New model for the prediction of visual outcomes in young children with mechanical ocular conditions and comparison with other models

Purpose: Herein, we compared the efficacy among the Ocular Trauma Score (OTS), Toddlers Ocular Trauma Score (TOTS), and Pediatric Ocular Trauma Score (POTS) for prognosis prediction in Indian children who had mechanical ocular conditions causing traumatic cataract. Methods: This prospective, interventional study recruited consecutive children undergoing operation for traumatic cataracts caused by mechanical eye injuries at Drashti Netralaya. The following details were obtained from their medical files: the circumstance and time of injuries, penetrating injury type, initial and final visual acuity (VA), time of operation, and associated eye diseases. Specific variables were employed to determine the OTS, TOTS, and POTS. For all patients, the final and predicted VA determined using all scores were compared using Fischer’s exact test. Accuracy, specificity, and sensitivity were evaluated for all the scores by using the area under receiver operating characteristic curve. Results: We enrolled 124 eyes. Patients’ mean value for age was 4.6 ± 1.29 years; 44 (35.41%) and 74 (64.5%) were female and male patients, respectively. Visual outcomes significantly improved after operation, and the outcomes did not differ between closed? and open?globe injuries (P = 0.162). The actual and predicted VA did not exhibit a statistically significant difference among the three scores. TOTS and POTS were more suitable for evaluating low?risk injuries, whereas the OTS could more efficiently examine high?risk cases. Conclusion: TOTS and POTS were more accurate than the OTS in VA prediction after operation in toddlers with traumatic cataracts caused by mechanical globe injury. TOTS and POTS were more suitable for evaluating low?risk injuries, whereas the OTS could more efficiently examine high?risk cases. All the examined scores can be helpful in estimating VA following treatment

Trauma ocular a globo cerrado en la edad pediátrica / Closed globe injuries in pediatric age

Los traumas oculares son frecuentes en las urgencias de oftalmología. El tratamiento constituye un reto para el oftalmólogo, pues se enfrenta a un daño integral y complejo. Se presenta un paciente de 16 años, el cual fue hospitalizado en el Instituto Cubano de Oftalmología Ramón Pando Ferrer hace cuatro años por haber recibido un trauma contuso en ojo derecho el cual provocó hifema total. Durante su estadía hospitalaria se realiza lavado de cámara anterior ya que no se logró la reabsorción espontánea del mismo. Al visualizarse todas las estructuras oculares se diagnostican complicaciones como subluxación del cristalino, catarata, panuveítis, hemovítreo, desgarro retiniano y glaucoma traumáticos. Se bloquea el desgarro con láser y una vez compensado el cuadro inflamatorio, es egresado bajo tratamiento y seguimiento por oftalmología pediátrica. No se logra controlar el glaucoma y se implanta dispositivo de drenaje Molteno lo que estabiliza la tensión ocular. Se realiza posteriormente cirugía de catarata, manteniéndose compensado del glaucoma sin tratamiento y con calidad visual(AU)

Ocular traumas are frequent in ophthalmology emergencies. Treatment is a challenge for the ophthalmologist, as he faces a comprehensive and complex damage. A 16-year-old patient is presented, who was hospitalized at the Cuban Institute of Ophthalmology Ramón Pando Ferrer 4 years ago for having received a blunt trauma to the right eye which caused total hyphema. During his hospital stay, anterior chamber lavage was performed since spontaneous reabsorption was not achieved. When all ocular structures are visualized, complications such as lens subluxation, cataract, panuveitis, hemovitreous, traumatic retinal tear and glaucoma are diagnosed. The tear was blocked with a laser and once the inflammatory condition was compensated, he was discharged under treatment and monitoring by pediatric ophthalmology. The glaucoma could not be controlled and a Molteno drainage device was implanted, which stabilizes the ocular tension. Cataract surgery was subsequently performed, keeping the glaucoma compensated without treatment and with visual quality(AU)

Caracterización de pacientes con úlcera grave de la córnea y queratoplastia terapéutica

RESUMEN Introducción: La queratoplastia ha sido la técnica más empleada para el tratamiento de las alteraciones corneales. Objetivo: Describir las características clínico-epidemiológicas de la queratoplastia terapéutica en pacientes con úlcera grave de la córnea. Método: Se realizó un estudio observacional descriptivo y transversal a 17 ojos de 16 pacientes operados de queratoplastia terapéutica que presentaron úlcera grave de la córnea, ingresados en el servicio de Oftalmología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba en el periodo de enero de 2018 a diciembre de 2019. Se estudiaron las variables edad, sexo, procedencia, ocupación, factores predisponentes, tiempo de evolución previo al ingreso, tratamiento tópico previo y germen causal. En el análisis estadístico se utilizó la frecuencia absoluta y el porcentaje para las variables cualitativas y para las cuantitativas, la media y la desviación estándar. Resultados: Predominaron los pacientes del sexo masculino, jubilados con más de 60 años. Prevaleció el trauma ocular no quirúrgico como factor predisponente. Previo al ingreso se aplicó con mayor frecuencia el colirio antibiótico y el tiempo de evolución promedio fue de 12,2 días. El grupo de gérmenes más preponderante fue el de las bacterias. Conclusiones: El vínculo entre el germen causal y la aplicación de medicamentos tópicos previos de manera prolongada propicia que la enfermedad evolucione tórpidamente hacia formas graves de úlcera corneal. Lo que ofrece una respuesta deficiente y prolongada a los esquemas convencionales de tratamiento, que en ocasiones llevan a una queratoplastia terapéutica-tectónica.

