A new classification for epidemiological study of mechanical eye injuries.

OBJECTIVE: Considering the difficulty in classifying some cases with eye trauma by Birmingham Eye Trauma Terminology (BETT) in our epidemiological study, we introduce a new classification for epidemiological study of mechanical eye injuries based on BETT. METHODS: A retrospective investigation was carried out in 31 hospitals from January 2005 to December 2010. All medical records of inpatients with eye injuries were reviewed. A total of 10 718 patients (11 227 eyes) were diagnosed as mechanical eye injuries. All mechanical eye injuries were tried to be classified using BETT. While some eye injuries were difficult to categorize. We recorded the injury type and case number. A new classification based on BETT was also used for the same project. RESULTS: Of 10 718 patients (11 227 eyes) with mechanical eye injuries, the following cases cannot be classified by BETT: 1 488 patients (1 559 eyes) with merely orbital or ocular adnexa injury, 1 961 (2 054) globe injuries associated with orbital or ocular adnexa injury, 271 (284) ocular surface foreign body (OSFB) or ocular wall foreign body (OWFB), 77 (89) contusion, 9 (11) lamellar laceration associated with OSFB or OWFB, 29 (30) rupture associated with OSFB, OWFB or intraocular foreign body and 60 (62) lace- ration associated with OSFB or OWFB. While according to our new classification, all eye injuries can be categorized without any difficulty. CONCLUSION: Difficulty in classifying some eye injuries in epidemiological study by BETT brings some trouble to our study, which can be solved by our new eye injury classification to some extent. It is hoped that other ophthalmologists present better ones to make the classification more perfect.

[Clinical characteristics of paraneoplastic retinopathy and optic neuropathy].

OBJECTIVE: To analyze the clinical characteristics of paraneoplastic retinopathy and optic neuropathy(PRON). METHODS: Case series study. Eight patients were enrolled from October 2006 to March 2012 visited in ophthalmology department, the People Liberation Army General Hospital. The patients were underwent a series of examinations, including fundus photography, visual electrophysiology, fundus fluorescein angiography, optic coherent tomography,fundus autofluorescent imaging, perimetry, ultrasonography, magnetic resonance imaging, spinal tap and cerebrospinal fluid test, paraneoplastic syndrome (PNS) antibody test. The patients were followed up in outpatient department and(or) by phone. The clinical manifestation,entity types, and treatment were analyzed. RESULTS: Of the eight patients, there were cancer associated retinopathy(CAR) 3 cases, bilateral diffuse uveal melanocytic proliferation (BDUMP) 2 cases and paraneoplastic optic neuropathy(PON) 3 cases. Five patients were detected the PNS antibodies and revealed three patients with positive results. As for the primary malignancy,four of the eight patients were lung carcinoma,others included invasive thymoma, kidney cancer, acute lymphocytic leukemia and cervical cancer, each for one case. All the patients complained vision blurring or progressive visual decrease. Other complaints included dark shadow in two patients, shimmering, dazzling, double vision and eye pain, each in one patient. One patient complained progressive decreased vision in both eyes prior to the diagnosis of lung cancer. Of the 16 eyes of the eight patients, there were six patients with no light perception vision, five from light perception to 0.05, and other five with no less than 0.4 vision, in the end of the follow up. Five patients were treated with steroid with unsatisfactory efficacy. CONCLUSIONS: Each entity of PRON has its own clinical characteristics. PRON especially BDUMP may be a pre-metastatic disease.

Laser in situ keratomileusis surgery is not safe for military personnel.

OBJECTIVE: To investigate the relationship between eye injury and laser in-situ keratomileusis (LASIK) surgery in military personnel. METHODS: This retrospective study collected the data from 27 evacuation hospitals of Chinese army. All medical records of eye injuries in military personnel admitted to the 27 hospitals between January 2006 and December 2010 were reviewed. Patients'detailed information was analyzed, including the injury time, place, type, cause, as well as examination, treatment and outcome. RESULTS: There were 72 eye-injured patients who had been treated by LASIK before. The incidence was rising year by year. Among them, 69 patients were diagnosed with mechanical ocular injury and 3 with non-mechanical ocular injury; 29 patients had traumatic flap-related complications and 21 patients need surgery. There was statistical difference when compared with those having no refractive surgery history. Visual acuity recovered well at discharge. CONCLUSION: There is a high risk of potential traumatic flap problems after LASIK and it is not recommended in army service.

Epidemiology of eye injuries sustained by military personnel in China.

