A unique late-onset intraocular lens opacification 23 years after implantation: a clinical and laboratory case report.

We report an unusual, rare case of opacification of the hydrophilic acrylic intraocular lens (IOL) 23 years after the initial surgery with significant visual deterioration. Opacification of the hydrophilic acrylic IOL was primarily due to the formation of folds on the surface of the lens material, and less so due to calcium phosphate deposits. Calcification opacification can be attributed to recent events, as evidenced by deposits of dicalcium phosphate dihydrate (CaHPO42H2O) and octacalcium phosphate (Ca8H2(PO4)65H2O), both of which are transient calcium phosphate phases, converting hydrolytically to the thermodynamically most stable hydroxyapatite (Ca10(PO4)6(OH)2). To our knowledge, this case of hydrophilic acrylic IOL opacification is the only one that has been described so late, 23 years after cataract surgery.

Explantation of a sutureless scleral fixated Carlevale intraocular lens due to calcification: a clinical and laboratory report.

BACKGROUND: Hydrophilic intraocular lens opacification is a rare complication due to calcification. With current new surgical techniques, including lamellar endothelial keratoplasty and vitrectomies, this irreversible complication is becoming more common. In this case study, we present clinical and laboratory features of a case of Carlevale hydrophilic acrylic IOL calcification. CASE PRESENTATION: Observational case report of a single incident case. An 83-year-old man was referred to our ophthalmic department complaining of right eye vision blurring for six months. Slit-lamp biomicroscopy revealed IOL opacification. Deposits of calcium phosphate were found both on the IOL's surface and inside it, according to thorough investigation using optical, scanning electron microscopy (SEM), and energy-dispersive X-ray (EDX) spectrometry. CONCLUSIONS: To the best of our knowledge, this is the first case to describe the laboratory evidence of Carlevale hydrophilic IOL calcification, suggesting possible explanation mechanisms based on underlying pathology and surgical technique. It reminds us that these findings suggest that physicians should be aware of possible hydrophilic IOL calcification.

Immunohistochemical Profiles of LOXL-1, FBN1, TGF-ß1, and COX-2 in Pseudoexfoliation Syndrome.

PURPOSES: To (i) determine expression patterns of lysyl oxidase-like 1 (LOXL1), fibrillin-1 (FBN1), transforming growth factor beta-1 (TGF-ß1), and cyclooxygenase-2 (COX-2) in lens epithelium and anterior lens capsule in pseudoexfoliation (PEX) syndrome and (ii) delineate the roles of these proteins in the etiopathogenesis of PEX. MATERIALS AND METHODS: Study participants, all of whom had undergone cataract surgery, comprised 47 patients with and 27 patients without (controls) PEX syndrome. Immunohistochemistry on paraffin sections of lens capsule and lens epithelium was performed. RESULTS: Immunoexpression of LOXL1 and FBN1 on the outer surface of the lens capsule was significantly higher (p < 0.001), and nuclear immunopositivity for LOXL1 was more frequently observed (p = 0.017), in PEX patients compared with control patients. Cytoplasmic expression of LOXL1 and COX-2 was significantly lower (p = 0.015 and p = 0.042, respectively) in PEX patients compared with controls. TGF-ß1 exhibited diffuse immunostaining detected in all cell layers in PEX patients (p <0.001). Significant direct correlations of cytoplasmic LOXL1 with FBN1 and TGF-ß1, and of COX-2 with FBN1, TGF-ß1, and LOXL-1, were observed only in PEX patients. CONCLUSIONS: Results of our study provide valuable information vis-à-vis expression and localization of TGF-ß1, LOXL1, and FBN1, as well as their associations in the lens epithelium and lens capsule. These data not only advance our knowledge of the etiopathogenesis of PEX syndrome, but also include novel findings, for example, immunostaining patterns of TGF-ß1 in PEX syndrome. We suggest that COX-2 plays a role in the pathobiology of PEX syndrome and should be the subject of future investigations.