ABSTRACT Introduction: Keratoplasty has been the most used technique for the treatment of corneal alterations. Objective: To describe the clinical-epidemiological characteristics of therapeutic keratoplasty in patients with severe corneal ulcer. Method: A descriptive and cross-sectional observational study was carried out on 17 eyes of 16 patients operated on for therapeutic keratoplasty who presented severe corneal ulcer, admitted to the Ophthalmology service of the Hospital "Dr. Juan Bruno Zayas Alfonso" in Santiago de Cuba, in the period from January 2018 to December 2019. The variables studied were: age, gender, origin, occupation, predisposing factors, time of evolution prior to admission, previous topical treatment and causal germ. In the statistical analysis, the absolute frequency and the percentage were used for the qualitative variables, and for the quantitative ones, the mean and the standard deviation. Results: Male patients predominated, retired with more than 60 years. Non-surgical ocular trauma prevailed as a predisposing factor. Prior to admission, antibiotic eye drops were applied more frequently, and the average evolution time was 12.2 days. The most preponderant group of germs was bacteria. Conclusions: The link between the causal germ and the application of previous topical medications in a prolonged manner favors the torpid evolution of the disease towards severe forms of corneal ulcer. This evolution offers a poor and prolonged response to conventional treatment schemes, which sometimes lead to a therapeutic-tectonic keratoplasty.

RESUMO Introdução: A ceratoplastia tem sido a técnica mais utilizada para o tratamento das alterações corneanas. Objetivo: Descrever as características clínico-epidemiológicas da ceratoplastia terapêutica em pacientes com úlcera de córnea grave. Método: Estudo observacional descritivo e transversal em 17 olhos de 16 pacientes operados de ceratoplastia terapêutica que apresentavam úlcera de córnea grave, internados no serviço de Oftalmologia do Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" em Santiago de Cuba no período de janeiro de 2018 a dezembro de 2019. Foram estudadas as variáveis idade, sexo, procedência, ocupação, fatores predisponentes, tempo de evolução antes da admissão, tratamento tópico prévio e germe causal. Na análise estatística, utilizou-se a frequência absoluta e o percentual para as variáveis qualitativas e para as quantitativas, a média e o desvio padrão. Resultados: Predominou pacientes do sexo masculino, aposentados com mais de 60 anos. O trauma ocular não cirúrgico prevaleceu como fator predisponente. Antes da internação, colírios antibióticos foram aplicados com maior frequência e o tempo médio de evolução foi de 12,2 dias. O grupo de germes mais preponderante foi o de bactérias. Conclusões: A ligação entre o germe causal e a aplicação de medicações tópicas prévias de forma prolongada favorece a evolução entorpecida da doença para formas graves de úlcera de córnea. O que oferece uma resposta pobre e prolongada aos esquemas de tratamento convencionais, que por vezes conduzem a uma queratoplastia tectónica terapêutico.

Ozonoterapia como tratamiento coadyuvante en la úlcera corneal grave bacteriana / Ozone therapy as adjunctive treatment in severe bacterial corneal ulcer / Ozonoterapia como tratamento adjuvante em úlcera bacteriana da córnea grave

Introducción: La evolución espontánea o los casos mal tratados de la úlcera corneal conllevan el riesgo de extensión de la infección, con severa afectación visual e integridad estructural del ojo. Objetivo: Describir las características clínico-epidemiológicas de pacientes con úlcera corneal grave bacteriana tratada con ozonoterapia local coadyuvante al tratamiento protocolizado. Método: Se realizó un estudio observacional, descriptivo y transversal con 48 pacientes ingresados en el servicio de Oftalmología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso", de Santiago de Cuba, en el periodo de enero de 2017 a diciembre de 2019. Las variables del estudio fueron: edad, sexo, factores predisponentes, microorganismos, signos de mejoría clínica, resultados al tratamiento y complicaciones. Para la validación estadística se utilizó prueba Chi-cuadrado. Resultados: La edad promedio de los pacientes fue de 54,1 años, el 62,5 % eran hombres. Predominó el trauma ocular (63,3 %) en el sexo masculino y enfermedades oculares (44,4 %) en el femenino. La mejoría de los signos fue más representativa a los 14 días. Se logró resultados satisfactorios en el 100 % de los pacientes con microorganismos grampositivos. El 10,4 % presentó perforación corneal. Conclusiones: La ozonoterapia es una terapia válida como tratamiento en la úlcera corneal grave de etiología bacteriana y responde a la búsqueda de alternativas para pacientes con resistencia a los tratamientos antibacterianos que se ofertan en el cuadro básico de salud.

