Fonsecaea pedrosoi as a rare cause of acute conjunctival ulceration / Fonsecaea pedrosoi como agente raramente associado à úlcera conjuntival aguda

ABSTRACT Conjunctival ulceration accompanied with secretion and pain was observed in a 30-year-old male, 3 days after a perforating corneal trauma. Cultures of conjunctival ulcer samples grew Fonsecaea pedrosoi, a major causative agent of chromoblastomycosis that is typically transmitted during trauma. The conjunctival ulcer was successfully treated with amphotericin B, itraconazole, and fluconazole. This case report summarizes the diagnosis and treatment of a conjunctival ulcer due to F. pedrosoi, which is a rare complication of contaminated ocular trauma. To the best of our knowledge, this is the first reported case of F. pedrosoi causing acute conjunctival ulceration in the literature.

RESUMO O quadro clínico de uma úlcera conjuntival acompanhada de secreção e dor foi observado em homem de 30 anos de idade, 3 dias após um trauma perfurante da córnea. As culturas de uma amostra retirada da úlcera conjuntival foi positiva para Fonsecaea pedrosoi, uma cromoblastomicose, geralmente transmitido após traumatismos. O caso foi tratado com sucesso com a anfotericina B, itraconazol e fluconazol. Este relato de caso reporta o diagnóstico e tratamento de uma úlcera conjuntival causada por F. pedrosoi, que raramente é visto nos olhos expostos a traumatismos contaminados. Até onde sabemos, este é o primeiro caso relatado na literatura de F. pedrosoi causando úlcera conjuntival aguda.

Ultrasound biomicroscopy confirmation of corneal overriding due to improper suturing of full-thickness corneal laceration / Confirmação por biomicroscopia ultrassônica de encavalamento corneano devido à sutura inadequada de laceração de espessura total da córnea

We herein present a case with corneal overriding due to improper suturing of a full-thickness corneal laceration. There was a 2.5-mm difference between horizontal and vertical white-to-white measurements in the cornea. However, slit lamp examination failed to demonstrate the exact architecture of the laceration. Ultrasound biomicroscopy defined the wound edges thoroughly and confirmed the presence of corneal overriding. Six weeks after suture enhancement, the abnormal oval appearance of the cornea was absent and correct apposition of the corneal edges was seen on ultrasound biomicroscopy. Ultrasound biomicroscopy can be used in preoperative surgical planning of cases with complicated corneal lacerations. It can be used to adjust and enhance wound architecture in eyes with penetrating injury.

Apresentamos um caso com encavalamento corneano devido à sutura inadequada de uma laceração da córnea de espessura total. Houve uma diferença 2,5 mm entre as medidas do branco ao branco horizontais e verticais na córnea. No entanto, o exame da lâmpada de fenda não conseguiu demonstrar a arquitetura exata da laceração. A biomicroscopia ultrassônica definiu as bordas da ferida completamente e confirmou a presença de encavalamento da córnea. Seis semanas após a melhora da sutura, a aparência oval anormal da córnea havia desaparecido, e a correta aposição das bordas da córnea foi identificada na biomicroscopia ultrassônica. A biomicroscopia ultrassônica pode ser usada no planejamento cirúrgico pré-operatório de casos com lacerações corneanas complicadas. Ela pode ser utilizada para ajustar e melhorar a arquitetura da ferida em olhos com lesão penetrante.

Vision-related quality of life in patients after ocular penetrating injuries / Qualidade de vida relacionada à visão em pacientes após ferimentos oculares penetrantes

Purpose: To measure and investigate visual functioning and health-related quality of life (QOL) in patients after ocular penetrating injuries (OPI). Methods: Fifty-four adult patients with OPI and 26 healthy control subjects were enrolled in the study. The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) and the 36-Item Short Form Health Survey (SF 36) were administered. Sociodemographic and clinical data also were collected. The primary outcome measures were comparisons and multivariate analysis among groups for the NEI VFQ-25 and SF 36 subscale scores. Results: All NEI VFQ-25 scores, except general health, were significantly lower in the OPI group than those in the control group. All SF 36 scores were significantly lower in the OPI group than in the control group. The NEI VFQ-25 subscale item scores showed no significant differences with respect to age, educational level, or visual acuity in the injured eye. The SF 36 subscale item scores revealed no significant differences according to gender or educational level. Conclusions: Patients with OPI have increased psychological symptoms and lower levels of QOL than healthy control subjects have. Deteriorations in QOL should be kept in mind when managing patients with OPI. .

