Epidemiology and Clinical Patterns of Ocular Trauma at a Level 1 Trauma Center in Korea

Background@#To evaluate the patterns of distribution and clinical manifestations of ocular injuries referred to the level 1 trauma center of Pusan National University Hospital (PNUH) in Korea. @*Methods@#We analyzed 254 of 4,287 patients who were referred to the Department of Ophthalmology at the level 1 trauma center of the PNUH, from January 2016 through December 2018. Data on the incidence of ocular injuries, sex, age, monthly and seasonal distribution, day and time of injury, side of injury, cause, residence of patients, referral time to an ophthalmologist and subsequent examination time, final visual acuity (VA), and complications were obtained from medical records and retrospectively reviewed. The patients were grouped according to their main diagnosis using the Birmingham Eye Trauma Terminology System (BETTS) and Ocular Trauma Score (OTS). @*Results@#The incidence of ocular injuries with major trauma was higher in men (n = 207, 81.5%), the median age at time of injury was 54 years, and Pusan recorded the most cases.The incidences of ocular injury were 1.47/100,000, 1.57/100,000, 1.48/100,000 in 2016, 2017 and 2018, respectively. The most common cause was by a motorbike accident, followed by a pedestrian traffic accident and falls. According to the BETTS classification, open-globe injuries represented 4% of cases, closed-globe injuries represented 12.6%, and other injuries represented 83.1%. Open-globe injuries were significantly associated with low final VA (P = 0.01). In the OTS, 79.4% of patients received 4 or 5 points and 13.7% of patients received 1 or 2 points. The patients who received 1 or 2 points in the OTS score showed final VA below hand movement (P < 0.001), except for two patients. Lid laceration and low initial VA were highly correlated with poor final VA (P < 0.001). @*Conclusion@#This is the first study on the epidemiology and clinical manifestations in trauma patients with ocular injuries at a level 1 trauma center. The incidences of ocular injuries with major trauma were about 1.47–1.57/100,000. BETTS, OTS, lid laceration and initial VA were associated with final VA. We expect our study to provide a basis of data for the evaluation, prevention, and management of ocular injuries in patients with systemic trauma.

Multilayer Collagen Sheet Graft for Corneal Perforation with a Corneal Ulcer

Purpose@#To report a rare case of corneal perforation treated with a multilayer collagen sheet graft transplantation after amniotic membrane graft failure to prevent corneal perforation in a fungal corneal ulcer.Case summary: A 64-year-old woman with a past history of rheumatoid arthritis 1 year prior was transferred to our hospital due to unresponsive treatment of a corneal ulcer. Although the corneal ulcer of the right eye was treated with antibiotics for 10 days, loss of the corneal epithelial layer and corneal stromal infiltration were observed on examination. A culture test was conducted on the corneal ulcer that identified the pathogen as the Paecilomyces strain. Corneal perforation occurred 1 month after undergoing an amniotic membrane graft to prevent this outcome. A multilayer collagen sheet graft (Aongen®; Pharos Tech Medical, Seoul, Korea) was applied at the perforated corneal ulcer site without a donor cornea. One year after this operation, visual acuity has not been restored; however, corneal perforation of the ulcer site has not progressed. @*Conclusions@#If there is no donor cornea, partial corneal transplantation using a multilayer collagen sheet graft is thought to be a therapeutic method to treat corneal perforation in cases involving impacted corneal perforation or corneal perforation that occurs in corneal disease.

Multilayer Collagen Sheet Graft for Corneal Perforation with a Corneal Ulcer

Purpose@#To report a rare case of corneal perforation treated with a multilayer collagen sheet graft transplantation after amniotic membrane graft failure to prevent corneal perforation in a fungal corneal ulcer.Case summary: A 64-year-old woman with a past history of rheumatoid arthritis 1 year prior was transferred to our hospital due to unresponsive treatment of a corneal ulcer. Although the corneal ulcer of the right eye was treated with antibiotics for 10 days, loss of the corneal epithelial layer and corneal stromal infiltration were observed on examination. A culture test was conducted on the corneal ulcer that identified the pathogen as the Paecilomyces strain. Corneal perforation occurred 1 month after undergoing an amniotic membrane graft to prevent this outcome. A multilayer collagen sheet graft (Aongen®; Pharos Tech Medical, Seoul, Korea) was applied at the perforated corneal ulcer site without a donor cornea. One year after this operation, visual acuity has not been restored; however, corneal perforation of the ulcer site has not progressed. @*Conclusions@#If there is no donor cornea, partial corneal transplantation using a multilayer collagen sheet graft is thought to be a therapeutic method to treat corneal perforation in cases involving impacted corneal perforation or corneal perforation that occurs in corneal disease.