INTRAVITREAL RANIBIZUMAB AS AN ADJUNCTIVE TREATMENT FOR COATS DISEASE (6-YEAR FOLLOW-UP).

PURPOSE: To evaluate the effectiveness of intravitreal ranibizumab in combination with laser photocoagulation in the management of Coats disease. METHOD: Six intravitreal injections of 0.5 mg (0.05 mL) ranibizumab were performed, each 4 weeks apart. Correspondence to therapy was evaluated using visual acuity measurements and optical coherence tomography images. Six months after the initiation of treatment, laser photocoagulation was applied on the telangiectasias and on the surrounding ischemic areas, followed by a single intravitreal ranibizumab injection. Three months later, laser photocoagulation was repeated in purpose to prevent recurrence. RESULTS: In the sixth month, no improvement in visual acuity was recorded, as thick circinate hard exudates still remained in the submacular space. Nevertheless, retinal detachment had completely subsided, and fluorescein angiography showed a significant decrease of leakage from the telangiectatic vessels. At the 12-month follow-up visit, an impressive improvement was recorded, with total absorption of the submacular exudate and visual acuity being 20/30. At the 20-month follow-up visit, his visual acuity was 20/20 and the retina was flat with no signs of macular edema or exudates. At the 6-year follow-up visit, the patient was absolutely stable. DISCUSSION: Elevated vascular endothelial growth factor levels have been demonstrated in Coats disease. Anti-vascular endothelial growth factor agents assist to the decrease of vascular permeability of the capillary endothelial cells, thus increasing the efficiency of laser application.

Calcification of Hydrophilic Acrylic Intraocular Lenses With a Hydrophobic Surface: Laboratory Analysis of 6 Cases.

PURPOSE: To investigate the nature and characteristic features of deposits causing opacification of intraocular lenses (IOLs) based on the examination of clinical findings using scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDX) analysis. DESIGN: Retrospective, observational case series. METHODS: This is a multicenter study of 6 hydrophilic acrylic IOLs (Lentis LS-502-1; Oculentis GmbH, Berlin, Germany) with a hydrophobic surface that were explanted from 5 patients because of opacification. Three patients had an uncomplicated phacoemulsification. One patient underwent combined phacoemulsification and pars plana vitrectomy for retinal detachment and later silicone oil endotamponade owing to redetachment. The last patient had a pars plana vitrectomy and silicone oil instillation combined with phacoemulsification for tractive retinal detachment and diabetic retinopathy. The explanted lenses were submitted to our laboratory and were examined by SEM and EDX in order to identify the morphologic features and the composition of the deposits. RESULTS: SEM and EDX analyses confirmed the presence of calcific deposits in the interior of the opacified hydrophilic IOLs, with a pattern showing the formation of lumps on the surface. The lumps were due to subsurface formation of calcium phosphate crystalline deposits. The crystallite clusters seemed to diffuse from the IOL interior to the surface. CONCLUSIONS: We demonstrated the calcification pattern of the hydrophilic IOL (Lentis LS-502-1) with a hydrophobic surface. Although hydrophilic acrylic lenses have a hydrophobic surface, the development of calcification is a possible threat initiating from the hydrophilic subsurface of the IOLs.

Lack of association of the M129V polymorphism of the PRNP gene with pseudoexfoliation syndrome.

PURPOSE: In this study we aimed to evaluate the polymorphism at codon 129 (M129V) of the PRNP gene as a secondary risk factor for pseudoexfoliation syndrome (PEX). METHODS: Two hundred and seventy-five unrelated subjects, including 156 patients with PEX and 119 unrelated control subjects, were recruited from the University Hospital of Patras, Greece. All patients and controls were of Caucasian or European ancestry. The PRNP M129V (A/G) single-nucleotide polymorphism was genotyped by real-time polymerase chain reactions. Association of the polymorphism with PEX was assessed using the two-sided Pearson's chi-squared or Fisher's exact test. RESULT: No significant difference between patients and controls was observed in terms of frequencies of alleles and genotypes of the PRNP gene. CONCLUSION: Polymorphism at M129V of the PRNP gene was evaluated as a secondary risk factor for developing PEX. Our results suggest that this PRNP gene polymorphism is not associated with PEX.