Objetivo: Medir e investigar a função visual e a qualidade de vida relacionada à saúde (QOL) em pacientes após ferimentos ocular penetrantes (OPI). Método: Cinquenta e quatro pacientes adultos com OPI e 26 indivíduos saudáveis (controles) foram incluídos no estudo. O questionário de função visual do National Eye Institute (NEI VFQ-25) e a avaliação curta de 36 itens (Short Form Health Survey - SF 36) foram administrados. Dados sociais, demográficos e clínicos também foram coletados. As comparações e análise multivariada entre os grupos para as subescalas do NEI VFQ-25 e do SF 36 foram consideradas como resultados primários. Resultados: Todos os índices do NEI VFQ-25, exceto saúde geral, foram significativamente menores no grupo OPI do que aqueles no grupo controle. Todos os índices do SF 36 foram significativamente menores no grupo OPI do que no grupo controle. Os índices das subescalas do NEI VFQ-25 não apresentaram diferenças significativas em relação à idade, escolaridade, ou acuidade visual no olho ferido. Os índices das subescalas do SF 36 não revelaram diferenças significativas de acordo com o nível de escolaridade ou sexo. Conclusões: Pacientes com OPI apresentaram sintomas psicológicos aumentados e níveis mais baixos de qualidade de vida que os indivíduos saudáveis. Deteriorações na qualidade de vida devem ser consideradas ao gerenciar pacientes com OPI. .

Herida penetrante escleral con cuerpo extraño intraocular. Presentación de un caso / Penetrating Scleral Injury with Intraocular Foreign Body. A Case Report

El trauma ocular constituye un problema de salud en el mundo actual y una causa común de deficiencia visual que deja en el paciente serias secuelas y trastornos psicológicos. Se presenta el caso de un paciente de 46 años, masculino, que acudió al cuerpo de guardia de Oftalmología del Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos, refiriendo que al estar martillando hierro sobre hierro sintió que algo se le proyectó a nivel del ojo derecho. Presentaba dolor, lagrimeo, ojo rojo y visión algo borrosa. Se le diagnosticó una herida penetrante escleral con cuerpo extraño intraocular. Se procedió al estudio que contempló biomicroscopia, radiografía de órbita y ultrasonido ocular. Se realizó tratamiento quirúrgico mediante extracción extracapsular del cristalino con implante de lente intraocular mediante la técnica de Blumenthal y abordaje a nivel de pars plana para la extracción del cuerpo extraño intraocular.

Ocular trauma is a health problem in the world today and a common cause of visual impairment leading to severe sequelae and psychological disorders. The case of a 46-year-old male patient who attended the Ophthalmology emergency services of the Dr. Gustavo Aldereguía Lima University General Hospital of Cienfuegos, recounting that while hammering iron on iron he felt that something entered his right eye, is presented. He suffered from pain, tearing, red eye and blurred vision. A penetrating scleral injury with an intraocular foreign body was diagnosed. Its study was conducted through biomicroscopy, orbital x-ray and ocular ultrasound. Surgical treatment by extracapsular lens extraction with intraocular lens implantation was performed using Blumenthal technique and pars plana approach for removal of the intraocular foreign body.

