Terroristic sniper shot ocular injuries: military and police casualties: case series.

INTRODUCTION: Sniper shot ocular injuries (SSOI) are rare and result in poor ocular outcomes due to high energy transfer both to the eye and the adjacent brain. To our knowledge, no reports of such injuries in terms of outcomes have been previously described in the literature. The aim of this case series was to describe the treatment performed and ocular outcomes of such injuries. METHODS: Five cases of terroristic SSOIs referred to Gulhane Military Medical Academy Department of Ophthalmology between 22 July 2015 and 30 January 2017 were reviewed. Comparisons were made between the location and mechanism of injury, initial and final ocular signs, interventions and additional extraocular injuries. RESULTS: Two cases were of police officers and the remaining were Turkish military soldiers. All of our cases were injured in urban district by terrorist snipers hidden in apartments. Four individuals were injured in the right eye and the other was injured bilaterally. Initial visual acuities (VA) ranged from no light perception (NLP) to 0.0 with logMAR. Final VA raised to 0.0 in three patients whereas in two of NLP patients it remained the same. Mean Ocular Trauma Score was 2.2. Two eyes necessitated evisceration and the others underwent vitrectomy surgery. CONCLUSIONS: The prognosis of SSOI is unpredictable and is highly dependent on the trajectory and energy deposition. Primary evisceration or enucleation should be reserved to severely ruptured globe cases with no chance of globe-saving procedures. If the globe remains intact, retinal and vitreal damage should be repaired. Due to risk of associated intracranial injury, all patients should be referred for neurosurgical opinion.

Multicenter study of pars plana vitrectomy for optic disc pit maculopathy: MACPIT study.

PurposeTo evaluate surgical intervention with pars plana vitrectomy (PPV) for correction of optic disc pit maculopathy (ODP-M).Patients and methodsRetrospective chart review from 13 centres of 51 eyes of 50 patients with ODP-M who underwent PPV between 2002-2014. Anatomic and final best-corrected visual acuity (BCVA) outcomes were evaluated for all cases with different adjuvant techniques.ResultsThere were 23 males and 27 females with median age 25.5 (6-68) years. Preoperative median foveal thickness was 694.5 (331-1384) µm and improved to 252.5 (153-1405) µm. Median BCVA improved from 20/200 (20/20000 to 20/40) to 20/40 (20/2000 to 20/20) with 20/40 or better in 31 eyes. Complete retinal reattachment was achieved in 44 eyes (86.3%) at 7.1 (5.9) months. The good surgical outcomes were achieved in different adjuvant groups. Median follow-up was 24 (6 to 120) months.ConclusionsThese results confirm the long-term effectiveness of PPV for ODP-M. Prospective studies are needed to determine the effectiveness of any adjuvant technique in improving the success of PPV for ODP-M.

An overlap of Coats and Eales diseases or a Coats variant?

OBJECTIVE: To report an association between Coats and Eales diseases, an uncommon presentation. CASE: A 21-year-old male presented with gradual visual impairment of two years duration in his left eye. The slit-lamp examination of the affected eye revealed +2 vitreous cells. The other findings were peri-papillary fluid accumulation and extensive macular lipid exudate deposition. Small white vessels were coursing over the macula. The major veins were dilated and tortuous and massive sheathing of both arteries and veins was forming a common sheath. In the mid-periphery and periphery of the retina, discrete hard exudates, tiny superficial retinal hemorrhages and massive vascular sheathing were present. In the inferotemporal region, two intra-retinal macrocysts were located distal to the retinal vasculature. Fluorescein angiography (FA) of the left eye highlighted numerous aneurysmal dilatations throughout the posterior pole. Fluorescein angiography also showed para-foveal telangiectasia and tiny telangiectatic vessels on the optic disk that led to late staining of the macula and optic disk. Hyperfluorescent patches of deep choroiditis were present in the early phases. There was segmental but no diffuse staining of the retinal veins which showed massive sheathing on fundoscopy. In the periphery, segmental venous staining and choroidal leakage to a lesser extent were observed. In the infero-temporal quadrant, a clear-cut zone of non-perfusion and vascular abnormalities (micro-macro aneurysms, veno-venous shunts, venous beading) at the junction between the perfused and non-perfused zones were present. The findings were reminiscent of both Coats and Eales diseases. CONCLUSION: Though known as two distinct entities, both retinal pathologies may present in a single form.

