Clinical, radiographic, and intraoperative risk factors for retinal detachment after open globe injury.

PURPOSE: Retinal detachment (RD) is a vision-threatening complication of open globe injuries (OGI). This study sought to assess clinical, radiographic, and intraoperative risk factors for RD after OGI. A secondary goal was to test the retinal detachment after open globe injury (RD-OGI) score. METHODS: Records of patients undergoing OGI repair at a single trauma center over 3 years were reviewed using a retrospective case series design. Eyes that were enucleated or lost to follow up within 30 days of OGI without evidence of RD were excluded. Potential risk factors for RD development were assessed by logistic regression or chi-square tests were appropriate and were entered into a multivariate logistic regression if significant on univariate analysis. Risk of RD for each eye was categorized by its RD-OGI score. RESULTS: Seventy-three eyes (72 patients) were included. In univariate analysis, afferent pupillary defect, worse visual acuity, posterior injury, vitreous hemorrhage, and posterior segment volume loss (PSVL) on CT were strong predictors of RD. In multivariate analysis, only PSVL on CT (adjusted OR 10.8, P = 0.025) maintained a statistically significant association with RD risk. At 1 year, 5% of low-risk eyes, 20% of moderate-risk eyes, and 67% of high-risk eyes developed RD. These rates were not significantly different from the RD-OGI derivation or validation cohorts (P = 0.90 and P = 0.67, respectively). CONCLUSION: PSVL on CT increases the risk of RD after OGI. The RD-OGI Score was a good prognostic tool for assessing RD risk after OGI in this population.

Intraocular mitomycin C use in the treatment and prophylaxis of proliferative vitreoretinopathy in severe traumatic retinal detachments.

PURPOSE: To evaluate the anatomic and visual outcomes of a new intraocular mitomycin c (MMC) application technique in the treatment of severe traumatic retinal detachment (RD) with advance proliferative vitreoretinopathy (PVR). METHODS: The records of 15 eyes of 14 patients who underwent vitreoretinal surgery and intraoperative MMC application were reviewed retrospectively. SURGICAL TECHNIQUE: After performing complicated vitreoretinal surgical procedures (Pars plana vitrectomy, PVR membrane stripping, large retinotomy/retinectomies and intraocular foreign body removal if found etc. . .) retina was attached with perfluorocarbon liquid (PFCL) and partial fluid-air exchange. Endolaser was performed. PFCL was removed to the posterior borders of retinochoroidal wounds, breaks or retinectomy sites. The remaining PFCL was enough to cover and prevent MMC contact with the posterior vital structures including optic disc, macula and underlying RPE and major vascular arcades. Ciliary epithelium and other anterior segment structures were protected from MMC contact with the use of air in the rest of the eye. Then, a 10 µg/mL concentrated MMC solution was carefully injected above the PFCL bubble until it covered PVR or potential areas of PVR development and removed after 60 s. Finally, the remaining PFCL was removed and all eyes were filled with silicone oil. The patients were followed at least 6 months after silicone oil removal. Visual and anatomic outcomes were determined during follow-up period. RESULTS: The mean follow-up time was 19.6 ± 6 months (range 12-27 months). About 100% retinal attachment was achieved with one vitreoretinal surgery during the follow-up period. PVR was not detected around the retinal breaks or retinotomy sites in any eye. Limited macular epiretinal membrane was detected in two eyes and subsequently peeled during silicone oil removal. Preoperative visual acuities were hand motions in seven eyes and light perception in eight eyes. Nine of 15 eyes had a visual acuity of ⩾0.1 during the follow-up period. The mean preoperative visual acuity was logMAR 2.16 ± 0.15 and postoperative visual acuity was 0.80 ± 0.50 (p = 0.001). There were no additional complications related to intraoperative MMC use during follow-up period. CONCLUSION: Temporary intraocular MMC use in vitreoretinal surgery yielded good anatomic and visual outcomes after the treatment of traumatic RDs with PVR or those with high risk of PVR development. Furthermore, MMC application appeared to prevent further PVR development after vitreoretinal surgery.

Traumatic Retinal Detachment in Patients with Self-Injurious Behavior: An International Multicenter Study.