Repair of corneal perforation with sutureless photochemical tissue bonding / 中华创伤杂志

ObjectiveTo develop a new sutureless technique (photochemical tissue bonding,PTB ) for repair of corneal perforation. Methods A total of 60 rabbits were used for creating corneal perforation models.The corneal perforation on the left eye was repaired by sutures and the injury on the right eye was fixed with the use of amniotic membrane with PTB.The outcomes of the two mentioned repair methods were compared by observing the leakage of aqueous and the morphology of the anterior chamber at different instants,measuring the intraocular pressure (IOP) and observing the formation of neo-vessels and scars of cornea in the use of histological analysis. Results There was no leakage of aqueous and no difference for morphology evaluation in both treatments.PTB could adhere AM on the cornea to restore the corneal perforation.The peak IOP in the PTB treatment group at days 0,7 and 14 postoperative [ (531.2 ±49.5) mm Hg,(542.6 ±74.8) mm Hg and (603.9 ±69.1) mm Hg,respectively] was significantly higher than that in the suture group at the same instants [ (41.3 ±12.7) mm Hg,(142.6 ±25.4) mm Hg and (333.3 ± 66.7) mm Hg,respectively] (P ＜0.O1 ).Compared with suture repair,the treatment with PTB resulted in a better outcome of wound healing with less neo-vessels and less scars of cornea. Conclusion PTB treatment for repair of corneal perforation is superior to suture repair.

Perfluoroctano em cavidade orbitária após vitrectomia posterior e sutura de perfurante ocular: relato de caso / Perfluoro-n-octane in orbital cavity after posterior vitrectomy and suture of eye perforating injury: case report

O objetivo é relatar, pela primeira vez, o caso de um paciente submetido à vitrectomia posterior e sutura de perfurante ocular que evoluiu com extravasamento de perfluoroctano para cavidade orbitária. Paciente do sexo masculino, 39 anos, hígido, encaminhado para avaliação oftalmológica após ter sofrido trauma no olho direito com pedaço de metal há um dia. Ao exame, apresentava redução súbita da acuidade visual à direita com ferimento perfurante ocular córneo-escleral, corpo estranho intraocular e descolamento de retina. O paciente foi submetido à sutura de perfurante, introflexão escleral e vitrectomia posterior com utilização de perfluoroctano, quando foi constatada transfixação do globo ocular. No pós-operatório, evoluiu com proptose e presença de imagens hiperdensas à tomografia computadorizada de órbitas, sugerindo tratar-se de extravasamento de perfluoroctano para a cavidade orbitária. Dessa forma, diante de ferimento perfurante ocular, deve--se sempre atentar para a possibilidade de existência de corpo estranho intraocular, bem como para possível ocorrência de transfixação do globo ocular, no momento de se realizar a programação cirúrgica destes casos.

A case of a perfluoro-n-octane leakage into the orbital cavity after corneoscleral suture, scleral buckling and pars plana vitrectomy in an eye with perforating injury after trauma is reported for the first time. A previously healthy 39-year-old man was sent for ophthalmic evaluation one day after suffering a penetrating ocular trauma in his right eye while hammering a nail. On the initial evaluation, the patient presented sudden reduction of visual acuity on his right eye with a perforating corneoscleral injury, intraocular foreign body and retinal detachment. The patient was submitted to corneoscleral suture, pars plana vitrectomy with perfluoro-n-octane administration to flatten the retina and scleral buckling, when it was found transfixation of the globe by the intraocular foreign body. Postoperatively, computed tomography scans of the orbit were ordered due to proptosis, which showed the presence of hyperdense images, suggesting leakage of perfluoro-n-octane into the orbital cavity. Thus, in cases of perforating eye injury, one should be suspicious about the possibility of intraocular foreign body, as well as possible occurrence of transfixation of the globe when scheduling the surgery.

Application of Color Doppler ultrasound in diagnosis of traumatic retinal detachment / 中国基层医药

Objective To research the diagnosis value in color Doppler ultrasound on traumatic retinal detachment. Methods 30 cases(30 eyes)with traumatic retinal detachment were confirmed by B-mode ultrasonography and surgery. The characteristics and blood flow were observed by color Doppler ultrasound. Results 30 cases, among partial detachment in 18 cases, completely detachment in 9 cases, old detachment in 2 cases, and completed with detachment of choroids in 1 case;30 cases, greater than 0.1 in 7 eyes ( 23.3% ), 0. 01 ～0. 1 in 10 eyes (33.3%),counting fingers in 4 eyes( 13.3% ) ,manual in 5 eyes ( 16.6% ) ,no light perception in 4 eyes( 13.3% ); The visual acuity in patients after treatment had significantly increased compared with before treatment( χ2 =7. 394 ,P =0. 015 );The lower intraocular pressure of retinal hemorrhage, serous choroidaland hemorrhagic choroidal had no significant difference[4 eye(33. 3% ) ,4 eye(33. 3% ) ,4 eye(33.3% ) ,respectively] (χ2 =3. 004,P=0. 343). Conclusion The color doppler ultrasound diagnosis in traumatic retinal detachment, with its capacity of early finding and accurate and reliable, have significant meaning to clinical treatment and prognosis.