Ocular injuries from improvised explosive devices.

PURPOSE: To document the characteristics, treatments, and anatomical and functional outcomes of patients with ocular trauma from improvised explosive devices (IEDs). METHODS: Retrospective review of ocular injuries caused by IEDs, admitted to our tertiary referral centre. RESULTS: In total, sixty-one eyes of the 39 patients with an average age of 24 years (range, 20-42 years) were included in the study. In total, 49 (80%) eyes of the patients had open-globe and 12 (20%) had closed-globe injury. In eyes with open-globe injury, intraocular foreign body (IOFB) injury was the most frequently encountered type of injury, observed in 76% of eyes. Evisceration or enucleation was required as a primary surgical intervention in 17 (28%) of the eyes. Twenty-two (36%) eyes had no light perception at presentation. Patients were followed up for an average of 6 months (range, 4-34 months). At the last follow-up, 26 (43%) of 61 eyes had no light perception. Postoperative proliferative vitreoretinopathy (PVR) developed in 12 (50%) of the 24 eyes that underwent vitreoretinal surgery, and four of these eyes became phthisical. There were no cases of endophthalmitis. The presence of open-globe injury and presenting visual acuity worse than 5/200 were significantly associated with poor visual outcome (<5/200, P<0.05). In eyes with open-globe injury, the presence of an IOFB was not associated with poor visual outcome (P>0.05). CONCLUSION: Ocular injuries from IEDs are highly associated with severe ocular damage requiring extensive surgical repair or evisceration/enucleation. Postoperative PVR is a common cause of poor anatomical and visual outcome.

Anatomical and functional outcomes in contusion injuries of posterior segment.

PURPOSE: To evaluate the clinical features, and anatomical and visual outcomes in patients with closed-globe contusion injury involving the posterior segment. METHODS: Retrospective review of posterior segment contusion injuries admitted to our tertiary referral center. RESULTS: In all, 115 patients (115 eyes) with complete data were reviewed. Surgery had been performed in 79 (69%) patients. The mean follow-up period was 6 months (range, 2-34 months). Retinal detachment, in 31% of eyes, was the most frequently encountered posterior segment pathology. The presence of retinal detachment was associated with poor visual outcome (<20/100), (P<0.001). Coexisting (five patients, 4%) and postoperative proliferative vitreoretinopathy (PVR) (two patients, 2%) was the main cause of failure in these cases. A significant positive correlation was obtained between initial and final visual acuity levels in both the medical treatment group and the surgical treatment group (P<0.05). The presenting visual acuity of <20/400 was associated with poor visual outcome (P<0.05 for both groups). Poor visual outcome in 13 patients with successful repair of retinal detachment was due to the macular lesions and the optic atrophy. CONCLUSION: Retinal detachment was the most frequently encountered posterior segment pathology subsequent to closed-globe contusion injuries. In addition to macular scarring and optic nerve damage, development of PVR has prognostic significance in these eyes.

Long-term results of Nd:YAG laser treatment for premacular subhyaloid haemorrhage owing to Valsalva retinopathy.

AIMS: Valsalva retinopathy produces sudden visual loss, which may be prolonged if untreated. Nd:YAG laser enables rapid diffusion of premacular subhyaloid haemorrhage. This study was performed to assess the long-term results and safety of Nd:YAG laser treatment in cases with Valsalva retinopathy. METHODS: Sixteen patients had Nd:YAG laser treatment to drain premacular haemorrhage. The follow-up period was 24 months. RESULTS: All eyes had marked clearing of haemorrhage and immediate improvement of vision following laser treatment. In 14 eyes visual acuity improved to 20/20 level at the end of the first week and the remaining two patients achieved 20/20 level within 1 month. No patient had evidence of retinal or choroidal damage. CONCLUSION: Nd:YAG laser treatment for Valsalva retinopathy is an effective, non-invasive, and safe procedure for patients with a premacular subhyaloid haemorrhage larger than 3 disc diameter and no longer than 3 weeks of duration.

