Management on Complicated Ocular Trauma

AbstractOcular repeated air blast injuries occur from low overpressure blast wave exposure, which are often repeated and in quick succession. We have shown that caspase-2 caused the death of retinal ganglion cells (RGC) after blunt ocular trauma. Here, we investigated if caspase-2 also mediates RGC apoptosis in a mouse model of air blast induced indirect traumatic optic neuropathy (b-ITON). C57BL/6 mice were exposed to repeated blasts of overpressure air (3 × 2 × 15 psi) and intravitreal injections of siRNA against caspase-2 (siCASP2) or against a control enhanced green fluorescent protein (siEGFP) at either 5 h after the first 2 × 15 psi (“post-blast”) or 48 h before the first blast exposure (“pre-blast”) and repeated every 7 days. RGC counts were unaffected by the b-ITON or intravitreal injections, despite increased degenerating ON axons, even in siCASP2 “post-blast” injection groups. Degenerating ON axons remained at sham levels after b-ITON and intravitreal siCASP2 “pre-blast” injections, but with less degenerating axons in siCASP2 compared to siEGFP-treated eyes. Intravitreal injections “post-blast” caused greater vitreous inflammation, potentiated by siCASP2, with less in “pre-blast” injected eyes, which was abrogated by siCASP2. We conclude that intravitreal injection timing after ocular trauma induced variable retinal and ON pathology, undermining our candidate neuroprotective therapy, siCASP2.

Download Full-text

Gamma-Irradiated Cornea in Combat-related Ocular Trauma

Military Medicine ◽

10.1093/milmed/usaa479 ◽

2020 ◽

Author(s):

Brian M Davis ◽

Carson Clabeaux ◽

Anton Vlasov ◽

Paul Houghtaling

Keyword(s):

Ocular Trauma ◽

Cost Savings ◽

Corneal Tissue ◽

Significant Cost ◽

Visual Rehabilitation ◽

Military Health ◽

Corneal Injury ◽

Gamma Irradiated ◽

The Military ◽

Penetrating Ocular Trauma

ABSTRACT Corneal injury is a known risk for deployed troops worldwide. To the authors’ knowledge, there has been no reported use of gamma-irradiated corneas in the setting of severe corneal trauma. Our report highlights the case of a 36-year-old active duty solider who sustained bilateral penetrating ocular trauma from a nearby ordnance explosion. We propose that ocular surgeons should consider utilizing gamma-irradiated corneas in (1) a situation where the corneal tissue is so damaged that it would be challenging to accomplish an adequate repair while providing the opportunity for future visual rehabilitation and (2) remote and/or deployed environments where storage of fresh donor tissue is limited. The long shelf life of gamma-irradiated corneas reduces the need for specialized storage equipment and the need for continuous resupply, both potentially leading to significant cost savings for the Military Health System.

Download Full-text

Blunt ocular trauma: What is hidden behind?

Visual Journal of Emergency Medicine ◽

10.1016/j.visj.2021.100987 ◽

2021 ◽

Vol 22 ◽

pp. 100987

Author(s):

M.J. Vicente Altabás ◽

B. Arias-Peso ◽

M.A. Vicente Altabás

Keyword(s):

Ocular Trauma ◽

Blunt Ocular Trauma

Download Full-text

Comparison of Simulation-Based versus Cadaveric-Tissue-Based Ocular Trauma Training on Novice Ophthalmologists: Repair of Corneal Laceration Model

Journal of Academic Ophthalmology ◽

10.1055/s-0041-1725093 ◽

2021 ◽

Vol 13 (01) ◽

pp. e57-e65

Author(s):

Boonkit Purt ◽

Timothy Ducey ◽

Sean Sykes ◽

Joseph F. Pasternak ◽

Denise S. Ryan ◽

...

Keyword(s):

Primary Outcome ◽

Wound Closure ◽

Ocular Trauma ◽

Controlled Trial ◽

Preliminary Evaluation ◽

Skills Acquisition ◽

Visual Axis ◽

Significant Difference ◽

Skills Laboratory ◽

Corneal Laceration

Abstract Purpose The aim of this study was to evaluate whether the simulated tissue models may be used in place of animal-based model for corneal laceration repair for surgical skills acquisition. Design Prospective randomized controlled trial. Participants Seventy-nine military and civilian 2nd- and 3rd-year ophthalmology residents and 16 staff ophthalmologists participating in the Tri-Service Ocular Trauma Skills Laboratory at the Uniformed Services University (Bethesda, MD). Methods Resident ophthalmologists underwent preliminary evaluation of their ability to close a 5-mm linear, full-thickness corneal laceration involving the visual axis. They then were randomized to undergo 90 to 120 minutes of either simulator-based (SIM) or swine cadaveric-tissue-based (CADAVER) corneal laceration repair. The same evaluation was performed post training. On a more limited basis, the study was repeated for attending ophthalmologists to act as a pilot for future analysis and test efficacy for “refresher” training. Main Outcome Measures Successful wound closure with secondary outcomes of suture length, tension, depth, and orientation, as graded by attending ophthalmologists. Results No significant difference in CADAVER versus SIM groups in the primary outcome of watertight wound closure of the corneal laceration. CADAVER group performed better than SIM group for certain metrics (suture depth, p = 0.009; length, p = 0.003; and tension, p = 0.043) that are associated with poor wound closure and increased amount of induced corneal astigmatism. For attending ophthalmologists, six of the eight in each group (SIM and CADAVER) retained or improved their skills. Conclusions For resident ophthalmologists, SIM training is sufficient for achieving the primary outcome of watertight wound closure. However, CADAVER training is superior for wound metrics for the ideal closure. For attending ophthalmologists, SIM training may be useful for retention of skills.

Download Full-text