OBJECTIVE: To investigate the epidemiological characteristics of eye injuries sustained by military personnel in Chinese army. METHODS: Eleven military evacuation hospitals located in different regions were selected for this study. We reviewed all the medical records of eye injuries sustained by military personnel between January 2005 and December 2009. Patients'information was collected. All data were put into database and analyzed statistically. RESULTS: Totally there were 415 inpatients with eye injuries (442 eyes) and their mean age was 24.40 years. Eye injury accounts for 13.51% of all eye diseases in this study. From 2006 to 2009, the number of eye injury increased gradually. Among them, 175 (42.17%) were injured in leisure time, and 145 (34.94%) in working time. Twenty-two (5.30%) patients had an eye surgery or history of eye disease before injury. In all, 246 patients (59.28%) were sent to evacuation hospital within 24 hours and 64 (56.64%) underwent surgeries in 24 hours after injury. There were 389 patients (93.73%) hospitalized for 1 time. Visual acuities of 187 eyes (42.31%) were grade 1 (larger than or equal to 20/40) after injury. When discharge, 349 eyes (78.96%) obtained a visual acuity of grade 1. CONCLUSION: Eye injury has a very frequent incidence in Chinese army and much more attention should be paid to prevent it.

The survey of the causes of eye injury of various services in China.

The cause of eye injury in various services may be different. Preventing the injury according to the cause would be more effective. We investigated 502 (549 eyes) cases of ocular injury in 21 military hospitals in China. Sports-related injury was the first cause of ocular injury (181/502, 36.1%), and it was more often seen in navy and air force personnel. A total of 69.1% of sports-related ocular injuries were caused by playing basketball and 18.8% by playing football. Work-related injury was the second cause (140/502). The highest ratio of work-related injury was in the surface warship force (31/67, 46.3%). The ratios of military training-related injury in the army and armed police were 21.4% and 21.3%, respectively, but it is only 4.4% in the navy. The analysis of training subjects showed that about 49.2% of injuries occured during skill training, such as parachuting and operating firearms, and 29.5% occurred during physical exercise or counter-acting exercises. We also found that the ratio of sports-related injury increased and military training-related injury decreased with the level of education.

[Analysis on characteristics of ocular trauma caused by military affairs in soldiers].

OBJECTIVE: To investigate and analyze the epidemiological, clinical and prognostic characteristics of ocular trauma in soldiers caused by military affairs and compared with those in trauma caused by non-military causes. METHODS: A retrospective study on eye injury cases of military inpatients in 15 military general hospitals from 2001 to 2005 was performed and the data of 716 cases (772 eyes) were statistically analyzed. RESULTS: Three hundred and sixty inpatients (398 eyes) caused by military affairs accounted for 50.28% (360/716) of all military inpatients with eye injuries. The difference between trauma cases caused by military affairs and non-military affairs included: higher male/female ratio, 99.45% (358/360), 96.38% (343/356) (χ(2) = 6.92, P = 0.009) and younger age, averaged (23.14 ± 5.23) yrs vs. (26.94 ± 10.45) yrs (t = -6.163, P < 0.001). The most frequent causes in trauma caused by military affairs were explosion (12.78%, 46/360) and construction of national defense (12.78%, 46/360); whereas sports in leisure accounted for 35.96% cases in trauma caused by non-military affairs. The other characters of trauma caused by military affairs included: more non-mechanical globe injuries, 12.06% (48/398), 2.67% (10/374) (χ(2) = 23.12, P < 0.001), less mechanical injuries, 81.91% (326/398), 90.64% (339/374) (χ(2) = 11.59, P = 0.001); a higher proportion of open globe injuries (especially intraocular foreign body); more full-thickness laceration of globe wall needed primary repair, 57.26% (71/124), 84.78% (39/46) (χ(2) = 11.13, P = 0.001); higher rates of enucleation/evisceration, 4.52% (18/398), 1.07% (4/374), (χ(2) = 7.10, P = 0.008), lower vision, 15.33% (61/398), 4.81% (18/374) (χ(2) = 22.07, P < 0.001) and more blindness, 25.38% (101/398), 10.42% (39/374) (χ(2) = 28.03, P < 0.001); less eyes with final vision ≥ 0.5, 28.02% (111/396), 35.66% (133/373) (χ(2) = 4.81, P = 0.028) and less eyes with increasing vision, 68.68% (272/398), 76.41% (285/374) (χ(2) = 5.35, P = 0.021). CONCLUSIONS: Eye injury caused by military affairs is more severe and poorer in prognosis and is the direct factor that causing the decrease of military power. Emphasis should be placed on the prevention and treatment of eye injuries caused by military affairs.

Development of sympathetic ophthalmia following globe injury.