ABSTRACT Introduction: Spontaneous evolution or poorly treated cases of corneal ulcer carry the risk of extension of the infection, with severe visual impairment and damage to the structural integrity of the eye. Objective: To describe the clinical-epidemiological characteristics of patients with severe bacterial corneal ulcer treated with local ozone therapy as an adjunct to the standard protocol treatment. Method: An observational, descriptive and cross-sectional study was carried out on 48 patients admitted to the Ophthalmology service of the Hospital General Docente "Dr. Juan Bruno Zayas Alfonso", from Santiago de Cuba, in the period from January 2017 to December 2019. The study variables were: age, gender, predisposing factors, microorganisms, signs of clinical improvement, treatment results and complications. Chi-square test was used for statistical validation. Results: The average age of the patients was 54.1 years; 62.5% of them were men. Ocular trauma (63.3%) predominated in males, and ocular diseases (44.4%) in females. The improvement of the signs was more common after 14 days. Satisfactory results were achieved in 100% of patients with gram-positive organisms. 10.4% presented corneal perforation. Conclusions: Ozone therapy is valid as a treatment for severe corneal ulcer of bacterial etiology, and responds to the search for alternatives for patients with resistance to the antibacterial treatments that are offered in the basic health system.

RESUMO Introdução: A evolução espontânea ou casos mal tratados de úlcera de córnea trazem o risco de extensão da infecção, com comprometimento visual grave e integridade estrutural do olho. Objetivo: Descrever as características clínico-epidemiológicas de pacientes com úlcera bacteriana de córnea grave tratados com ozonioterapia local como coadjuvante ao tratamento protocolizado. Método: Foi realizado um estudo observacional, descritivo e transversal com 48 pacientes internados no serviço de Oftalmologia do Hospital General Docente "Dr. Juan Bruno Zayas Alfonso", de Santiago de Cuba, no período de janeiro de 2017 a dezembro de 2019. As variáveis do estudo foram: idade, sexo, fatores predisponentes, microrganismos, sinais de melhora clínica, resultados do tratamento e complicações. O teste do qui-quadrado foi usado para validação estatística. Resultados: A idade média dos pacientes foi de 54,1 anos, 62,5% eram homens. O trauma ocular (63,3%) predominou no sexo masculino e as doenças oculares (44,4%) no feminino. A melhoria da sinalização foi mais representativa aos 14 dias. Resultados satisfatórios foram alcançados em 100% dos pacientes com organismos gram-positivos. 10,4% apresentaram perfuração corneana. Conclusões: A ozonioterapia é uma terapia válida como tratamento para úlcera de córnea grave de etiologia bacteriana e responde à busca de alternativas para pacientes com resistência aos tratamentos antibacterianos que são oferecidos no quadro básico de saúde.

Trauma ocular en el servicio de Oftalmología del Hospital General Docente Dr. Agostinho Neto, 2014-2019 / Eye trauma in the ophthalmology consultation in the General Teaching Hospital Dr. Agostinho Neto in the period 2014-2019

RESUMEN * Introducción: En el Hospital General Docente "Dr. Agostinho Neto" se desconocen las características de los pacientes atendidos por trauma ocular. Objetivo: Caracterizar el trauma ocular en pacientes ingresados en el servicio de Oftalmología del citado hospital en el período de enero de 2014 a julio de 2019. Método: Se realizó un estudio descriptivo, retrospectivo y longitudinal del total de pacientes con este diagnóstico (n=49). Se estudiaron las variables: sexo, edad, procedencia, ocupación, tipo de trauma, diagnóstico y complicaciones, y modificaciones de la agudeza visual de acuerdo al tratamiento que aplicó. Resultados: El 79,0 % de los pacientes fueron hombres, tenían entre 19 y 40 años de edad (43,0 %), procedían de áreas rurales (57,0 %) y se dedicaban a labores agrícolas (45,0 %). El 76,0 % presentó un trauma ocular abierto, la herida corneal fue el más usual (55,1 %). El 95,9 % de los pacientes recibieron tratamiento quirúrgico y reparación de la herida el 83,6 %. Antes y después del tratamiento, el 47,0 % y el 41,0 % respectivamente de los pacientes presentaron agudeza visual y visión cuenta dedos a percepción luminosa. La catarata traumática fue la complicación más frecuente (33,0 %). Conclusiones: El trauma no es un problema de salud, pero sí limita la calidad de vida de los perjudicado al afectar la agudeza visual.