Epidemiological findings of ocular trauma in childhood

PURPOSE: To describe epidemiological findings of ocular trauma in childhood in an emergency unit. METHODS: A retrospective study was carried out including patients under 16 years old who were treated for ocular trauma at the emergency unit of the Federal University of São Paulo from September 2001 to September 2004. Age, sex, involved eye, place, circumstance and mechanism of injury, initial visual acuity and immediate management were recorded. RESULTS: A total of 273 patients were included in the study. The age group comprising most cases was 7 to 10 years (39.9 percent). The most frequent cause of ocular injury was traumatism by external agents like stone, iron and wood objects (27.9 percent). The commonest place was the home (53.1 percent). Initial visual acuity was over 20/40 in 63.4 percent of cases. Closed globe injury occurred in 201 (73.6 percent) accidents. Seventy-six children (27. 8 percent) were treated with medicines and in forty-eight (17.6 percent) cases surgery was necessary. CONCLUSION: Ocular trauma in childhood was more frequent in the male schoolchild and was due mostly to traumatism with agents like stone, wood and iron pieces, domestic utensils and leisure objects. The injuries occurred most frequently at home. Closed globe injuries predominated. Programs of education and prevention for ocular trauma in childhood are necessary.

OBJETIVO: Descrever os achados epidemiológicos do trauma ocular na infância em uma unidade de emergência. MÉTODOS: Em estudo retrospectivo, foram analisados prontuários de pacientes menores que 16 anos que foram atendidos por trauma ocular no Pronto-Socorro de Oftalmologia da Universidade Federal de São Paulo de setembro de 2001 a setembro de 2004. Foram coletadas informações a respeito da idade, sexo, olho envolvido, local, circunstância e mecanismo do trauma, acuidade visual inicial e conduta imediata. RESULTADOS: Um total de 273 pacientes foi incluído no estudo. A faixa etária com maior número de casos foi a de 7 a 10 anos (39,9 por cento). A causa mais freqüente de lesão ocular foi traumatismo com objetos externos como pedra, ferro ou madeira (28,9 por cento) e o local mais comum foi a própria casa (53,1 por cento). A acuidade visual inicial foi melhor que 20/40 em 63,4 por cento dos casos. Houve trauma ocular fechado em 201 (73,6 por cento) acidentes. Setenta e seis pacientes (27,8 por cento) foram tratadas com medicamentos e em quarenta e oito (17,6 por cento) casos foi necessário procedimento cirúrgico. CONCLUSÃO: O trauma ocular na infância foi mais freqüente no sexo masculino, em escolares e foi associado a objetos tais como pedra, madeira, ferro, utensílios domésticos e brinquedos. Os acidentes aconteceram mais freqüentemente em casa e trauma fechado foi a lesão predominante. São necessários programas de educação e prevenção do trauma na infância.