Lysyl oxidase-like 1 polymorphisms in a southwestern Greek cataract population with pseudoexfoliation syndrome.

PURPOSE: The aim of this study was to determine the possible association of rs1048661 and rs3825942 single nucleotide polymorphisms (SNPs) in the lysyl oxidase-like 1 (LOXL1) gene of cataract patients from southwestern Greece with pseudoexfoliation (PEX) syndrome. PATIENTS AND METHODS: Ninety-three patients with PEX syndrome and 74 without PEX syndrome were recruited with the principal diagnosis being cataract. LOXL1 SNPs, rs1048661 and rs3825942, were genotyped by using polymerase chain reaction. RESULTS: The G allele of rs1048661 was found in 96.7% in the PEX group as compared to 80.5% of non-PEX alleles (P=19×10(-4); Odds ratio [OR] =5.37; 95% confidence interval [CI] =1.68-17.12). Similarly, the G allele of rs3825942 was found in 72.1% of the PEX group as compared to 41.8% of non-PEX alleles (P=4×10(-5); OR =3.78; 95% CI =1.98-7.23). The T and A allele frequencies of rs1048661 and rs3825942, respectively, were underrepresented in the PEX group patients as compared to non-PEX group. CONCLUSION: Our data confirm previously reported association between LOXL1 polymorphisms and PEX syndrome in a southwestern Greek population. A significant association was found for the G allele of rs1048661 and rs3825942 demonstrating that the GG haplotype is a high-risk factor for the development of PEX syndrome.

Fungal isolation from disinfectant solutions of contact lens storage cases among asymptomatic users.

OBJECTIVES: To investigate the incidence of fungal contamination of store disinfectant solutions contained in contact lens storage cases belonging to asymptomatic contact lens users. METHODS: Asymptomatic contact lens users were asked to bring their storage cases, lenses included, without having opened the lid of the cup after placing lenses inside. The following information was recorded: age, sex, type of refractive error, contact lens material, schedule of wear, and brand of disinfectant solution. Included subjects had to comply with lens handling, cleaning, and replacement instructions given by the manufacturer or their attending optometrist. One sample per cup of contact lens case was collected using a sterile syringe. Samples were cultured on proper media for 96 hr at 35°C. Fungi were identified to species level by standard methodology. RESULTS: A total of 216 samples were collected from 117 contact lens storage cases. All participants were using monthly disposable hydrogel lenses on a daily wear basis. Seven fungal species were isolated from 15 specimens (6.9%) collected from 12 storage cases (10.2%). These included one Fusarium solani, four Aspergillus niger, two Aspergillus fumigatus, five Candida parapsilosis, one Candida tropicalis, one Rhodotorula rubra, and one F. solani in combination with Candida guilliermondii. Disinfectant solutions containing hydrogen peroxide were found to be less effective than various alternative solutions in eliminating fungal species. CONCLUSIONS: The results of this study show that even when contact lens users report compliance for handling, cleaning, and replacement according to the manufacturer's instructions, the potential risk of contact lens-related fungal keratitis still remains.

Pseudoexfoliation syndrome and cardiovascular diseases.

