2 054) globe injuries associated with orbital or ocular adnexa injury, 271 (284) ocular surface foreign body (OSFB) or ocular wall foreign body (OWFB), 77 (89) contusion, 9 (11) lamellar laceration associated with OSFB or OWFB, 29 (30) rupture associated with OSFB, OWFB or intraocular foreign body and 60 (62) lace- ration associated with OSFB or OWFB. While according to our new classification, all eye injuries can be categorized without any difficulty.</p><p><b>CONCLUSION</b>Difficulty in classifying some eye injuries in epidemiological study by BETT brings some trouble to our study, which can be solved by our new eye injury classification to some extent. It is hoped that other ophthalmologists present better ones to make the classification more perfect.</p>

Laser in situ keratomileusis surgery is not safe for military personnel / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the relationship between eye injury and laser in-situ keratomileusis (LASIK) surgery in military personnel.</p><p><b>METHODS</b>This retrospective study collected the data from 27 evacuation hospitals of Chinese army. All medical records of eye injuries in military personnel admitted to the 27 hospitals between January 2006 and December 2010 were reviewed. Patients'detailed information was analyzed, including the injury time, place, type, cause, as well as examination, treatment and outcome.</p><p><b>RESULTS</b>There were 72 eye-injured patients who had been treated by LASIK before. The incidence was rising year by year. Among them, 69 patients were diagnosed with mechanical ocular injury and 3 with non-mechanical ocular injury; 29 patients had traumatic flap-related complications and 21 patients need surgery. There was statistical difference when compared with those having no refractive surgery history. Visual acuity recovered well at discharge.</p><p><b>CONCLUSION</b>There is a high risk of potential traumatic flap problems after LASIK and it is not recommended in army service.</p>

Epidemiology of eye injuries sustained by military personnel in China / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the epidemiological characteristics of eye injuries sustained by military personnel in Chinese army.</p><p><b>METHODS</b>Eleven military evacuation hospitals located in different regions were selected for this study. We reviewed all the medical records of eye injuries sustained by military personnel between January 2005 and December 2009. Patients'information was collected. All data were put into database and analyzed statistically.</p><p><b>RESULTS</b>Totally there were 415 inpatients with eye injuries (442 eyes) and their mean age was 24.40 years. Eye injury accounts for 13.51% of all eye diseases in this study. From 2006 to 2009, the number of eye injury increased gradually. Among them, 175 (42.17%) were injured in leisure time, and 145 (34.94%) in working time. Twenty-two (5.30%) patients had an eye surgery or history of eye disease before injury. In all, 246 patients (59.28%) were sent to evacuation hospital within 24 hours and 64 (56.64%) underwent surgeries in 24 hours after injury. There were 389 patients (93.73%) hospitalized for 1 time. Visual acuities of 187 eyes (42.31%) were grade 1 (larger than or equal to 20/40) after injury. When discharge, 349 eyes (78.96%) obtained a visual acuity of grade 1.</p><p><b>CONCLUSION</b>Eye injury has a very frequent incidence in Chinese army and much more attention should be paid to prevent it.</p>

Development of sympathetic ophthalmia following globe injury / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sympathetic ophthalmia (SO), a rare, bilateral, diffuse granulomatous uveitis, usually occurs after open globe injury or intraocular surgery. We sought to identify the risk factors for the development of SO after open globe injury and describe their demographic and clinical features and outcomes of treatments.</p><p><b>METHODS</b>A retrospective study of inpatients with globe injury in 15 tertiary referral hospitals of China from January 2001 to December 2005 was conducted. The information of demography, nature and mechanism of injury, time and ways of treatments and outcomes was reviewed. Diagnosis of SO was made based on a history of ocular trauma or surgery and subsequent development of bilateral or contralateral uveitis consistent with SO. Any association between related parameters and development of SO was analyzed.</p><p><b>RESULTS</b>Among 9103 patients (9776 eyes) of globe injury, SO occurred after open globe injury in 18 cases with an occurrence rate of 0.37%, vitrectomy of closed globe injury in 2 (0.37%) and perforation of burned eyes in another 2. For open globe injury, the median age ((36.72 +/- 13.59) years, P = 0.01) was higher in patients with SO; there were no significant effects of sexes, injury type, uvea proplaps, once or multi-intraocular surgery, once or multi-vitrectomy and endophthalmitis on incidence of SO; 0.70% endophthalmitis concurred with SO; 83.33% of SO occurred within 1 year after injury or last ocular surgery. SO developed in a fellow eye one week after evisceration of the perforating burned eye. Good final visual acuity was obtained in sympathizing eyes with prompt treatment.</p><p><b>CONCLUSIONS</b>For open globe injuries, SO sufferers were relatively older and any injury type could induce SO with equal possibility. The initial open globe injury was more likely to be the trigger of SO than subsequent intraocular surgeries including vitrectomy. Prophylactic enucleation after injury is not recommended.</p>