ABSTRACT * Introduction: The characteristics of the patients with eye trauma treated in the General Teaching Hospital Dr. Agostinho Neto remain mostly unknown. Objective: To characterize eye trauma in the patients in the ophthalmology consultation in the mentioned institution, in the stretch of time between January 2014 to July 2019. Method: A descriptive, retrospective and longitudinal study was carried out on the total amount of patients with the diagnosis (n=49). The different variables taken into account were: gender, age, place of origin, occupation, type of trauma, diagnosis and complications, and the modifications in visual acuity according to the treatment given. Results: 79.0 % of the patients were men, with ages ranging between 19 to 40 years old (43.0 %), from rural areas (57.0 %), and involved in agricultural works (45.0 %). 76.0 % were open eye traumas, being corneal wounds the most common one (55.1%). 95.9 % of the patients were surgically treated, and 83.6 % went through wound healing processes. Before and after the treatment, the 47.0 % and the 41.0 % of the patients, respectively, presented visual acuity and good 'counting fingers' and 'visual perception' tests results. Traumatic cataracts were the most common complication (33.0 %). Conclusions: eye traumas are not a significant health issue, but impacts directly in the life quality of the affected, damaging their visual acuity.

A prospective cohort study on the epidemiology of ocular trauma associated with closed-globe injuries in pediatric age group

Purpose: To study the epidemiology of mechanical ocular trauma and closed globe injury using the Birmingham Eye Trauma Terminology System in patients belonging to the pediatric age group. Methods: This work involved a prospective cohort study of all ocular trauma patients (pediatric age group) registered between 2002 and 2017 at the ocular trauma care center. The data were collected using the international ocular trauma society form through our online MIS data and exported to the Excel sheet. The statistical analyses including the univariate analysis and cross tabulation were carried out using SPSS 22 software. Results: Our cohort consisted of 12687 patients with mechanical ocular trauma. There were 7546 (59.4%) eyes with open globe ocular injuries and 5328 (41.9%) with closed globe injuries. Of all closed globe injury patients, 1010 (19.0%) belonged to the pediatric age group (0-18 years), including 690 males (68.3%) and 320 females (31.7%). The mean age of the patients was 10.2 ± 5.1 years. Of all closed globe injuries, 692 (68.5%) were closed globe contusion and 318 (31.5%) were lamellar laceration. Conclusion: Closed globe injury is an important in cause of vision loss in children (24% <1/60). The condition is more prevalent in males and >51.7% in children under 10 years of age. The treatment has significant impact on the visual outcome in patients belonging to the pediatric age group.

Atendimento às urgências oftalmológicas em unidade de pronto atendimento / Assistance to ophthalmic urgencies in emergency care unit

Objetivo: Descrever os atendimentos oftalmológicos realizados em uma unidade geral de pronto atendimento. Métodos: Estudo prospectivo, observacional e descritivo cuja coleta de dados foi realizada em prontuários de pacientes atendidos na unidade por queixas oftalmológicas no período entre julho e novembro de 2018. Resultados: Foram revisados 445 prontuários de pacientes oftalmológicos, representando 2,18% do número total de pacientes atendidos no período. Foram encontrados 182 (40,89%) pacientes com diagnóstico de conjuntivite, 139 (31,23%) de trauma ocular e 78 (17,52%) com outros diagnósticos. Dentre os pacientes com trauma ocular, 115 (82,73%) eram do sexo masculino e 42 resultaram de acidente de trabalho. Conclusões: Conclui-se que a maioria dos pacientes oftalmológicos foi atendida com diagnóstico de conjuntivite ou trauma ocular e parte desses não faziam uso de EPI no momento da ocorrência. Os resultados permitem inferir que os médicos plantonistas precisam ter noções sobre as doenças oftalmológicas prevalentes na unidade de pronto atendimento e que desponta a necessidade de se promover campanhas para a prevenção de acidentes de trabalho junto às empresas da região, acompanhadas de fiscalização, para reduzir o acometimento de pacientes com trauma ocular resultante da não observância das normas de proteção.

Objective: To describe the ophthalmologic services performed in a general emergency care unit. Methods: Prospective, observational and descriptive study whose data collection was performed on medical records of patients seen at the unit for eye complaints in the period between July and November 2018. Results: 445 medical records of ophthalmological patients were reviewed, representing 2,18% of the number total number of patients seen in the period. 182 (40.89%) patients were diagnosed with conjunctivitis, 139 (31.23%) with ocular trauma and 78 (17.52%) with other diagnoses. Among the patients with ocular trauma, 115 (82.73%) were male and 42 resulted from an occupational accident. Conclusions: Most ophthalmologic patients were treated with a diagnosis of conjunctivitis or ocular trauma and part of them did not use PPE at the moment of the accident. The results allow us to infer that physicians on duty need to have knowledge about the ophthalmological diseases prevalent in the emergency care unit and that there is a need to promote campaigns for the prevention of work accidents with companies in the region, accompanied by inspection, reducing the involvement of patients with eye trauma who were not obeying the rules of protection.