Retinectomy with 360? for severe ocular rupture / 中华眼底病杂志

Objective To investigate the effect of retinectomy 360? for severe ocular rupture and evaluate the related factors associated with prognosis. Methods We retrospectively analyzed 28 consecutive patients (28 eyes), 18 men and 10 women, with severe ocular rupture admitted to the Chinese PLA General Hospital between January 1999 and October 2002. The patient′s ages ragned from 16 to 58 years, mean 29 years. According to the internation standardized classification of ocular trauma, the injuries located in zone Ⅰ in 5 eyes, zone Ⅰ-Ⅱ in 8 eyes,zone Ⅱ in 3 eyes, zone Ⅱ-Ⅲ in 5 eyes, zone Ⅲ in 7 eyes, zone Ⅱ in 3 eyes, zone Ⅱ-Ⅲ in 5 eyes and zone Ⅲ in 7 eyes. The presenting visual acuity was in grade 4 (0. 02 to light perception) in 19 eyes, and grade 5 in 9 eyes. In 28 patients, 13 had the total absence of iris and lens, 10 had iris deletion more than 1/2, and 15 had lens opacity or rupture. Ultrasound biomicroscopy and B-scan revealed ciliochoroidal detachment in 17 eyes. The B-scan revealed vitreous hemorrhage and retinal detachment in all paitents. The intraocular pressure was from 5 to 11 mm Hg in all patients. The therappeutic operative procedures which were performed by one surgeon in all of the affected eyes included standard 3-port pars plana vitrectomy with scleral encircling buckle, endophotocoagulation and tamponading with silicone oil in all patients; lensectomy in 15 eyes; 360? retinotomy and retinectomy at anterior equator in 16 patients, and posterior equator in 12 eyes. Results During the operation, all patients were confirmed with vitreous hemorrhage and retinal detachment, including hemorrhagic ciliary body detachment in 9 eyes, suprachoroidal hemorrhage in 12 eyes, retinal twisting like morning glory in 11 eyes, and retinal incarceration in 17 eyes. Postoperative follow-up In 26 eyes who were followed up postoperatively from 6 months to 46 months, retinal reattachment was found in 20 patients (76. 9%) in whom the retina of 3 was reattached after revitrectomy and the silicone oil of 8 was removed at the fourth month after operation. In 20 eyes with reattached retina, 14 (70. 0%) had corrected visual acuity of 0. 02 or more, including 7 (35. 0%) had 0. 05 or more, 3 had 0. 1 or more, and 1 had the best visual acuity of 0. 3. Conclusion Retinectomy may improve the prognosis of severe ocular rupture and save the visual function of some patients.

Surgical treatment for severe ocular rupture with blood staining of cornea and non-light perception / 中华眼底病杂志

Objective To evaluate the effects of surgical treatment for severe ocular rupture with blood staining of cornea and non-light perception, and analyze the relative factors. Methods Seven severely ruptured eyes of 7 patients with blood staining of cornea and non-light perception underwent second-stage penetrating keratoplasty combined with vitrectomy using temporary keratoprosthesis. All injured eyes had blood staining of cornea, hemorrhage in anterior chamber and vitreous, and choroidal and retinal detachment before the second-stage surgery. The average interval of the two surgical stages was 18 days (12-21 days). The preoperative visual acuity was non-light perception in all injured eyes with the mean intraocular pressure of 3 mm Hg (1 mm Hg=0.133 kPa) (2- 5 mm Hg). The mean follow-up period was 12 months (6-30 months). Results The postoperative visual acuity was better than light perception in 5 eyes with the best corrected visual acuity of light perception to 0.06. The retina was attached in 5 eyes (5/7). The mean postoperative intraocular pressure was 12 mm Hg (5- 15 mm Hg) which was significantly higher than the preoperative one (P

Función visual en pacientes operados de cuerpo extraño intraocular / Visual function in patients operated on of intraocular foreign body

Se realiza el estudio de 82 pacientes (82 ojos) con cuerpo extraño intraocular (CEIO), a los que se les realizó el examen oftalmológico (según el estado del globo ocular), así como otros exámenes complementarios que permitieron tomar una acción medicoquirúrgica adecuada. El seguimiento clínico se efectuó hasta el año de la cirugía. La mayoría de los CEIO afectaron ambos segmentos del globo ocular, la mayor parte se localizan en el segmento posterior (90,2 %). Se apreció una relación directa entre la presencia de infecciones y el empeoramiento de la agudeza visual (AV) al año de la cirugía, lo cual no se comportó así con el tiempo de permanencia del CEIO. De los 51 pacientes con mala AV en el preoperatorio, el 39,2 % mejoró su visión al término del estudio, el resto de los casos (77,5 %) quedó en igual estado funcional.