PURPOSE: To describe the clinical characteristics, surgical outcomes, and management recommendations in patients with traumatic rhegmatogenous retinal detachment (RRD) resulting from self-injurious behavior (SIB). DESIGN: International, multicenter, retrospective, interventional case series. PARTICIPANTS: Patients with SIB from 23 centers with RRD in at least 1 eye. METHODS: Clinical histories, preoperative assessment, surgical details, postoperative management, behavioral intervention, and follow-up examination findings were reviewed. MAIN OUTCOME MEASURES: The rate of single-surgery anatomic success (SSAS) was the primary outcome. Other outcomes included new RRD in formerly attached eyes, final retinal reattachment, and final visual acuity. RESULTS: One hundred seven eyes with RRDs were included from 78 patients. Fifty-four percent of patients had bilateral RRD or phthisis bulbi in the fellow eye at final follow-up. The most common systemic diagnoses were autism spectrum disorder (35.9%) and trisomy 21 (21.8%) and the most common behavior was face hitting (74.4%). The average follow-up time was 3.3 ± 2.8 years, and surgical outcomes for operable eyes were restricted to patients with at least 3 months of follow-up (81 eyes). Primary initial surgeries were vitrectomy alone (33.3%), primary scleral buckle (SB; 26.9%), and vitrectomy with SB (39.7%), and 5 prophylactic SBs were placed. Twenty-three eyes (21.5%) with RRDs were inoperable. The SSAS was 23.1% without tamponade (37.2% if including silicone oil), and final reattachment was attained in 80% (36.3% without silicone oil tamponade). Funnel-configured RRD (P = 0.006) and the presence of grade C proliferative vitreoretinopathy (P = 0.002) correlated with re-detachment. The use of an SB predicted the final attachment rate during the initial surgery (P = 0.005) or at any surgery (P = 0.008. These associations held if restricting to 64 patients with ≥12 months followup. Anatomic reattachment correlated with better visual acuity (P < 0.001). CONCLUSIONS: RRD resulting from SIB poses therapeutic challenges because of limited patient cooperation, bilateral involvement, chronicity, and ongoing trauma in vulnerable and neglected patients. The surgical success rates were some of the lowest in the modern retinal detachment literature. The use of an SB may result in better outcomes, and visual function can be restored in some patients.

Clinical presentations and surgical outcomes of intraocular foreign body presenting to an ocular trauma unit.

OBJECTIVES: To describe, evaluate, and identify the characteristics, prognostic factors, and visual outcomes in patients with intraocular foreign body (IOFB) in a Latin American population. METHODS: A retrospective, observational case-series of patients with a diagnosis of IOFB. Variables analyzed included age, gender, initial and final best correct visual acuity (BCVA), ocular trauma score, intraocular pressure, mechanism of injury, material and number of IOFB, zone of injury, timing of primary repair and IOFB removal, complications, and follow up. RESULTS: Sixty-one patients with IOFB were identified of which 97% were male with a mean age of 37.9 years (SD 2.16). The most common IOFB location was intravitreal (43%). IOFBs were metallic in 78%, vegetal in 3%, and other materials in 11%. Primary repair and secondary IOFB removal were performed at a mean timepoint of 3 days and 5 days, respectively. Systemic and topical antibiotics were administered to all patients. The initial BCVA was 1.62 logMAR and the final was 0.6 logMAR, which was statistically significant (Pearson's chi-squared test, p value 0.01). No cases of endophthalmitis were seen. CONCLUSION: IOFB removal can be delayed when there are no signs of infection or evidence of retinal detachment, without an increased risk of endophthalmitis and a negative impact on visual outcomes. Use of topical and systemic antibiotics appear sufficient to prevent endophthalmitis in these cases.

On the Spatiotemporal Material Anisotropy of the Vitreous Body in Tension and Compression.

Although linked to several vitreoretinal pathologies including traumatic retinal tears, breaks, and symptomatic vitreomacular traction, the dynamic material behavior of the vitreous body in response to mechanical loads is not well understood. The purpose of this study was to evaluate spatiotemporal patterns of collagen fiber reorganization and vitreous deformation (strain) in response to tensile and compressive forces. Using thick slabs of bovine eyes we examined collagen fiber reorganization following tensile and compressive step-loading with quantitative polarized light imaging. Strains were measured from sparse marker arrays and temporal collagen behavior was estimated from creep compliance rheological tests. Results showed that under applied loads (1) collagen fibers became significantly more aligned at the vitreous base (near the pars plana and the ciliary body), (2) vitreous located directly behind the lens deformed significantly more than surrounding regions, and (3) changes in collagen fiber alignment occurred on a short (<5 s) timescale. Together these results show that, despite a homogeneous visual appearance, the vitreous body exhibits anisotropic material behavior in tension and compression. Spatiotemporal patterns of collagen rearrangement were consistent with epidemiological patterns of traumatic retinal damage and vitreoretinal topology. High strains in the vitreous corresponded with locations of lower collagen content that are prone to age-related degeneration. These data suggest that differential fiber alignment and mechanical deformation could contribute to the pathogenesis of these diseases. Computational models that incorporate these experimental data will help improve our understanding of the biomechanical mechanisms that contribute to the pathogenesis of traumatic retinal damage, vitreous degeneration, and vitreoretinal disease.