Pseudoexfoliation (PEX) syndrome is a well-recognized late-onset disease caused by a generalized fibrillopathy. It is linked to a broad spectrum of ocular complications including glaucoma and perioperative problems during cataract surgery. Apart from the long-known intraocular manifestations, PEX deposits have been found in a variety of extraocular locations and they appear to represent a systemic process associated with increased cardiovascular and cerebrovascular morbidity. However, as published results are inconsistent, the clinical significance of the extraocular PEX deposits remains controversial. Identification of PEX deposits in the heart and the vessel wall, epidemiologic studies, as well as, similarities in pathogenetic mechanisms have led to the hypothesis of a possible relation between fibrillar material and cardiovascular disease. Recent studies suggest that PEX syndrome is frequently linked to impaired heart and blood vessels function. Systemic and ocular blood flow changes, altered parasympathetic vascular control and baroreflex sensitivity, increased vascular resistance and decreased blood flow velocity, arterial endothelial dysfunction, high levels of plasma homocysteine and arterial hypertension have all been demonstrated in PEX subjects. Common features in the pathogenesis of both atherosclerosis and PEX, like oxidative stress and inflammation and a possible higher frequency of abdominal aorta aneurysm in PEX patients, could imply that these grey-white deposits and cardiovascular disorders are related or reflect different manifestations of the same process.

Cavernous hemangioma of the optic disk.

PURPOSE: To report a case of an unusually large cavernous hemangioma of the optic disk. METHOD: Case report with funduscopic, fluorescein angiography, and magnetic resonance imaging correlations. A 20-year-old woman with no ocular or systemic history was diagnosed with cavernous hemangioma of the optic disk in a routine eye examination. RESULTS: Fundus examination revealed an extremely large cavernous hemangioma of the optic disk, almost 4.5 disk diameter. Fluorescein angiography showed delayed filling of the lesion with intravascular plasma-erythrocyte separation and no leakage. No systemic involvement was found. CONCLUSION: This case represents an atypical presentation of cavernous hemangioma of the optic disk, among the largest reported in the literature. After a 5-year follow up period, no change has been documented.

Experimental investigation on mechanism of hydrophilic acrylic intraocular lens calcification.

PURPOSE: To construct a model simulating intraocular lens (IOL) opacification attributable to the formation of calcium phosphate deposits and to investigate the kinetics of deposit formation. DESIGN: Prospective laboratory investigation. SETTING: Department of Ophthalmology, Medical School and Department of Chemical Engineering, Laboratory of Inorganic and Analytical Chemistry, University of Patras, Greece. STUDY POPULATION: Three hydrophilic acrylic IOLs (26% water content) were placed inside a 10-mL double-walled thermostated reactor simulating the anterior chamber. Simulated aqueous humor was injected continuously into the reactor using a pump with variable speed. OBSERVATION PROCEDURES: The observation of IOLs was carried out in situ daily by optical microscopy. Scanning electron microscopy and energy-dispersive radiographic spectroscopy were used for the identification of the morphologic features and the composition of the deposits. RESULTS: The lenses were removed and inspected 5, 9, and 12 months after the initiation of the experiment. Investigation showed deposits of calcium phosphate crystallites in the interior of opacified IOLs. However, these deposits were not observed on the surface of the IOLs. CONCLUSIONS: In agreement with earlier reports by our group and in the literature, IOL opacification is the result of calcification. It is suggested that the surface hydroxyl groups of the polyacrylic polymeric components of the IOLs are capable of inducing surface nucleation and crystal growth of calcium phosphates. However, most important is the finding that the calcification of IOLs is initiated from their interior through the development of sufficiently high local supersaturation, realized through the diffusion of calcium and phosphate ions.

Exfoliation syndrome related to sensorineural hearing loss.

BACKGROUND: To investigate the relationship between exfoliation syndrome and sensorineural hearing loss. METHODS: A prospective study was designed. Patients with evidence of ocular exfoliation syndrome (study group) and individuals without any clinical signs of exfoliation syndrome (control group) were selected. Cases and controls were chosen to have similar demographic characteristics. Study and control group subjects with a history of conditions affecting hearing function were excluded. Pure-tone audiometry was performed in all participants in both groups and hearing thresholds were measured at frequencies of 0.25, 0.5, 1, 2, 4 and 8 kHz (kilohertz) for each ear. RESULTS: A total of 69 subjects participated in the study. The study group included 47 subjects and the control group 22. There was no significant difference in mean age (P = 0.985) and gender (P = 0.378) between groups. Mean pure-tone hearing thresholds were significantly higher in study group at frequencies of 4 kHz (P = 0.004) and 8 kHz (P = 0.001), but not at frequencies of 0.25, 0.5, 1 and 2 kHz. The greatest difference in the comparison of mean hearing thresholds between study and control group was noted at 8 kHz. CONCLUSIONS: The above results are in accordance with previous studies and provide additional evidence of the association between exfoliation syndrome and sensorineural hearing loss at high frequencies. Particular effect was shown on the highest frequency of 8 kHz. These findings may support the systemic nature of exfoliation syndrome.

