Panscleritis After Blunt Ocular Trauma in A Child with Epididymitis / 中国医学科学杂志(英文版)

We reported an 8-year-old boy with panscleritis in left eye and right epididymitis after falling on the ground. Etiologic diagnosis played a key role in this case. Systemic examinations ruled out systemic autoimmune diseases, tumors, and infections as the cause of scleritis and suggested that the disease was caused by a local delayed-type hypersensitivity (DTH) induced by ocular trauma and was non-infectious. Still, the right epididymitis was infectious. Both conditions were treated successfully using steroids and antibiotics, respectively. Thus, early etiologic diagnosis and reasonable treatment are crucial to prevent visual loss.

Edema de Berlín secundario a Traumatismo ocular cerrado / Berlin Edema secondary to closed eye trauma / Edema de Berlim secundário a trauma ocular fechado

INTRODUCCIÓN: el trauma ocular es una de las causas que difieren entre áreas urbanas de un país a otro y entre diferentes clases demográficas o socioeconómicas. OBJETIVO: Demostrar la evolución y características clínicas del edema de Berlín secundario a trauma ocular cerrado. MATERIALES Y MÉTODOS: se realizó un estudio de caso observacional en un paciente masculino de 11 años que presentó una AVMC 20/20 en OD y cuenta dedos 50 cm en OI posterior a trauma ocular cerrado contuso con objeto romo. Desde el inicio desarrolló una conmoción retiniana asociada a edema de Berlín en OI. Con seguimiento desde 11 de diciembre de 2019 al 27 de enero de 2020. Las variables fueron: agudeza visual mejor corregida, retinografía, tomografía de coherencia óptica de dominio espectral macular. RESULTADOS: se indicó metilprednisolona 500 mg endovenoso diario por 3 días; prednisona 30 mg oral disminuyendo gradualmente durante 10 días; acetato de prednisolona 1% tópico cada 2 horas, moxifloxacina 0,5% cada 6 horas, ciclopentolato 1% cada 8 horas. 7 semanas después, no hubo mejoría clínica a pesar de medicación, manteniéndose en observación médica con AVMC OD 20/20 y OI cuenta dedos 2 metros. DISCUSIÓN: edema de Berlín (commotio retinae) una afección común causada por una lesión contusa en el ojo, suele ser autolimitante y no existe un tratamiento como tal. CONCLUSIÓN: el trauma ocular cerrado contuso con compromiso retiniano puede causar daño macular como el edema de Berlín, como éste caso que puede condicionar el pronóstico visual a pesar de que mayormente es favorable.

INTRODUCTION: ocular trauma is one of the causes that differ between urban areas from one country to another and between different demographic or socioeconomic classes. OBJECTIVE: to demonstrate the evolution and clinical characteristics of Berlin edema secondary to closed ocular trauma. MATERIALS AND METHODS: an observational case study was conducted in an 11-year-old male patient who presented a 20/20 BCVA in RE and 50 cm finger count in LE after blunt ocular trauma with blunt object. From the beginning, she developed a retinal concussion associated with Berlin edema in LE. With follow-up from December 11, 2019 to January 27, 2020. Variables were included: best-corrected visual acuity, retinographies, and macular spectral domain optical coherence tomography. RESULTS: methylprednisolone 500 mg intravenous daily for 3 days was indicated; prednisone 30 mg oral gradually decreasing over 10 days; 1% prednisolone acetate topical every 2 hours, moxifloxacin 0.5% every 6 hours, cyclopentolate 1% every 8 hours. 7 weeks later, there was no clinical improvement despite medication, and he was kept under medical observation with BCVA RE 20/20 and LE with a 2-meter finger count. DISCUSSION: Berlin edema (commotio retinae), a common condition caused by a blunt injury to the eye, is usually self-limiting and there is no treatment as such. CONCLUSION: blunt ocular trauma with retinal involvement can cause macular damage such as Berlin edema, as in this case, which can condition the visual prognosis even though it is mostly favorable.