Successful Management in a Case of Traumatic Retinal Detachment due to Open Globe Injury Using Microincisional Vitrectomy.

BACKGROUND: Retinal detachment (RD) following ocular trauma often results in guarded visual prognosis and sometimes leads to loss of the eye. With the advent of microincisional vitrectomy surgery and the development of surgical techniques, the management of ocular trauma has been transformed. CASE PRESENTATION: A 34-year-old man sustained an open globe injury from fragmented glass at work. He received primary repair and another follow-up surgery 9 days later, including vitrectomy, silicone oil tamponade, and lensectomy for RD and traumatic cataract at another medical center. However, his retina was totally detached and completely curled up in a roll with choroid on display when he was seen by us 1 month later. He was managed with vigilant and patient peeling and unfolding of the retina using a 23-gauge forceps and silicone oil tamponade, and achieved anatomical success and preservation of his eye at 6-month follow-up. CONCLUSIONS: This report demonstrates that even in cases which appear to be hopeless at presentation, the surgeon's perseverance and surgical technique can salvage an eye that may otherwise be phthisical. It also encourages retinal surgeons to use microincisional vitrectomy to manage severe traumatic RD.

Traumatic retinal detachment--the difficulty and importance of correct diagnosis.

Accurate characterization of a retinal detachment as traumatic is often difficult, but is important because it may instigate a careful search for occult coexistent traumatic pathology, affect the prognosis and the treatment of both eyes, influence insurance coverage benefits and medical-legal determinations, and is essential for epidemiologic studies. We review the epidemiology and pathophysiology of traumatic retinal detachment, common obstacles to correct diagnosis, diagnostic guidelines, and outline categories of traumatic causal relationships. Because there is no generally accepted definition of traumatic retinal detachment, we offer a practical one. Categorization as traumatic should be based on the particular history and physical examination rather than epidemiologic criteria.

Desprendimiento de Retina Bilateral Asociado al Bungee Jumping: Reporte de Caso / Bilateral retinal detachment associate to bungee jumping: Case report

Objetivo: Describir el caso de un paciente joven con antecedente de miopía bilateral y degeneración en Lattice en el ojo izquierdo (OI), que desarrolló un desprendimiento de retina bilateral después de realizar una actividad de alto riesgo tipo bungee jumping. Diseño: Reporte de caso. Metodología: Reporte de caso retrospectivo mediante la recopilación de datos clínicos, estudios imagenológicos y valoraciones postoperatorias. Resultado: Recuperación de la agudeza visual posterior a tres procedimientos quirúrgicos de 20/400 en ojo derecho (OD) y de 20/30 en OI en el paciente con antecedente de desprendimiento de retina bilateral. Conclusión: El desprendimiento de retina traumático secundario a actividades de alto riesgo donde está implicado el movimiento de latigazo es poco común, sin embargo, la identificación temprana de patologías como la miopía y degeneración en lattice, en personas que van a realizar deportes extremos, debe considerarse. También es importante que las compañías que promocionan este tipo de actividades conozcan esta patología, ya que a pesar de ser infrecuente, puede llegar a desarrollarse.

Purpose: To describe the case of a young patient with a history of bilateral pathologic myopia and lattice degeneration in the left eye who developed bilateral retinal detachment after making a bungee jumping activity. Design: Case report. Methods: A descriptive, case report study type was performed by collecting clinical data, imaging studies and postoperative evaluations. Result: Subsequent recovery of visual acuity after three surgical procedures of 20/400 in right eye and 20/30 in the left eye in the case report patient with a history of bilateral retinal detachment. Conclusion: Traumatic retinal detachment secondary to high-risk activities where is involved the whipping motion is uncommon, however, early identifi cation of diseases as myopia and lattice degeneration in people who practice this extreme sports should be identifi ed. It is also important that companies promoting such activities acquire knowledge about it, taking into account, that despite it is a rare disease, it may develop.