Extracción de cuerpo extraño penetrante corneal e intracamerular / Removal of a penetrating corneal and intracameral foreign body

RESUMEN Paciente de 56 años quien acudió a la consulta por disminución de la visión, dolor y enrojecimiento ocular izquierdo, con antecedentes patológicos personales de hipertensión arterial esencial y antecedentes patológicos oculares de trauma ocular con fragmento de madera al cortar leña hace 37 años. El cuerpo extraño penetró hasta la cámara anterior y permaneció intracorneal, ya que en aquel momento no pudo ser removido en su totalidad. Se describe la técnica quirúrgica empleada, sobre la cual la información revisada ha sido escasa referente a los procederes quirúrgicos de remoción de cuerpos extraños semejantes, por lo que la técnica descrita debe contribuir a enfrentar futuros casos similares(AU)

ABSTRACT A 56-year-old male patient attends consultation with left eye vision reduction, pain and redness. The patient has a history of essential hypertension and eye trauma caused by a wood splinter while chopping wood 37 years ago. The foreign body went in as far as the anterior chamber and remained intracorneal, since at that time it could not be totally removed. A description is provided of the surgical technique used. Scant information was found about surgical procedures to remove similar foreign bodies. Therefore, the technique herein described should be useful to treat analogous cases(AU)

Ocular trauma score como predictor de agudeza visual en pacientes con trauma ocular grave: predictor de pronóstico visual en urgencia oftalmológica / Ocular trauma score as a predictor of visual acuity in patients with severe ocular trauma: visual prognosis in ophthalmological urgency

El objetivo de este trabajo fue determinar la relación entre el pronóstico visual según el Ocular Trauma Score (OTS) y la agudeza visual (AV) a los 6 meses de ocurrido el trauma ocular, en pacientes atendidos en la Unidad de Trauma Ocular del Hospital del Salvador, Santiago de Chile. Se hizo uso de un estudio descriptivo, longitudinal, retrospectivo. Se accedió a los registros clínicos de pacientes atendidos por trauma ocular grave entre el 1 de enero de 2014 al 15 de marzo 2015. 145 pacientes conformaron una muestra de 153 ojos. Se estableció la relación entre OTS obtenido y la AV a 6 meses del trauma mediante el coeficiente de correlación de Spearman. De los ojos estudiados, el grupo mayor N=68 (44,4%) calificó para OTS 3 y el menor N=16 (10,5%) para OTS 1. Se presentaron cinco categorías de visión, en un tiempo inicial la mayoría de los casos presentaron AV de luz, mala proyección-cuenta dedos (n=89). Tras seis meses dicha distribución se desplazó hacia la categoría 20/40 - 20/20 (n=68). Se encontró una fuerte asociación (r=0,711 p=0,000) entre el OTS calculado y la AV luego de seis meses de seguimiento. El OTS demostró poseer un gran valor predictivo y es una herramienta aplicable en nuestro medio, los datos obtenidos indican que existe un mejor pronóstico visual que los obtenidos en otro estudio. Cabe destacar que es la primera instancia en que se evalúa la aplicación del OTS en Chile.

This work aimed to determine the relationship between the visual prognosis according to the Ocular Trauma Score (OTS) and visual acuity (AV) 6 months after the ocular trauma in patients treated at the Eye Trauma Unit from the Hospital del Salvador, in Santiago, Chile. A descriptive, longitudinal and retrospective study was performed. We accessed registers of clinical patients attended for severe eye trauma from 1 January 2014 to 15 March 2015. 145 patients constitute a sample of 153 eyes. A connection was established between the OTS obtained and the AV 6 months after the trauma via the Spearman correlation coefficient. From the eyes studied, the greatest group N=68 (44.4%) qualified for OTS 3 and the smallest N=16 (10.5%) for OTS 1. Five eye categories were presented, in the beginning, most of the cases presented visual acuity with bad projection ­ hand motion (n=89). After six months of distribution, it moved to the category 20/40 ­ 20/20 (n=68). A strong relation (r=0,711 p=0,000) was found between the estimated OTS and the AV after six months of tracking. The OTS proved to have great predictive valor and is an applicable tool in our area, the data obtained showed that there is a better visual prognosis than the obtained in other studies. It is worth noting that this is the first stage where the application of OTS is assessed in Chile.

Epidemiological profile of pediatric ocular trauma in a tertiary hospital of northern India / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Ocular trauma is one of the most common causes of acquired blindness in children. It measures about 8%-14% of total childhood injuries. This study aims to determine the epidemiological profile of ocular trauma in the pediatric age group attending a tertiary hospital in northern India.</p><p><b>METHODS</b>A retrospective study was conducted in our hospital between June 2014 to July 2015 and all the children aged 0-16 years presenting with ocular trauma in eye outpatient department and emergency were enrolled in the study. Various epidemiological parameters like age, sex distribution, duration of presentation, mode of injury, type of injury and final visual outcome were analyzed.</p><p><b>RESULTS</b>Of total 357 patients, 271 (76%) were below the age of 12 years; 41.1% of children with ocular trauma belonged to age group 2-6 years. The male to female ratio was 2.9:1. Out of total patients, 242 (67.8%) presented with closed globe injury. Among the closed globe injury, the history of fall was present in about 35% of children, followed by trauma while playing with bat/ball (15.7%) and finger nail trauma (13.2%). Among open globe injury, trauma with needle, knife, glass and pen were common causes. Home was the most common place of injury (47.8%), followed by streets (17.9%) and playground (14.9%).</p><p><b>CONCLUSION</b>Children are vulnerable to ocular trauma and need more supervision. Sharp objects like needles, knives, household chemicals like acids should be out of reach of children.</p>