82 patients (82 eyes) with intraocular foreigh body (IOFB) that underwent opthalmological examination (according to the state of the eyeball) and other complementary test that allowed to apply an adequate medical and surgical procedure were studied. These patients were folowed up for a year. Most of the IOFB affected both segments of the eyeball and located in the posterior segmen (90,2 %). It was oberved a direct relationship between the presence of infections and the worsening of visual acuity (VA) after a year. It was not the same with time of permanence of the IOFB. Of the 51 patients with poor VA in the postoperative, 39,2 % improved their vision at the end of the study. The rest of the cases (77,5 %) maintained the same functional state.

Clinical analysis of vitrectomy for endophthalmitis / 中华眼底病杂志

ObjectiveTo investigate the etiological factors of endophthalmitis and evaluate the outcomes of vitrectomy for endophthalmitis.MethodsFrom January 1999 to December 2001, 53 consecutive patients (54 eyes ), 38 men and 15 women, diagnosed as endophthalmitis were retrospectively evaluated. The patients′ ages ranged from 1 year to 74 years (mean 32 years). Two patients (2 eyes) with mild inflammation received antibiotic medication therapy, 5 patients (5 eyes) with no light perception and severe inflammation underwent evisceration, and the other 46 patients (47 eyes) underwent pars plana vitrectomy. Postoperative follow-up ranged from 2 to 32 months (mean 10.5 months). ResultsEndophthalmitis was diagnosed as resulting from penetrating injury in 32 eyes (59.26%), endogenous endophthalmitis in 8 eyes (14.81%), cataract surgery in 7 eyes (12.96%), glaucoma surgery in 2 eyes (3.70%), vitrectomy in 3 eyes (5.56%), radial keratotomy in 1 eye (1.85%), and unknown reason in 1 eye (1.85%). The postoperative visual acuities (VA) of these patients increased significantly (P=0.003). The VA of the patients underwent vitrectomy in 3 days was obviously better than those after 3 days (P=0.014), and the VA of the patients underwent vitrectomy in 7 days was obviously beter than those after 7 days (P=0.021). Thirty-seven eyes (68.52%) had functional success (VA≥0.02), 47 eyes (87.04%) had anatomical success (VA

Relaxing retinotomy for the treatment of perforating traction retinal detachment / 中华眼底病杂志

Objective To explore the therapeutic value and effects of relaxing retinotomy for perforating traction retinal detachment(PTRD). Method A retrospective survey was done in 21 patinets (21 eyes) with PTRD who underwent vitrectomy combined with relaxing retinotomy in our hospital from 1998 to 2001. Results The retinae were completely reattached in all 21 cases. The visual acuity of 12 patients (57%) was counting finger, and the best visual acuity was 0.05. Among the 18 patients who were followed up for 6 to 25 months, 14(77.8%) remained retinal reattachment. Conclusions Relaxing retinotomy is effective for anatomic reattachment of PTRD, especially to the patients with retinal incarceration and severe proliferative vitreoretinopathy.

An autoradiographic study of cell proliferatoin in penetrating wounds of sclera in rabbits / 解放军医学杂志

Objective To study the healing process of penetrating injury of sclera. Methods A rabbit model with penetrating injury of sclera was made by incising the sclera accompanied by intravitreous injection of autologous blood. The animals were sacrificed at different time intervals after injury. Two hours before the animals were sacrificed, 3 H thymidine ( 3 H-TdR ) was injected into the vitreous cavity. The enucleated eye balls were fixed, dehydrated, embedded with paraffin, and sectioned for light microscopic examination and autoradiographic study. The numbers of cells that incorporated 3 H-TdR at different time intervals were compared. Results After the sclera was injured, inflammation occurred mainly in the superficial part of the sclera, from which most of the proliferating cells filling the wounds came. These cells grew along the vitreous strands to the blood clot in the vitreous cavity. Tractional retinal detachments were induced in 9 of the 12 rabbits within 2 weeks after injury. Cells of different ocular tissues incorporated 3 H-TdR, of which the cells from superficial sclera accounted for the majority. Incorporation of 3H-TdR by these fibroblasts peaked on the 5th day after injury(P