BACKGROUND: Sympathetic ophthalmia (SO), a rare, bilateral, diffuse granulomatous uveitis, usually occurs after open globe injury or intraocular surgery. We sought to identify the risk factors for the development of SO after open globe injury and describe their demographic and clinical features and outcomes of treatments. METHODS: A retrospective study of inpatients with globe injury in 15 tertiary referral hospitals of China from January 2001 to December 2005 was conducted. The information of demography, nature and mechanism of injury, time and ways of treatments and outcomes was reviewed. Diagnosis of SO was made based on a history of ocular trauma or surgery and subsequent development of bilateral or contralateral uveitis consistent with SO. Any association between related parameters and development of SO was analyzed. RESULTS: Among 9103 patients (9776 eyes) of globe injury, SO occurred after open globe injury in 18 cases with an occurrence rate of 0.37%, vitrectomy of closed globe injury in 2 (0.37%) and perforation of burned eyes in another 2. For open globe injury, the median age ((36.72 +/- 13.59) years, P = 0.01) was higher in patients with SO; there were no significant effects of sexes, injury type, uvea proplaps, once or multi-intraocular surgery, once or multi-vitrectomy and endophthalmitis on incidence of SO; 0.70% endophthalmitis concurred with SO; 83.33% of SO occurred within 1 year after injury or last ocular surgery. SO developed in a fellow eye one week after evisceration of the perforating burned eye. Good final visual acuity was obtained in sympathizing eyes with prompt treatment. CONCLUSIONS: For open globe injuries, SO sufferers were relatively older and any injury type could induce SO with equal possibility. The initial open globe injury was more likely to be the trigger of SO than subsequent intraocular surgeries including vitrectomy. Prophylactic enucleation after injury is not recommended.

360-degree retinectomy for severe ocular rupture.

OBJECTIVE: To investigate the effect of 360-degree retinectomy for severe ocular rupture and evaluate the related factors associated with prognosis. METHODS: A retrospective analysis was performed on 28 consecutive patients, 18 men and 10 women, with severe ocular rupture admitted to the Chinese PLA General Hospital between January 1999 and January 2002. The patients' ages ranged from 16 to 58 years, mean 29.5 years. All operations were performed by the first author. All patients underwent standard 3-port pars plana vitrectomy with scleral encircling buckle, endophotocoagulation, and tamponaded with silicone oil. Lensectomy were performed on 15 eyes. 360-degree retinotomy and retinectomy were performed at anterior equator on 16 eyes, and posterior equator on 12 eyes. RESULTS: During operation, all patients were confirmed to have vitreous hemorrhage and retinal detachment, in which hemorrhagic ciliary body detachment was found in 9 eyes, suprachoroidal hemorrhage in 12 eyes, retinal twisting like flower stalk in 11 eyes, and retinal incarceration in 17 eyes. Postoperative follow-up was conducted in 26 cases, ranged from 6 months to 46 months. Retinal reattachment achieved in 20 eyes (76.9%), in which three patients' retina was reattached after revitrectomy. The silicone oil was removed at the fourth month in 8 eyes postoperatively. Corrected visual acuity of 0.02 or more was in 14 eyes (70.0%) among the 20 patients with reattached retina. Visual acuity of 0.05 or more was in 7 eyes (35.0å), and 0.1 or more was in 3 eyes. The best visual acuity was 0.3 in 1 eye. CONCLUSIONS: Retinectomy may improve the prognosis of severe ocular rupture and save the visual function of some patients.

Traumatic endophthalmitis following penetrating ocular injuries with retained intraocular foreign bodies.

OBJECTIVE: To evaluate the outcome and analyze the methods of surgical treatment of traumatic endophthalmitis following penetrating eye injuries with retained eye foreign bodies. METHODS: A total of 62 consecutive cases (58 men, 4 women) from January 1999 to December 2001 with IOFBs following penetrating eye injuries were retrospectively studied. The ages ranged from 8 to 46 years (mean 23 years). Sixty patients (63 eyes) underwent pars plana vitreotomy and 1 patient underwent external magnet extraction. The follow-up ranged from 3 to 36 months (mean 12.5 months). RESULTS: Ten eyes developed endophthalmitis, among which 7 (10.94%) were diagnosed preoperatively. The most frequently cultured organism was Staphylococcus epidermis (44.44%, 4/9). Postoperatively, retinal detachment due to vitreoretinal proliferation occurred in 5 patients with endophthalmitis and in 9 patients without endophthalmitis. All the retinal detachments were reattached with additional vitreoretinal surgery. Two eyes with endophthalmitis and two without endophthalmitis were eviscerated. CONCLUSIONS: Post-traumatic endophthalmitis with intraocular foreign bodies (IOFBs) deserves great attention because of its high incidence and poor prognosis. Vitrectomy is suggested for the treatment of IOFBs and its complications, and it should be performed as soon as possible. Routine intravenous administration of antibiotics combined with periocular injection and topical antibiotics postoperatively are recommended.