Parstatin suppresses ocular neovascularization and inflammation.

PURPOSE: Parstatin is a 41-mer peptide formed by proteolytic cleavage on activation of the PAR1 receptor. The authors recently showed that parstatin is a potent inhibitor of angiogenesis. The purpose of the present study was to evaluate the therapeutic effect of parstatin on ocular neovascularization. METHODS: Choroidal neovascularization was generated in mice using laser-induced rupture of Bruch's membrane and was assessed after 14 days after perfusion of FITC-dextran. Oxygen-induced retinal neovascularization was established in neonatal mice by exposing them to 75% O(2) at postnatal day (P)7 for 5 days and then placing them in room air for 5 days. Evaluation was performed on P17 after staining with anti-mouse PECAM-1. The effect of parstatin was tested after intravitreal administration. The effects of subconjunctival-injected parstatin on corneal neovascularization and inflammation in rats were assessed 7 days after chemical burn-induced corneal neovascularization. Retinal leukostasis in mice was assessed after perfusion with FITC-conjugated concanavalin A. RESULTS: Parstatin potently inhibited choroidal neovascularization with an IC(50) of approximately 3 µg and a maximum inhibition of 59% at 10 µg. Parstatin suppressed retinal neovascularization with maximum inhibition of 60% at 3 µg. Ten-microgram and 30-µg doses appeared to be toxic to the neonatal retina. Subconjunctival parstatin inhibited corneal neovascularization, with 200 µg the most effective dose (59% inhibition). In addition, parstatin significantly inhibited corneal inflammation and VEGF-induced retinal leukostasis. In all models tested, scrambled parstatin was without any significant effect. CONCLUSIONS: Parstatin is a potent antiangiogenic agent of ocular neovascularization and may have clinical potential in the treatment of angiogenesis-related ocular disorders.

Application of anodic stripping voltammetry for zinc, copper, and cadmium quantification in the aqueous humor: implications of pseudoexfoliation syndrome.

Anodic stripping voltammetric (ASV) procedure, using mercury film electrode, was optimized and applied to determine the concentrations of zinc, cadmium, and copper in the aqueous humor. Concentration levels as low as 1 ppb of the test metals was possible to be detected using short electrolysis times (120 s) and microquantities of aqueous humor (up to 35 µL). As a first application of the voltammetric analysis of trace metals in the aqueous humor, the role of the three selected trace elements in the pseudoexfoliation (PEX) syndrome was examined. Samples from aqueous humor were collected during cataract extraction from patients with and without PEX. The zinc and copper concentration levels in the aqueous humor did not show statistically significant difference in the study and control group. Cadmium was detected in a small number of samples, without however statistical differences between the two groups. ASV proved to be a highly precise and sensitive tool for the quantification of heavy metal ions in aqueous humor. Further studies may lead to useful conclusions for the role of zinc, copper, or cadmium in PEX syndrome.

Corneal-conjunctival squamous cell carcinoma.

