Frosted branch angiitis with penetrating ocular trauma and retained intraocular foreign body

A 54-year-old male sustained ocular trauma with a projectile. Examination of the right eye revealed an intraocular foreign body (IOFB) adjacent to the optic nerve head, vitritis, vitreous hemorrhage, and translucent perivascular sheathing of the retinal vessels in all quadrants suggesting frosted branch angiitis (FBA). The patient underwent vitrectomy with removal of the IOFB and silicone oil tamponade under steroid cover. With continued use of systemic and topical steroids after surgery, complete resolution of FBA and improvement in vision were noted in a week. Prompt resolution of FBA after IOFB removal points toward a strong association between the presence of IOFB and FBA.

The Relationship between Visual Outcome and Ocular Trauma Score after Open Globe Injuries in Children

PURPOSE: We evaluated the prognostic factors of open globe injuries in children and adolescents, and compared the ocular trauma score (OTS) and pediatric penetrating ocular trauma score (POTS). METHODS: We performed a retrospective review of 77 children under 18 years of age who visited our clinic with open globe injuries between May 1993 and April 2014. We investigated the factors that may affect final visual acuity. We also compared the OTS and POTS using receiver operating characteristic curves as a method to predict final visual acuity. RESULTS: By univariate analysis, an initial visual acuity less than 20/200, globe rupture, wound size greater than 7.0 mm, retinal detachment, lens dislocation, and total number of operations contributed to worse visual outcomes (<20/200). Conversely, central corneal involvement, traumatic cataract, wound size less than 7.0 mm, and initial visual acuity greater than 20/200 were better prognostic indicators (≥20/32). Both OTS and POTS had diagnostic value as a predictor of final visual acuity, although there were no statistically significant differences between the two scoring systems. CONCLUSIONS: Initial visual acuity and wound size are important prognostic factors for the final visual acuity in children and adolescent, following open globe injuries. Both OTS and POTS are reliable prognostic models for open globe injuries in children and adolescents.

Posterior approach vitrectomy treating penetrating ocular trauma with intraocular foreign body / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the effect of early posterior approach vitrectomy in the treatment of penetrating ocular trauma with intraocular foreign body.METHODS: Totally 10 cases of penetrating ocular trauma with intraocular foreign bodies(IOFB) in the past two years were included.Emergency vitrectomy, intraocular foreign body removal and silicone oil tamponade were performed by the same surgeon.Antibiotics and steroids were given after surgeries.Retinal photocoagulation was done according to fundus conditions after surgeries.RESULTS: One patient combined with preoperation endophthalmitis and severely damaged retina failed to recover, eventually came to phthisis bulbi.Vitrectomy and IOFB removal were all successfully performed in the other patients.The postoperation follow-up time was 3-18mo.Two of the patients received secondary vitrectomy and silicone replacement surgeries due to recurrent retinal detachment.The remaining patients had no further bleeding with intraoclar pressure(IOP) 8-21mmHg.At the last follow-up, three of them gained best corrected visual acuity better than 0.1, two patients had visual acuity of 0.01 to 0.1 and four patients had poor visual acuity of light perception to FC/50cm because of macular damage.The patient with phthisis bulbi had no light perception.CONCLUSION: Early vitrectomy, foreign body removal and silicone oil tamponade is an effective treatment for patients with penetrating eyeball injury with IOFB.

Clinical Course and Predictive Factors of Final Visual Acuity in Children with Penetrating Ocular Trauma

PURPOSE: To investigate the clinical course and the predictive factors of final visual acuity in children with penetrating ocular trauma. METHODS: The medical records of 63 eyes of 62 children with penetrating ocular trauma were reviewed retrospectively, and the relationships between factors and final visual acuity were analyzed. RESULTS: Penetrating ocular trauma was frequent in male patients and preschool age children. The most common mechanism of injury was sharp trauma, and the most common location of injury was limited to the cornea. Among the associated injuries, uveal prolapse and lens damage were most frequent. As a primary operative management, primary wound closure was done in 62 eyes, and evisceration in one eye. Over half took an operation more than twice, and the lens damage is the most common cause of additional operation. Endophthalmitis was found in 4.8%, and phthisis in 6.3%. Final visual acuity over 0.5 was 35.5%, between 0.025 and 0.5 was 33.9%, and under 0.025 was 30.6%. Relationships between factors and final visual acuity were analyzed using single variate and multivariate analysis, and the presence of lens damage or posterior segment involvement was a significant predictor of final visual acuity. CONCLUSIONS: In spite of marked improvement in the microsurgical techniques, penetrating ocular trauma in children showed bad prognosis that 2/3 of them achieved final visual acuity under 0.5. The presence of lens damage or posterior segment involvement was a significant predictive factor of final visual acuity in patients with penetrating ocular trauma. We hope that using these predictive factors help clinicians decide appropriate treatment for children with penetrating ocular trauma.

Clinical Results of Primary Posterior Chamber Intraocular Lens Insertion in the Setting of Penetrating Ocular Trauma: whether PCL insertion or not

PURPOSE: To evaluate the clinical outcome of patients who underwent a lensectomy and IOL implantation at the time of the primary repair due to a penetrating ocular injury. METHODS: We analyzed the records of 25 eyes of 25 perforating injury patients[Group A (13 eyes)-who had undergone simultaneous corneal laceration repair, cataract extraction and IOL implantation, and Group B (12 eyes)-who had undergone corneal laceration repair, cataract extraction and had their refractive error corrected by contact lens or glasses later]. retrospectively from March, 1991 to June,1999. We examined the relationship between their final visual acuity and the influencing factors such as cause of injury, length and feature of the lacerated cornea, initial visual acuity and postoperative complications, etc. RESULTS: The average age of patients was 36.8 and 25.7 years in group A and B, respectively. The major cause of injury was a metallic foreign body. In group A, the wound is relatively short and has a linear shape. In group B, it is a nearly curved line. An anterior vitrectomy was done in 6 patients in both groups, respectively. Nine patients (69%) achieved a final visual acuity of 10/20 or better in group A and only four patients (33%) in group B. The postoperative complications were transient elevation of IOP (1 eye) and corneal ulcer (1 eye) in group A, and vitreous opacity (1 eye) and retinal detachment (1 eye) in group B. CONCLUSIONS: It is recommended for visual rehabilitation and attainment of binocular visual function to implant the IOL at the time of primary repair caused by a penetrating ocular injury.

A Clinical Study of Posterior Segment Injuries of Non-penetrating Ocular Trauma

Posterior segment injuries due to non-penetrating ocular trauma have protean ocular manifestations. Vision may be unaffected or completely lost according to the injured area. Although most cases require no specific treatment, early accurate diagnosis and appropriate prophylactic treatment will prevent some patients from late visual loss. We analyzed retrospectively 36 eyes of 36 patients with non-penetrating posterior segment trauma who had visited our clinic from August, 1994 to February, 1997. Thirty two of the patients(88.8%) were male and the peak age group was in the third decade. Thirteen of the patients(21%) had Berlin`s edema, which was one of the most common findings seen in the posterior segment. The most common anterior segment finding associated with non-penetrating ocular trauma was hyphema(20%). The most common cause of non-penetrating trauma was violence(first, foot)(38.8%). Final visual acuity was better in eyes without the lesion involving the macula.