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.

Ocular manifestations of intracranial germinomas: three cases report and literature review.

Intracranial germinomas are malignant neoplasms of gonadal origin, which have some features in terms of age, sex, and clinical manifestations. They mainly occur in children and adolescents. Patients with intracranial germinomas mainly manifest with hypothalamic pituitary axis dysfunction and/or compression syndromes. Visual disturbance is one of the most significant clinical presentations, which is mainly caused by tumor cell infiltration into the optic pathway. In this article, we present three cases of patient with intracranial germinoma to analyze the ocular manifestations. All the three patients presented with endocrine symptoms in the early stage and with visual disturbances (including decreased visual acuity and visual field defects) later. In general, germinoma is diagnosed by its characteristic radiological appearance, supported by tumor markers and/or stereotactic biopsy. However, decisive diagnoses were established when ocular manifestations were presented. A suspicion for germinoma should be considered, when young patients manifest visual disturbances accompanied by endocrine symptoms.

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.

Intraocular foreign bodies in china: clinical characteristics, prognostic factors, and visual outcomes in 1,421 eyes.

PURPOSE: To investigate epidemiologic and clinical characteristics, prognostic factors, and visual outcomes of posttraumatic intraocular foreign body (IOFB). DESIGN: Retrospective, consecutive case series. METHODS: Information from 1,421 eyes (1299 inpatients) with IOFB selected from all open-globe injury cases (4,968 eyes of 4,865 inpatients) in 15 tertiary hospitals in China over a 5-year period were collected from a standardized preformulated database of eye injuries. Factors affecting retinal lesions or detachment, development of endophthalmitis, and visual outcome were analyzed statistically. RESULTS: IOFBs represented 28.60% of all open-globe injuries. Of the 1,421 eyes, endophthalmitis developed in 232 (16.76%), and independent protective factors included primary repair within 24 hours (odds ratio [OR], 0.59; P = .006) and self-sealing wounds (OR, 0.69; P = .013). At discharge or follow-up, the enucleation rate was 7.53%, best-corrected visual acuity (VA) improved in 54.33%, and 4.85% had no light perception. Wound length of at least 3 mm and IOFB located in the posterior segment increased the risk of retinal lesion or detachment, and both (OR, 1.66; P < .001; OR, 4.04; P < .001) were significant negative predictors for visual outcome, along with wound larger than IOFB in largest length (OR, 2.38; P = .002) and endophthalmitis (OR, 2.01; P = .0003). Better initial VA (OR, 0.76; P < .001) was a protective factor for final VA. CONCLUSIONS: For IOFBs, primary wound closure by repair within 24 hours or self-sealing independently reduces the risk of endophthalmitis. Worse presenting VA, larger wounds, IOFB in posterior segment, wound larger than IOFB in largest length, and endophthalmitis predict worse visual outcome.

[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.

[Epidemiological characteristics of eye injury among soldiers in 15 military hospitals].

OBJECTIVE: To investigate and analyze the epidemiological characteristics of eye injury among military inpatients. METHODS: Data of eye injury among military inpatients from 15 military general hospitals during 2001 - 2005 were recorded and statistically analyzed. RESULTS: There were 716 military inpatients with eye injuries, taking up 7.41% of the whole ocular trauma inpatients in corresponding time period. Military inpatients with eye injuries were admitted more in spring and summer; with sex ratio as 46.73:1; mean age as (24.99 +/- 8.40) years and 82.27% in 17-29 years while 7.82% were binocular injuries. A certain proportion of the complication appeared after the myoporthosis operations. Mechanical and non-mechanical eye injuries took up 92.49% and 7.51% respectively. Sports (17.62%), explosion (11.92%) and fighting (11.40%) related factors were the main causes of injuries. 51.55% of the accidents took place during working or training processes and 30.31% was on military training sites. At discharge, 22 eyeballs were removed mainly due to open globe injuries, 9 eyes with no light perception but vision acuity equalled to or more than 0.5 in 62.16% of the patients. CONCLUSION: Of those eye injury inpatients, military training and construction for defense were the main causes related to occupational eye injuries among soldiers. Mutilation power of eye injury should not be ignored and epidemiological survey on military eye injuries need to be carried out more extensively.