Comparison of peripheral retinal degeneration in macular hole caused by high myopia and trauma / 眼科新进展

Objective To compare the occurrence of the peripheral retinal degeneration in macular hole due to high myopia (＞-6.00 D) and trauma.Methods Data of 106 patients (106 eyes) with macular hole undergoing vitrectomy operation were analyzed,and they were divided into two groups according to myopic refractive degree:group A (68 eyes of 68 patients with high myopia) and group B (38 eyes of 38 patients with trauma).The peripheral retinas of all patients were examined carefully through preoperative three-mirror contact lens test and intraoperative the vitrectomy surgery.Results There were 52 eyes with peripheral retinal degeneration in group A,accounting for 76.47％,while group B had 8 eyes with peripheral retinal degeneration,accounting for 21.05％ in group B.The occurrence rates of peripheral retinal degeneration between the two groups approached significant difference (x2 =30.48,P =0.000).Among 52 eyes with retinal degeneration in the retina of the group A,non-oppressed whitening degeneration presented in 42 eyes,and the detection rate was 61.76％,lattice degeneration was in 44 eyes,with the detection rate of 64.71％,cystic degeneration in 19 eyes,with the detection rate of 27.94％ and other types of degeneration in 15 eyes,with the detection rate of 22.06％.There were 8 eyes with retinal degeneration in the retina of the group B,and non-oppressed whitening degeneration presented in 6 eyes,with the detection rate of 15.79％,lattice degeneration was in 7 eyes,with the detection rate of 18.42％,cystic degeneration in 4 eyes,with the detection rate of 10.53％ and other types of degeneration in 2 eyes,with the detection rate of 5.26％.Conclusion The occurrence rate of peripheral retinal degeneration in traumatic patients is obvious lower than that in patients with high myopia.

Clinical profile of medicolegal cases presenting to the eye casualty in a tertiary care center in India.

Purpose: The purpose of this study was to analyze the clinical profile of medicolegal cases (MLCs) presenting to the eye casualty in a tertiary care hospital. Materials and Methods: Retrospective review of records. The cases were grouped according to the Ocular Trauma Classification Group classification system. Results: Out of 188 MLCs, 164 (87.2%) were male. Mean age (±standard deviation) was 31.6 (±12.7) years. Age ranged from 7 to 75 years. Twenty‑six (13.8%) patients had bilateral involvement. The fist was the most common mode of injury, which was seen in 109 (58%) cases. A total of 27 (14.3%) patients had associated extraocular injury. No evidence of ocular or orbital trauma (malingering) could be found in 13 (7%) patients. Mechanical trauma was present in 169 (90%) patients with injury to globe in 129 (69%) patients and injury to lid or orbit without damage to the globe in 40 (21%) patients. Chemical injury was observed in 6 (3%) patients. Closed globe injury (CGI) was seen in 116 eyes and open globe injury (OGI) was noted in 29 eyes. The most common type of injury, zone, pupil, and grade of injury in CGI were Type A or contusion (79%), Zone I (72%), Pupil B (absence of relative afferent pupillary defect) in 95%, and Grade A [visual acuity (VA) ≥20/40] in 68% of the eyes, respectively. The most common type of injury, zone, pupil, and grade of injury in OGI were Type B or penetrating (48%), Zone II (38%), Pupil B (59%), and Grade D (VA 4/200‑light perception) (42%), respectively. Conclusions: The most common form and mode of ocular injury in MLC were closed globe injury and fist, respectively. The most common type of injury in CGI and OGI was contusion and penetrating injury, respectively.

A West Malaysian study of pediatric ocular trauma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To survey ophthalmological outcomes of pediatric patients who presented during a five - year period with ocular trauma to a tertiary referral center in West Malaysia. METHODS: All consecutive patients presenting to the Accident and Emergency Department from Jan. 2009 to Dec. 2013 were identified. Patients were recruited as study subjects if they were less than 15y of age and had sustained ocular trauma. Follow - up patients were excluded. Data collected including the subjects'demographic data and past medical and ocular history. Ocular injury, treatment and progress details were also recorded. RESULTS: The prevalence of pediatric ocular trauma was 17. 6 / 100000 per year. Males represented 69. 5% of the 426 subjects recruited. Mean subject age was 6. 08 years [ standard deviation ( SD): 2. 24]. Domestic tools (19. 7%) and falls (19. 7%) represented the commonest causes of trauma. Most subjects (79. 9%) had presenting visual acuity (VA) of 6 / 12 or better. The anterior segment of the eye (93. 9%) was most commonly injured, and 22. 8% of subjects required surgery. Relative afferent pupillary defect was associated with closed globe injury (P = 0. 001) and poorer final VA (P = 0. 001). Final VA in most subjects (92. 7%) was 6 / 12 or better. CONCLUSION: Increased awareness is necessary for the prevention and early ophthalmological intervention of pediatric ocular trauma, to ensure optimum visual rehabilitation for these patients.