INTRODUÇÃO: o trauma ocular é uma das causas que difere entre áreas urbanas de um país para outro e entre diferentes classes demográficas ou socioeconômicas. OBJETIVO: demonstrar a evolução e as características clínicas do edema de Berlim secundário a trauma ocular fechado. MATERIAIS E MÉTODOS: foi realizado um estudo de caso observacional em um paciente do sexo masculino, 11 anos, que apresentou BCVA 20/20 em OD e contagem de dedos de 50 cm em OE após trauma ocular fechado contuso com objeto contuso. Desde o início, ela desenvolveu uma concussão retina associada ao edema de Berlim em LE. Com acompanhamento de 11 de dezembro de 2019 a 27 de janeiro de 2020. As variáveis foram: melhor acuidade visual corrigida, retinografias e tomografia de coerência óptica de domínio espectral macular. RESULTADOS: foi indicada metilprednisolona 500 mg intravenosa ao dia por 3 dias; prednisona 30 mg oral diminuindo gradualmente ao longo de 10 dias; Acetato de prednisolona 1% tópico a cada 2 horas, moxifloxacina 0,5% a cada 6 horas, ciclopentolato 1% a cada 8 horas. 7 semanas depois, não houve melhora clínica apesar da medicação, e ela foi mantida em observação médica com AVMC OD 20/20 e LE com uma contagem de 2 metros nos dedos. DISCUSSÃO: o edema de Berlim (commotio retinae), uma condição comum causada por uma lesão contusa no olho, geralmente é autolimitado e não há tratamento como tal. CONCLUSÃO: o trauma ocular fechado com envolvimento retiniano pode causar danos maculares como o edema de Berlim, como neste caso, que pode condicionar o prognóstico visual, embora seja na maioria favorável.

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.

Optic nerve avulsion associated with central retinal artery occlusion following rotational globe injury

Avulsion of the optic nerve head is a rare and severe complication of ocular blunt trauma. Herein, we describe a case of 16-year-old boy, who presented with a rare combination of optic nerve avulsion associated with central retinal artery occlusion, following blunt trauma with a leather ball. This report highlights the potential blinding complication following rotational injury.

A Case of Orbital Apex Syndrome with Central Retinal Artery and Vein Occlusion Following Trauma

PURPOSE: To report a case of orbital apex syndrome (OAS) combined with central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) following blunt trauma. CASE SUMMARY: A 4-year-old female visited the hospital following a traffic accident. She was admitted because of multiple fractures of the skull and pneumocephalus. On day 5, she was referred to us with decreased visual acuity in her right eye. Her initial visual acuity was hand motions in the right eye and 0.8 in the left eye. The right eye showed a dilated pupil, ptosis, and total ophthalmoplegia, and the left eye showed limited abduction. A fundus examination revealed multiple retinal hemorrhages, tortuous veins, and an edematous white retina with a cherry-red spot in the right eye. Brain magnetic resonance imaging revealed an entrapped right optic nerve because of bony fragments in the orbital apex. The patient was diagnosed with OAS accompanied by CRAO and CRVO in the right eye, and with traumatic abducens nerve palsy in the left eye. After 6 months, the visual acuity was hand motions, and the fundus examination showed absorbed retinal hemorrhages, pale discs, and general retinal thinning of the right eye. Ptosis of the right eye and extraocular muscle movement of both eyes were improved. CONCLUSIONS: Combined CRAO and CRVO following trauma is very rare and is even more rarely associated with OAS. It is important for clinicians to be aware of the potential for central retinal vessel occlusions and OAS in cases of blunt ocular trauma.

Clinical value of different detection methods in blunt ocular trauma / 国际眼科杂志(Guoji Yanke Zazhi)

Blunt ocular can cause persistent change of eye structure and function, the method of detection which is closely related to eye injury including B - can ultrasonography, UBM, OCT, FFA, scanning laser polarimetry, fundus autofluorescence, each examination with particular emphasis. This paper aims to review the advantages and disadvantages of different inspection methods in order to provide reference for clinical diagnosis and treatment of blunt ocular trauma.