Hypericin-enhanced argon laser photocoagulation for subfoveal choroidal neovascular membrane in age-related macular degeneration: a pilot study.

PURPOSE: To evaluate the efficacy and safety of hypericin-enhanced argon laser photocoagulation (H-ALP) in the treatment of subfoveal choroidal neovascular membrane (CNM) secondary to age-related macular degeneration (ARMD). METHODS: After preliminary studies for definition of parameters, argon-green laser was administered 4 hours after single dose of oral 1800 mg hypericin (Saint-John's wort tablets, 0.3%, 300 mg) with a subthreshold light fluence, 24 J/cm2 in 34 eyes (20 with subfoveal classical and 14 with subfoveal occult CNM). Additionally, histopathologic examination was done in two eyes destined for enucleation and exenteration. Maintenance therapy (one tablet, twice a day) was performed for the following 6 months. Anatomic (complete closure of CNM) and functional success (improvement of final visual acuity in three or more Snellen lines) were analyzed with minimum 6-month follow-ups. RESULTS: Histopathologic examinations revealed photothrombosed choriocapillaries together with minimal retinal pigment epithelial disruption in H-ALP exposed areas. One to four (mean 1.88+/-0.91) treatment sessions were applied in 6 to 29 months (mean 12.2+/-5.1 months) follow-up period. Twenty-three (67.6%) eyes had 12 months follow-up. Two eyes in each group had functional success (20% in subfoveal classical and 14.3% in subfoveal occult CNM), which had a minimum 12-month follow-up. Anatomic success was achieved in 16 of 20 (80%) eyes with subfoveal classical and 10 of 14 (71.4%) eyes with subfoveal occult CNM. Severe gastric irritation was noted in 1 (2.9%) and pigment epithelial rupture in 2 (5.9%) patients. CONCLUSIONS: H-ALP is a novel and low-cost treatment for subfoveal CNM secondary to ARMD. It seems its efficacy depends on the photodynamic and antiproliferative properties of hypericin. Comparative studies are required to apply this new technique in ophthalmic practice.

Hypericin-enhanced argon laser photocoagulation for subfoveal choroidal neovascular membrane in age-related macular degeneration: a pilot study.

PURPOSE: To evaluate the efficacy and safety of hypericin-enhanced argon laser photocoagulation (H-ALP) in the treatment of subfoveal choroidal neovascular membrane (CNM) secondary to age-related macular degeneration (ARMD). METHODS: After preliminary studies for definition of parameters, argon-green laser was administered 4 hours after single dose of oral 1800 mg hypericin (Saint-John's wort tablets, 0.3%, 300 mg) with a subthreshold light fluence, 24 J/cm2 in 34 eyes (20 with subfoveal classical and 14 with subfoveal occult CNM). Additionally, histopathologic examination was done in two eyes destined for enucleation and exenteration. Maintenance therapy (one tablet, twice a day) was performed for the following 6 months. Anatomic (complete closure of CNM) and functional success (improvement of final visual acuity in three or more Snellen lines) were analyzed with minimum 6-month follow-ups. RESULTS: Histopathologic examinations revealed photothrombosed choriocapillaries together with minimal retinal pigment epithelial disruption in H-ALP exposed areas. One to four (mean 1.88+/-0.91) treatment sessions were applied in 6 to 29 months (mean 12.2+/-5.1 months) follow-up period. Twenty-three (67.6%) eyes had 12 months follow-up. Two eyes in each group had functional success (20% in subfoveal classical and 14.3% in subfoveal occult CNM), which had a minimum 12-month follow-up. Anatomic success was achieved in 16 of 20 (80%) eyes with subfoveal classical and 10 of 14 (71.4%) eyes with subfoveal occult CNM. Severe gastric irritation was noted in 1 (2.9%) and pigment epithelial rupture in 2 (5.9%) patients. CONCLUSIONS: H-ALP is a novel and low-cost treatment for subfoveal CNM secondary to ARMD. It seems its efficacy depends on the photodynamic and antiproliferative properties of hypericin. Comparative studies are required to apply this new technique in ophthalmic practice. (Eur J Ophthalmol 2006; 16: 119-28).