Effectiveness of Cyclosporine-steroid Treatment after Cataract Surgery according to Dry Eye Severity

PURPOSE: To evaluate the effectiveness of topically administered 0.05% cyclosporine combined with a topical steroid in the early postoperative period after cataract surgery, and to compare the therapeutic efficacy according to the severity of dry eye. METHODS: One hundred and fifty-six patients who underwent unilateral cataract surgery and received topical cyclosporine 0.05% for 8 weeks combined with a fluorometholone 0.1% steroid for 4-weeks were classified into three groups according to preoperative dry eye level: the control group, non-dry eye (n = 78); group 1, level I dry eye (n = 38); and group 2, level II dry eye (n = 40). The best-corrected distance visual acuity, intraocular pressure, dry eye symptom questionnaire (ocular surface disease index), tear film break-up time (TBUT), and Schirmer test-I (STI) were evaluated. RESULTS: The preoperative score of dry eye symptoms improved significantly at one week postoperatively and continued to improve until postoperative 8-weeks in all groups, especially in group 2 compared with the control. Groups 1 and 2 showed significant improvement in the TBUT at one week, four weeks, and eight weeks postoperatively, compared to eight weeks postoperatively in the control; Group 2, especially, showed significant improvement in TBUT. There was no difference in STI value after cyclosporine-steroid treatment in the control group; however, a significant difference was observed at four weeks postoperatively in dry eyes. No significant differences in STI results were observed among the three groups. CONCLUSIONS: Use of topical cyclosporine 0.05% combined with a topical fluorometholone 0.1% steroid after cataract surgery is more effective in dry eyes level II than in non-dry eyes, especially those with TBUT and dry eye symptoms at eight weeks postoperatively.

Modified Anderson Procedure in Infantile Nystagmus with Face Turn within 30 Degrees

PURPOSE: To evaluate the efficacy of modified Anderson procedure in infantile nystagmus with face turn less than 30 degrees. METHODS: This study was a retrospective review of the medical records of 13 consecutive patients who underwent a modified Anderson procedure for abnormal head position in infantile nystagmus at Pusan National University hospital from February 2002 to March 2017. We compared best-corrected visual acuity (logarithm of minimal angle of resolution, logMAR), refraction, degree of face turn, ocular motility, and angle of deviation preoperatively and at 1 week postoperatively, 6 months postoperatively, and the final visit. Recession of the yoke rectus muscles responsible for the slow phase of nystagmus was performed, depending on the direction of face turn; the medial rectus muscle of the eye to which the head was turned was recessed 10 mm, whereas the lateral rectus muscle of the contralateral eye was recessed 12 mm. RESULTS: The mean age of the patients was 8.9 (2–25) years, and the mean follow-up period after surgery was 51.3 (6–183) months. Twelve patients (92.3%) had no residual head posture or <10° at 6 months postoperatively, and three patients (23.1%) achieved this outcome with an additional operation. The mean degrees of face turn were 22.30° before surgery and 3.85° post-operatively (p = 0.001). Best-corrected visual acuity (logMAR) was 0.41 in the better eye and 0.50 in the worse eye before surgery; this improved to 0.34 and 0.45 at 6 months postoperatively (p = 0.068 and p = 0.228, respectively). Despite the large recessions involved, only one patient showed mild limitation of abduction after surgery. CONCLUSIONS: The modified Anderson procedure may be effective for correcting abnormal head position in infantile nystagmus with face turn less than 30 degrees; patients were not overcorrected.

Two Cases of Orbital Apex Syndrome after Blunt Orbital Trauma

PURPOSE: To report two cases of orbital apex syndrome caused by blunt orbital trauma without structural damage of the orbit. CASE SUMMARY: (Case 1) A 50-year-old male came to our clinic complaining of visual loss after blunt orbital trauma by a metal bar. The best-corrected visual acuity was no light perception and light reflex was not observed in the affected eye. He also presented with complete ptosis and ophthalmoplegia with relative sparing of adduction and depression. High signal intensity of the orbital soft tissue including the optic nerve sheath was revealed using a T2-weighted image in magnetic resonance imaging. After starting steroid pulse therapy, his visual acuity improved to counting fingers on the third day. Ocular movement and levator function recovered to the normal range while visual acuity remained counting fingers. (Case 2) A 64-year-old female presented with complete ptosis after trauma to her right eyeball. The best-corrected visual acuity was 20/25 in the right eye. Complete ptosis and ophthalmoplegia with relative sparing of abduction and depression in the right eye were observed at the initial presentation. Magnetic resonance images showed enhancement of the right periphery optic nerve and distal rectus muscle. Two months after undergoing steroid pulse therapy, levator function and ocular movement recovered completely, and visual acuity improved to 20/20. CONCLUSIONS: The orbital apex syndrome caused by blunt orbital trauma showed good response to steroid pulse therapy. Steroid treatments may therefore be considered for the treatment of traumatic orbital apex syndrome.