Eye injuries caused by shotgun and air-rifles treated at the University Eye Clinic in Belgrade 2000-2009.

INTRODUCTION: Eye injuries caused by shotgun buckshot or air-rifle bullets are not common but are very severe, causing blindness of the injured eye. OBJECTIVE: By comparison of different parameters, to determine which of these two types of injuries have more serious final effect on vision. METHODS: A retrospective comparative analysis of patients with shotgun and air-rifle injuries, treated in the period 2000-2009 at the University Eye Clinic in Belgrade was carried out, with patients being divided in two groups depending of the type of the weapon. Age of patients, occupation, days in the week and part of the day when the accidents happened, presence of the retained foreign body, as well as the visual acuity on admission and final visual outcome were reviewed and analyzed. RESULTS: There were 16 shotgun and 5 air-rifle injuries. Mean age of patients injured by shotgun was 45.5 +/- 11.9 years, while those injured by air-rifle bullets were only 15.0 +/- 1.0 years old. Shotgun accidents happened in hunters, on weekends, in the morning, while air-rifle accidents were typical for pupils, on working days, in the afternoon. Final visual acuity following buckshot injuries was: NLP in 6 (37.5%), less than 0.1 in 6 (37.5%) and normal (1.0) in 4 (25%) patients. Out of patients hit by air-rifle bullet, no light perception (NLP) was documented in 4 (80%) while visual acuity remained normal in one patient. CONCLUSION: All injuries by shotgun and air-rifle are very serious, ending in loss of vision in high percent of cases. Prevention is essential.

Pain during external dacryocystorhinostomy with local anesthesia.

BACKGROUND: External dacryocystorhinostomy (DCR) is often performed under local anesthesia (LA) without adequate knowledge of the pain experienced by the patient. MATERIAL/METHODS: We subdivided our surgical technique into stages easily understood by the patients (introducing cotton tipped applicators, performing parabulbar injection, creating the incision, bone cracking (opening the ostium), manipulating the nose, intubating, closing the wound, and packing with gauze). A total of 50 patients ranging in age from 31 to 83 years of age (63.64±9.64) underwent external DCR. Each patient was asked 30 minutes after surgery to indicate the intensity of pain experienced at each stage of the surgery and during intramuscular (i.m.) injection of an antibiotic using a visual analog scale (VAS). RESULTS: Analysis of the VAS-based pain scores indicated 3 statistically equal occurrences of pain coinciding with the opening of the ostium, and receiving both parabulbar anesthetic and i.m. antibiotic injections. CONCLUSIONS: The level of pain experienced during the most unpleasant stage of external DCR (ostium opening) was similar to the pain experienced from an i.m. injection. Patients can be informed that pain during external DCR with local anesthesia is comparable to receiving an i.m. gluteal injection.

[Development and treatment of cataract in myopic eye with phakic intraocular lens Fyodorov in the posterior chamber].

This is a case report of a female patient who, due to high myopia, had silicone phakic intraocular lens type Fyodorov with plate-haptics implanted in the posterior chamber (PC pIOLs). The anterior subcapsular cataract (ASC) resulted in significant reduction of visual acuity and, therefore, the patient, after 16 years of the first surgery, underwent another surgical intervention. She had the pIOLs explantation, phacoemulsification and implantation of the flexible intraocular lens (IL) in the capsular bag. Explantation of the pIOLs, cataract surgery by phacoemulsification and IOL implantation were carried out through the same clear corneal incision and the intraoperative course was uneventful. The visual acuity of the operated eye was equal to pre-cataract period.