Trauma ocular contuso y afecciones de vítreo-retina / Blunt ocular trauma and vitreous and retinal disorders

Se consultó la bibliografía actualizada para ofrecer una orientación práctica sobre el manejo de las afecciones vítreorretinales más frecuentes provocadas por los traumas oculares contusos. Estos se encuentran presentes en 31 % de los casos y presentan como complicación seria más frecuente el desprendimiento de retina en 44 %. Se explicó la importancia de la creación de un registro nacional de trauma como herramienta inicial para la prevención de esta enfermedad. Finalmente se expuso algunas consideraciones y un flujograma orientador para el manejo de esta urgencia.

Current papers were reviewed to provide practical managing guidelines in most frequent vitreous and retinal disorders infringed by blunt ocular trauma. They are present in 31 % of traumas, with retinal detachment in 44 % of cases as the most frequent serious complication. The importance of the creation of a national eye injury registry as an initial tool to prevent this disease was explained. Finally, some considerations and a guiding flowchart for the management of this visual problem were included.

A Case of Anterior Lens Capsule Rupture from Blunt Ocular Trauma

PURPOSE: To report a case of isolated anterior capsule rupture with cataract after blunt ocular trauma. CASE SUMMARY: A 38-year-old male complained of decreased visual acuity in the right eye after blunt ocular trauma 5 days earlier. The visual acuity was counting fingers at 30 cm in the right eye, and intraocular pressure, measured using an applanation tonometer, was 25 mm Hg. Slit lamp examination showed a white intumescent cataract with anterior lens capsule rupture and cortical lens material extruding into the anterior chamber. Under local anesthesia, removal of the cataract was approached via a clear corneal incision. After removal of the cataract using irrigation and aspiration, the intact posterior capsule was observed. IOL haptic was implanted in the sulcus, and IOL optic was implanted in the bag. Postoperatively, the BCVA improved in the right eye to 0.8 at 1 month, and the intraocular pressure, by the Goldmann applanation tonometer was 13 mm Hg at that time.

Functional and structural analysis of partial optic nerve avulsion due to blunt trauma: Case report.

Partial optic nerve avulsion (ONA) secondary to finger gouging is an uncommon but devastating injury. A 21-year-old man who had an acute vision loss after accidentally getting poked by himself in his right eye when he fell down during jogging is reported. The patient was diagnosed with partial ONA. Magnetic resonance imaging revealed intact optic nerve. Optical coherence tomography (OCT) revealed deep cavity at the inferior-temporal half of the optic disc. Retinal nerve fiber layer thickness was also thin at the inferior quadrant with circumpapillary OCT scan. Visual field test and electrophysiological tests showed functional abnormality compatible with optic nerve lesion. Diagnostic tools for anatomical and functional evaluation may reveal the course of this injury.

Clinical Characteristics of Traumatic Rhegmatogenous Retinal Detachment

PURPOSE: To analyze the clinical characteristics and factors affecting visual outcome after surgery in rhegmatogenous retinal detachment resulting from blunt trauma. METHODS: We retrospectively reviewed the medical records of 122 patients (122 eyes) who were diagnosed with rhegmatogenous retinal detachment after blunt trauma and who had been under regular observation for at least six months. RESULTS: The frequency of traumatic rhegmatogenous retinal detachment was 122 eyes out of 989 total eyes with rhegmatogenous retinal detachment (12.3%). The mean age was 36.3 years (7-66): 93 (76.2%) male, 29 (23.8%) female. The most common type of retinal break was a horseshoe-shaped retinal tear (31.1%), and the most common location was the superotemporal quadrant (32.8%) and on the retinal equator or anterior to the equator (90.2%). Patients older than 50 years had a shorter latent period from the traumatic event to the symptom presentation (p=0.028). Whether the retinal detachment involve the macula, the extent of detachment, the initial visual acuity and the time interval from symptom presentation to treatment influenced on the postoperative visual recovery. CONCLUSIONS: Traumatic rhegmatogenous retinal detachment had a favorable visual recovery in cases of early diagnosis. Therefore, detailed and frequent examinations of the retinal periphery after ocular trauma are important if vision is to be preserved. Older patients showed a tendency to advance into traumatic rhegmatogenous retinal detachment more rapidly after trauma than did younger patients. Therefore, elderly patients will require special intensive treatment following traumatic retinal detachment.