PURPOSE: To report an extremely rare case of an extensive conjunctival-corneal invasive squamous cell carcinoma. METHODS: A healthy 68-year-old man referred to our department with a moderately elevated hyperemic nodular mass on his right ocular surface. The lesion was completely covering the corneal surface and involved the temporal limbus with bulbar conjunctiva. Surgical excision was performed with 2-mm tumor-free margins documented histologically and double-freeze cryotherapy was applied 360 degrees for inhibition of tumor recurrence. RESULTS: Histopathologic examination showed a moderately differentiated squamous cell carcinoma. The patient achieved a complete excision with no evidence of recurrence during the follow-up period of 12 months. CONCLUSIONS: This case points out the potential for a total covering of the cornea by squamous cell carcinoma. Wide surgical excision and double freeze-thaw cryotherapy may decrease the recurrence.

Opacification of hydrophilic acrylic intraocular lens attributable to calcification: investigation on mechanism.

PURPOSE: To identify the nature and to investigate the biochemical mechanisms leading to late opacification of implanted hydrophilic acrylic intraocular lenses (IOLs). DESIGN: Retrospective laboratory investigation. METHODS: setting: Department of Ophthalmology, Medical School, Department of Chemical Engineering, Laboratory of Inorganic and Analytical Chemistry, University of Patras and FORTH-ICEHT, Greece. study population: Thirty IOLs were explanted one to 12 years postimplantation attributable to gradual opacification of the lens material. observation procedures: Materials analysis was done using scanning electron microscopy (SEM) equipped with a microanalysis probe (EDS), confocal microscopy, x-ray diffraction (XRD), and Fourier transform infrared (FTIR) for the identification of the substances involved in the opacified lenses. RESULTS: SEM investigation showed plate-like as well as prismatic nanoparticle deposits of calcium phosphate crystallites on the surface and in the interior of opacified IOLs. The plate-like deposits exhibited morphology and particle size typical for octacalcium phosphate (OCP), while the respective characteristics of the prismatic nanocrystals were typical of hydroxyapatite (HAP). EDS analysis confirmed the chemical composition of the deposits. Aqueous humor analysis showed that the humor is supersaturated with respect to both OCP and HAP, favoring the formation of the thermodynamically more stable HAP, while the formation and kinetic stabilization of other transient phases is also very likely. In vitro experiments using polyacrylic materials confirmed the clinical findings. CONCLUSIONS: Hydrophilic acrylic IOLs' opacification may be attributed to the deposition of calcium phosphate crystallites. HAP is the predominant crystalline phase of these crystallites. Surface hydroxyl groups of the polyacrylic materials facilitate surface nucleation and growth.

The effect of nasal steroid administration on intraocular pressure.

The effect of systemic steroid administration on intraocular pressure (IOP) is well established. However less attention has been paid to the effect of steroids when administered in a nasal spray. We conducted a study to investigate a possible association between nasal steroids and elevated IOP in 54 patients who were being treated for allergic rhinitis. IOP was measured before the patients started therapy and thereafter every 5 days during that therapy. Follow-up ranged from 27 to 35 days (mean: 31). Statistical analysis revealed no significant elevation in IOP after nasal steroid administration. It seems that short-term administration of nasal steroids does not cause significant IOP elevation. Nevertheless, their long-term effects on this pressure should be investigated.

Structural alterations of the erythrocyte membrane proteins in diabetic retinopathy.