Electrophysiological evaluation of the safety of injection of tissue plasminogen activator into optic nerve in rabbits / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the safety of tissue plasminogen activator (tPA) intra optic nerve injection in rabbits. METHODS: Group 1 and 2 (6 eyes in each group) received injection of tPA 25μg and 12.5μg in 0.1mL balanced saline solution (BSS). Group 3 (6 eyes) received injection of 0 1mL BSS. Six eyes in group four as a normal control received no injection. The eyes were examined with slit lamp biomicroscope, indirect ophthalmoscope, visual evoked potentials (VEP) and electroretinography (ERG) at 1, 3, 7, 14 and 28 days after injection. RESULTS: No evidence of optic nerve or retinal toxicity or physical damage were revealed by ophthalmoscopy, VEP, and ERGs after the injection of tPA into the optic nerve. The means of the latency of the first peak of the VEP were 24.6±1.5, 24.1±1.9, 24.0±2.0 and 24.6±1.3mS respectively for the above specified groups (P=0.4112). The means of the amplitude of the first peak of the VEPs were 124±42, 145±41, 132±48 and 117±29μV respectively (P=0.0649). The means of the latency of a-waves were 6.0±0.4, 5.9±0.4, 5.9±0.5 and 5.8±0.3 mS respectively (P=0.6279). The means of the amplitude of a-waves were 110±14, 112±15, 110±16 and 108±11μV respectively (P=0.7248). The means of the amplitude of b-waves were 151±12, 148±14, 144±16 and 141±20μV respectively (P =0.0957).CONCLUSION: Injection of tPA upto 25μg in 0.1mL into optic nerve is well tolerated.

Injection of tissue plasminogen activator into the optic nerve in an animal model of retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the feasibility and efficacy of tissue plasminogen activator (tPA) injection into the optic nerve as a treatment for retinal vein occlusion in rabbits. METHODS: Rose Bengal-mediated laser-induced retinal vein occlusions were produced in rabbit eyes. Fluorescein angiography (FA) was performed on each eye 3 days before laser irradiation and 30 minutes after laser irradiation.The treatment group (n=20 veins) received intra-optic nerve injection of tPA (12.5μg in 0.05mL BSS) and the controls (n=24 veins) received 0.05mL BSS. FA was repeated to determine the recanalization of the vessel at 3 and 7 days after treatment, followed by histological examination.RESULTS: Rose Bengal-mediated laser-induced retinal vein occlusions were successfully developed and confirmed by FA. The incidence of the recanalization of the vessels in treatment animals was 70.0%, while 16.7% in the control animals (P=0.001). CONCLUSION: Intra-optic nerve tPA injection increased the incidence of recanalization of the occluded vessels. Although further studies are needed, our data suggested that injection of tPA into the optic nerve may have a potential benefit in the treatment of central retinal vein occlusion.

360-degree retinectomy for severe ocular rupture / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the effect of 360-degree retinectomy for severe ocular rupture and evaluate the related factors associated with prognosis.</p><p><b>METHODS</b>A retrospective analysis was performed on 28 consecutive patients, 18 men and 10 women, with severe ocular rupture admitted to the Chinese PLA General Hospital between January 1999 and January 2002. The patients' ages ranged from 16 to 58 years, mean 29.5 years. All operations were performed by the first author. All patients underwent standard 3-port pars plana vitrectomy with scleral encircling buckle, endophotocoagulation, and tamponaded with silicone oil. Lensectomy were performed on 15 eyes. 360-degree retinotomy and retinectomy were performed at anterior equator on 16 eyes, and posterior equator on 12 eyes.</p><p><b>RESULTS</b>During operation, all patients were confirmed to have vitreous hemorrhage and retinal detachment, in which hemorrhagic ciliary body detachment was found in 9 eyes, suprachoroidal hemorrhage in 12 eyes, retinal twisting like flower stalk in 11 eyes, and retinal incarceration in 17 eyes. Postoperative follow-up was conducted in 26 cases, ranged from 6 months to 46 months. Retinal reattachment achieved in 20 eyes (76.9%), in which three patients' retina was reattached after revitrectomy. The silicone oil was removed at the fourth month in 8 eyes postoperatively. Corrected visual acuity of 0.02 or more was in 14 eyes (70.0%) among the 20 patients with reattached retina. Visual acuity of 0.05 or more was in 7 eyes (35.0å), and 0.1 or more was in 3 eyes. The best visual acuity was 0.3 in 1 eye.</p><p><b>CONCLUSIONS</b>Retinectomy may improve the prognosis of severe ocular rupture and save the visual function of some patients.</p>

Traumatic endophthalmitis following penetrating ocular injuries with retained intraocular foreign bodies / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the outcome and analyze the methods of surgical treatment of traumatic endophthalmitis following penetrating eye injuries with retained eye foreign bodies.</p><p><b>METHODS</b>A total of 62 consecutive cases (58 men, 4 women) from January 1999 to December 2001 with IOFBs following penetrating eye injuries were retrospectively studied. The ages ranged from 8 to 46 years (mean 23 years). Sixty patients (63 eyes) underwent pars plana vitreotomy and 1 patient underwent external magnet extraction. The follow-up ranged from 3 to 36 months (mean 12.5 months).</p><p><b>RESULTS</b>Ten eyes developed endophthalmitis, among which 7 (10.94%) were diagnosed preoperatively. The most frequently cultured organism was Staphylococcus epidermis (44.44%, 4/9). Postoperatively, retinal detachment due to vitreoretinal proliferation occurred in 5 patients with endophthalmitis and in 9 patients without endophthalmitis. All the retinal detachments were reattached with additional vitreoretinal surgery. Two eyes with endophthalmitis and two without endophthalmitis were eviscerated.</p><p><b>CONCLUSIONS</b>Post-traumatic endophthalmitis with intraocular foreign bodies (IOFBs) deserves great attention because of its high incidence and poor prognosis. Vitrectomy is suggested for the treatment of IOFBs and its complications, and it should be performed as soon as possible. Routine intravenous administration of antibiotics combined with periocular injection and topical antibiotics postoperatively are recommended.</p>