Clinical Characteristics of Traumatic Rhegmatogenous Retinal Detachment

PURPOSE: To analyze the clinical characteristics and factors affecting visual outcome after surgery in rhegmatogenous retinal detachment resulting from blunt trauma. METHODS: We retrospectively reviewed the medical records of 122 patients (122 eyes) who were diagnosed with rhegmatogenous retinal detachment after blunt trauma and who had been under regular observation for at least six months. RESULTS: The frequency of traumatic rhegmatogenous retinal detachment was 122 eyes out of 989 total eyes with rhegmatogenous retinal detachment (12.3%). The mean age was 36.3 years (7-66): 93 (76.2%) male, 29 (23.8%) female. The most common type of retinal break was a horseshoe-shaped retinal tear (31.1%), and the most common location was the superotemporal quadrant (32.8%) and on the retinal equator or anterior to the equator (90.2%). Patients older than 50 years had a shorter latent period from the traumatic event to the symptom presentation (p=0.028). Whether the retinal detachment involve the macula, the extent of detachment, the initial visual acuity and the time interval from symptom presentation to treatment influenced on the postoperative visual recovery. CONCLUSIONS: Traumatic rhegmatogenous retinal detachment had a favorable visual recovery in cases of early diagnosis. Therefore, detailed and frequent examinations of the retinal periphery after ocular trauma are important if vision is to be preserved. Older patients showed a tendency to advance into traumatic rhegmatogenous retinal detachment more rapidly after trauma than did younger patients. Therefore, elderly patients will require special intensive treatment following traumatic retinal detachment.

A Case of Posterior Capsule Rupture after Blunt Ocular Trauma in a Child

PURPOSE: To report a case of isolated posterior capsule rupture (PCR) with cataract after blunt ocular trauma in a child. METHODS: A 6-year-old female visited our institution complaining of blurred vision (best corrected visual acuity: counting fingers at 30 cm) in the left eye three months after blunt ocular trauma. Slitlamp examination showed the cataract and PCR with intact anterior capsule. Removal of the cataract was approached via a scleral tunnel incision. Anterior vitrectomy was performed and a foldable intraocular lens (IOL) was inserted in the sulcus. RESULTS: Visual acuity was improved to 0.7 two days after the surgery and further improved to 1.0 at two months. CONCLUSIONS: An isolated PCR with cataract is a rare complication of blunt ocular trauma. We present a case of PCR after blunt ocular injury as well as a surgical procedure to safely remove the cataract via an anterior approach and implantation of the IOL in the sulcus.

A case of isolated posterior capsule rupture and traumatic cataract caused by blunt ocular trauma

An isolated rupture of the posterior capsule that is caused by a blunt ocular trauma has been rarely reported and is usually detected incidentally during surgery for a complicated cataract. We found an isolated posterior capsule rupture on the third day after trauma in a 25-year-old man who was admitted for the treatment of traumatic hyphema and we performed a phacoemusification and anterior vitrectomy with PC-IOL, implantation because of the traumatic cataract which had progressed after the injury. The PC-IOL was implanted safely into the capsular bag without severe enlargement of the posterior capsular rupture. The break seems to function as a capsulotomy which provides a clear visual axis. We report this case with a review of the literatures.

A Case of Isolated Posterior Capsule Rupture Caused by Blunt Ocular Trauma

Isolated rupture of the posterior capsule caused by blunt ocular trauma is rarely reported and is usually detected incidentally during surgery for the associated cataract. We report a case of isolated posterior capsule rupture detected during cataract surgery in a 33-year-old man who had traumatic cataract. In this case, the ruptured posterior capsule had relatively large defect in size(5x5 mm)with thickened and fibrosed edge and vitreous opacity existed. The surgical management of this case consisted of phacoemulsification with PC-IOL implantation and pars plana vitrectomy. During surgery, although the posterior capsule rupture was large, further rupture of the capsule was prevented by the fibrosed edge which tightened the margin ofthe ruptured capsule, and so PC-IOL implantation could be possible securely.