BACKGROUND: Several rheological disorders of the erythrocytes, such as increased aggregation and decreased deformability, have been observed in diabetes mellitus and have been implicated in the development of diabetic microangiopathy. Structural alterations of the erythrocyte membrane proteins caused by the diabetic process may be at the origin of those observations. In the present study, we searched for erythrocyte membrane protein alterations in diabetic retinopathy. METHODS: We examined peripheral blood samples from 40 type-2 diabetic patients with diabetic retinopathy of variable severity (19 males and 21 females, mean age 66.8 years, Group A) and we compared them with samples from 19 type-2 diabetic patients without diabetic retinopathy (13 males and six females, mean age 66.5 years, Group B) and 16 healthy volunteers (eight males and eight females, mean age 65.6 years, Group C). Erythrocyte membrane ghosts from all samples were subjected to SDS-PAGE, and the electrophoretic pattern of transmembrane and cytoskeletal proteins was analysed for each sample. The protein quantification of each electrophoretic band was accomplished through scanning densitometry. RESULTS: No significant deviations from normal electrophoresis were observed in Groups B and C, apart from an increase in band 8 in two samples from Group B (11%). In contrast, in 14 samples from Group A (35%) we detected increases in protein band 8 and/or membrane-bound haemoglobin along with a decrease in spectrin. Moreover, increased mobility of band 3, an aberrant high molecular weight (MW) (> 255 kDa) band and a low MW (42 kDa) band were evident in ten samples from Group A (25%). Glycophorins were altered in 46% of Group-A patients versus 38% of Group-B patients. Females and patients with long duration of diabetes presented more electrophoretic abnormalities. CONCLUSIONS: Structural alterations of the erythrocyte membrane proteins are shown for the first time in association with diabetic retinopathy. Their detection may serve as a blood marker for the development of diabetic microangiopathy. Further studies are needed to assess whether pharmaceutical intervention to the rheology of erythrocytes can prevent or alleviate microvascular diabetic complications.

Unusual case of acanthamoeba keratitis in a contact lens wearer.

PURPOSE: To present an atypical case of acanthamoeba keratitis in a soft contact lens wearer. METHODS: A case report of a 28-year-old female soft contact lens wearer with a 6-day history of redness and blurred vision in her right eye. Examination showed stromal keratitis that did not respond to therapy for herpes simplex virus. Four weeks later, the patient had increased stromal infiltration, an endothelial plaque, and a hypopyon. She did not complain of pain apart from mild discomfort. Corneal smears and anterior chamber tap were negative for bacteria, fungi, acanthamoeba, and herpes simplex virus, and the patient was prescribed fortified antibiotics. One week later, a large epithelial defect with a surrounding ring infiltrate was apparent. Corneal biopsy showed acanthamoeba. RESULTS: The acanthamoeba keratitis resolved with successful treatment. One year later, the patient had a residual visual deficit secondary to stromal scarring and her best-corrected visual acuity was 20/29. CONCLUSIONS: This case emphasizes the importance of considering acanthamoeba species in the differential diagnosis of keratitis, even without the classic symptom of severe pain. A high degree of suspicion with rapid and appropriate treatment may result in improved recovery of vision.

Ocular trauma in a Greek population: review of 899 cases resulting in hospitalization.

PURPOSE: To determine the annual hospitalization rate and risk factors of eye injuries requiring hospitalization in an area of Greece. METHODS: Retrospective case analysis of 899 consecutive patients with ocular injury admitted at the Department of Ophthalmology, University Hospital at Patras Medical School, Greece, over a 9-year period. RESULTS: The average annual rate of hospitalized ocular injuries was 71.0 eye injuries per 1000 admissions at the Department of Ophthalmology. The majority (80.2%) of patients were male. The average age was 35.0 years (range 6 months-98 years). Approximately half of all injuries occurred in persons younger than 29 years of age. Patients with Albanian ethnic background were at higher risk. The most common type of injury was closed-globe injury (49.5%) that affected more frequently the very young individuals (0-19 years) and persons older than 50 years of age. Open-globe injuries occurred most often in young adults, 20 to 39 years of age, and comprised over 35% of all eye injuries in this age group. Most injuries (32.8%) occurred at the workplace, most commonly during construction activities. Injuries at home approximated the work-related injuries (30.0%). A total of 398 (42.5%) eyes underwent surgical intervention on the eye globe, while 49 (12.3%) of them underwent multiple operations as part of their treatment. 18.2% of the eyes were blinded and 27.9% had significant visual acuity loss. An enucleation during the follow-up period was performed in 4 (1.0%) eyes. CONCLUSIONS: Trauma is an important cause of ocular morbidity in Greece. Risk factors include young age, male gender, Albanian ethnic background, and workplace. General safety precautions and behavior modification are indicated.