Paintball: juego de guerra, ¿Qué tan lesivo puede ser? / Paintball: war game how harmful can be?

Objetivo: Ilustrar las consecuencias oculares de pacientes que han sufrido trauma ocular con Paintball. Diseño: serie de casos. Materiales y Métodos: se realizó una revisión de las historias clínicas de pacientes tratados en el servicio de oftalmología del Hospital Militar Central que habían sido examinados por presentar trauma ocular secundario a lesiones por paintball. Se realizó seguimiento de los casos por 12 meses. Resultados: se evaluó la magnitud del trauma ocular secundario a paintball encontrándose muy baja recuperación de la agudeza visual y la necesidad de cirugía ocular en todos los pacientes Se determinó la severidad y extensión del daño ocular asociado a esta lesión.

Objective: to show the eye consequences of a group of patients who suffered eye trauma because of paintball. Design: case series. Materials and methods: through revision of medical records, information from patients treated at the ophthalmology area of the Hospital Militar Central, who presented a diagnosis of eye trauma caused by playing paintball, during 2011. We followed up the cases through 12 months of treatment. Results: We evaluated the magnitude of eye trauma produced by paintball, finding a very low final visual recovery and also the need for surgery in all patients. Determining the extent and severe eye damage caused by the trauma of paintball.

Clinical Observation on Different Administrations of Levofloxacin to Eyes Traumas during Perioperative Period for Preventing Infection / 浙江中医药大学学报

[Objective] To discuss the clinical effect of Levofloxacin in eye drop and oral taking on preventing infection for eyes traumas during perioperative period. [Method] Respectively select 126 cases of non-open eye trauma operation and 162 cases of open eye trauma operation, divide the non-open eye trauma patients into group A(Levofloxacin eye drop) 66 cases and group B(Levofloxacin injection in vein drop) 60 cases, compare both bacteria culture positive rates before administration and after operation;divide the open eye trauma patients into group C(Levofloxacin in eye drop and oral taking)80 cases and group D(Levofloxacin in vein drop) 82 cases, compare both positive rates of bacteria culture before and after the administration and operation.[Result] Comparing group A and group B with groups C and D, the positive rate before and after Levofloxacin administration, there ’s difference of statistical meaning, but without marked statistical meaning after operation. Side effects: the positive rate of bacteria culture was 56.25% before administration, and 10.13% after operation; for group D, they were 59.80% and 12.20% respectively, the difference had statistical meaning on Levofloxacin, but without difference of statistical meaning on positive rate. Purely using focal eye drop had no side effects on group A; the side effects of oral taking and focal administration on group C were much lower than groups B and D. [Conclusion] For eye trauma in perioperative period, the oral taking and eye drop of Levofloxacin have the same effects on infection prevention compared as vein drop, while the focal administration can reduce antibiotics usage and systemic administration, with little side effects, as wel as effectively prevent post-operation infection of eye trauma, worth clinical promotion and application.

Visual recovery and predictors of visual prognosis after managing traumatic cataracts in 555 patients.

Aim: The aim was to evaluate the visual recovery after managing traumatic cataracts and determine the predictors of a better visual prognosis. Materials and Methods: This was a prospective study. We enrolled patients with specific inclusion criteria, examined their eyes to review the comorbidities due to trauma, performed surgery for traumatic cataracts, and implanted lenses. The patients were reexamined 6 weeks postoperatively. We divided the cases of traumatic cataract into two groups, the “open globe” (Group 1) and “closed globe” (Group 2) groups, according to the ocular trauma based on the Birmingham Eye Trauma Terminology System (BETTS) and compared the determinants of visual acuity. Results: Our cohort of 555 eyes with traumatic cataracts included 394 eyes in Group 1 and 161 in Group 2. Six weeks postoperatively, the visual acuity in the operated eye was >20/60 in 193 (48%) and 49 (29%) eyes in Groups 1 and 2, respectively (P = 0.002, ANOVA). At follow-up, >20/60 vision was significantly higher in Group 1 than in Group 2 (OR = 1.61; 95% CI, 0.85–3.02). Overall 242 (43.5%) eyes gained a final visual acuity of >20/60. Conclusion: Open globe injury has a favorable prognosis for satisfactory (>20/60) visual recovery after the management of traumatic cataracts.

Predictive factors of visual outcome in open globe injuries in Thailand: a prospective study.