Analysis of 50 cases of traumatic retinal detachment diagnosed by color Doppler ultrasound and two-dimensional ultrasound / 国际眼科杂志(Guoji Yanke Zazhi)

AlM:To evaluate the value of color Doppler ultrasound in the diagnosis of traumatic retinal detachment. METHODS: All 50 cases ( 56 eyes ) of suspicious traumatic retinal detachment from January to June in 2013 were enrolled in this study. All first received the two-dimensional ultrasound, then the color Doppler ultrasound, finally, these results were compared with the results of surgery. RESULTS: All 56 eyes were observed intravitreal abnormal spots by the two-dimensional ultrasound, and 39 eyes were observed color blood signal by the color Doppler ultrasound. Forty eyes were approved retinal detachment by surgery. CONCLUSlON: lt is better to display the intravitreal abnormal spots and color blood signal by the color Doppler ultrasound than by the two - dimensional ultrasound, so there is important clinical significance of the color Doppler ultrasound in the diagnosis of traumatic retinal detachment.

Clinical study on Hypotony following blunt ocular trauma.

AIM: To evaluate the incidence and risk factors of hypotony in patients with blunt ocular trauma. METHODS: The medical records of 145 patients with blunt ocular trauma were reviewed. Hypotony was defined as an average intraocular pressure (IOP) of 5mmHg or less for three times. RESULTS: Among these 145 patients, hypotony was noted in 10 (6.9%) patients. The rate of hypotony in patients with ciliochoroidal detachment was 66.7% (2 out of 3 eyes), and 5.6% (8 out of 142 eyes) in patients without ciliochoroidal detachment, the difference was statistically significant (P=0.003). The rate of hypotony in patients with traumatic retinal detachment was 18.5% (5 out of 27 eyes), and 4.2% (5 out of 118 eyes) in patients without traumatic retinal detachment, the difference was statistically significant (P=0.026). The rate of hypotony in the patients with anterior proliferative vitreoretinopathy was 42.9% (3 out of 7 eyes) and 5.1% (7 out of 138 eyes) in the patients without anterior proliferative vitreoretinopathy, the difference was statistically significant (P=0.002). CONCLUSION: Ocular hypotension is a complication of blunt ocular trauma. The risk factors include ciliochoroidal detachment, traumatic retinal detachment, and anterior proliferative vitreoretinopathy.

Bilateral Retinal Detachment in a 15-Year-Old Child with Tourette Syndrome

PURPOSE: To report a case of bilateral retinal detachment in a 15-year-old child with Tourette syndrome. CASE SUMMARY: A 15-year-old child treated for Tourette syndrome for 4 years presented with decreased visual acuity of several days in duration. The fundus of the right eye was not observed due to lens opacity and posterior synechiae. The B-scan of the right eye showed funnel-shaped densely reflective echoes connected to the optic disc, suggesting a total retinal detachment. Fundus examination of the left eye revealed an inverted retinal flap, which covered the posterior pole. During vitrectomy of the left eye, a ciliary body detachment anterior to a giant retinal tear extending 360 degrees was observed. In addition, an inverted flap covering 2 superior retinal quadrants was observed. A perfluorocarbon liquid was injected to unfold the tear's inverted flap, and silicone oil tamponade was performed. CONCLUSIONS: Self-induced and repeated periocular trauma induced by motor tics of Tourette syndrome can result in bilateral retinal detachment. Regular ophthalmic examinations are helpful for early detection of ocular complications including periocular trauma induced by motor tics of Tourette syndrome.

Binocular Retinal Detachment after Incomplete Diving

PURPOSE: To report a case of traumatic retinal detachment associated with ocular injury in incomplete diving. METHODS: A 15-year-old female complaining of floaters before the eyes was referred to our hospital. In both fundus, we found retinal holes in inferonasal quadrant. We investigated physical properties of retinal detachment associated with diving. RESULTS: When the human body falls down from 10 m height, the impact power is the same as the pressure exerted by 595 kg weight to the body for one second. And this power may cause retinal detachment. CONCLUSIONS: Today there are many sport activities and retinal injuries can occur by various mechanism. We report our clinical experience with retinal detachment associated with diving.