Background: Eye injuries, especially open globe injuries, cause visual morbidities and socioeconomic burden. It is an urgent task to require good database and stakeholder involvement for open globe injuries. Objectives: Investigate the epidemiology and predictive factors of visual outcome in open globe injuries in an industrial area in Thailand. Methods: Consecutive cases of in-patient open globe injuries in Mettapracharak Eye Centre between February 2009 and January 2010 were examined. Patients were interviewed at first visit and followed-up for six months. The Birmingham Eye Trauma Terminology was used to classify types of injuries. Demographic data, cost of treatment, length of stay, and predictive factors (initial visual acuity, presence of relative afferent pupillary defect, hyphema, vitreous hemorrhage, intraocular foreign bodies, retinal detachment, time-duration to surgery, and wound length) were assessed. Results: Fifty-two out of 60 eyes were included. Most (82.7%) of patients were men and average age was 34.1 years (range: 8-68 years). About half (51.9%) were graduated from primary school and 65.3% were laborers. Most patients had not used protective devices. The endophthalmitis rate was 13.5%, and panophthalmitis rate was 5.8%. The enucleation rate was 9.6%. The median length of stay was nine days. Poor initial visual acuity and intraocular foreign bodies were significant predictive factors (p<0.05). Conclusion: Open globe injuries caused visual morbidity especially in young adult male, laborers with low education. Initial visual acuity and intraocular foreign bodies were significant predictive factors.

Management and treatment of bizarre open globe trauma in three steps: a case report / 国际眼科杂志(Guoji Yanke Zazhi)

This is a case presentation of a very bizarre open globe trauma with anterior segment foreign body-fishing hook stuck in the cornea and iris. Complications due to this kind of eye trauma might be very hazardous and with serious impact on visual function. We are representing our approach and experience of three step management of this kind of eye injury: first-extract the foreign body, close and reconstruct the eyeball, second-fight inflammation, and third-restore the visual function by cataract surgery.

Traumatismo ocular infantil con afectación de la agudeza visual en pacientes del Hospital de Clínicas: frecuencia, manejo y resultado visual final / Child ocular trauma affecting visual acuity in patients of the Hospital de Clínicas: frequency, management and final visual result

El objetivo de este trabajo es determinar la frecuencia del traumatismo ocular infantil con afectación de la agudeza visual (AV), manejo de urgencia y relación entre la AV al momento de la consulta y luego de un mes de evolución. Se realizó un estudio observacional, descriptivo, con 318 pacientes menores de 16 años, de ambos sexos, que acudieron al servicio de Oftalmología del Hospital de Clínicas, entre setiembre de 2006 y julio de 2007. De los pacientes que consultaron por traumatismo ocular con afectación de la agudeza visual se analizaron datos demográficos, agente causante del trauma, circunstancia, lugar donde se produjo el accidente, tiempo de evolución, AV, tipo de trauma, zona afecta y tratamiento de urgencia. De los 318 niños que consultaron al departamento de urgencias del servicio durante el periodo de estudio, 101 (31,7%) lo hicieron por traumatismo ocular. De éstos, 55 (54,5%) presentó disminución de la agudeza visual. El trauma fue cerrado en el 85,5% de los pacientes y abierto en el 14,5%. Los principales agentes causantes del trauma fueron rama de plantas, palo, piedra, explosivos, alambre y varilla de hierro. La AV al mes de la primera consulta mejoró en el 83,5% de los casos, permaneció igual en el 14,5% y empeoró en el 2%. Existe una relación directa entre AV inicial y AV al mes de la primera consulta (p= 0,01), y una relación inversa entre el tiempo de evolución y la AV al mes (p= 0,013).El traumatismo ocular infantil es un motivo de consulta frecuente en los servicios de urgencia oftalmológica. La AV inicial y el tiempo de evolución constituyen factores pronósticos de la AV final en estos pacientes.

The objective of this work was to determine the frequency of child ocular trauma affecting visual acuity (VA), management of urgencies and relation between the VA at the time of the consultation and after one month of evolution. This was an observational descriptive study of 318 patients, girls and boys under 16 years who attended the Ophthalmology Service of the Hospital de Clínicas from September, 2006 to July, 2007. The following data of the patients that consulted for eye trauma affecting their visual acuity were analyzed: demographic data, causative agent of the trauma, circumstances, place of accident, time of evolution, VA, trauma type, affected zone and urgency treatment. A total of 318 children consulted the urgency department of the service and 101 (31.7%) of them consulted for eye trauma. Of these, 55 (54.5%) showed a decrease of the visual acuity. The trauma was closed in 85.5% patients and open in 14.5%. The main causative agents of trauma were tree branches, sticks, stones, explosives, wires and iron rods. After one month of consultation, VA improved in 83.5% of the cases, remains equal in 14.5% and worsened in 2%. There was a direct relation between the initial VA and the VA at one month (p = 0.01) and an inverse relation between time of evolution and the VA at one month (p = 0.013). The child eye traumatism is a frequent reason of consultation in the ophthalmic urgency services. The initial VA and the time of evolution are prognosis factors of the final VA of these patients.