Open-Globe Injury With Intraocular Foreign Body

Purpose: To investigate characteristics of Open Globe Injuries (OGI) that presented with Intra-Ocular Foreign Body (IOFB), along with their long-term visual outcomes and complications. Methods: Retrospective interventional consecutive case series of OGIs with IOFBs that presented at Massachusetts Eye and Ear from 2010 to 2015. Data collected included time from injury to OGI repair, location of IOFB, retinal detachment (RD) rate, presenting and final visual acuity and subsequent surgeries. Results: Fifty-seven consecutive cases of OGIs with IOFBs were included. Mean follow-up was 28 months and median time from injury to OGI repair was 0 days. Overall, 38/57 (66.7%) eyes achieved final vision of 20/40 or better and 43/57 (75.4%) 20/150 or better. Thirty-three cases had IOFBs in the anterior segment only, 24 cases had posterior segment involvement. Thirty percent of cases (17/57) were complicated by an RD, 58.3% (14/24) in the posterior versus 9.1% (3/33) in the anterior IOFB group ( P = .01). There were no cases of endophthalmitis. Posterior IOFB and higher zone of injury were risk factors for RD both at presentation (both P < .001) and post-primary repair (both P < .001). Posterior IOFB was associated with higher vitrectomy rates both at presentation ( P < .001) and post-primary repair ( P = .002) and worse long-term visual outcome ( P = .01). Conclusions: OGIs with IOFB involving the posterior segment are associated with higher complication and re-operation rates and worse visual prognosis compared to those involving the anterior segment only.

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Safety and efficacy of posterior iris claw intraocular lens fixation in aphakic patients

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v16i2.368 ◽

2018 ◽

Vol 16 (2) ◽

pp. 124-133

Author(s):

Rosemary Tomy ◽

Rajkumar Maheshwari ◽

Ansa Parveen Kunhu Muhammed ◽

Venkataramana Kalikivayi ◽

Sajeev Cherian Jacob

Keyword(s):

Intraocular Lens ◽

Anterior Segment ◽

Case Series ◽

Visual Outcome ◽

Applanation Tonometry ◽

Long Term Results ◽

Retrospective Case ◽

Case Series Study ◽

Wide Range

Purpose: To assess the indications and visual outcome of eyes undergoing posterior iris fixated intraocular lens (IFIOL) implantation for aphakia, to identify reasons for poor visual outcome, and report occurrence of complications. Methods: In this retrospective case series study, all cases of posterior IFIOL fixation performed over a 30-month period were identified retrospectively. Preoperative and postoperative evaluations comprised objective and subjective refraction, best corrected visual acuity (BCVA), slit lamp biomicroscopy, applanation tonometry, and dilated fundus examination. Results: Fifty-six eyes of 56 patients were analyzed. Mean age was 60.55 ± 17.2 years. The most common indication for IFIOL implantation was surgical aphakia following complicated cataract surgery (n = 33; 58.9%) followed by trauma (n = 10; 17.9%), dropped nucleus/IOL during primary surgery (n = 6; 10.7%), and subluxated/dislocated lens-induced glaucomas (n = 5; 8.9%). BCVA better than or equal to their preoperative BCVA was achieved in 96.43% patients. The surgical aphakia and paediatric/adolescent groups had the best visual results while the dropped nucleus/IOL group and subluxated lens-induced glaucoma groups fared poorly. On the long-term follow-up visit, the most common complication noted was pigment dusting on the corneal endothelium (65.7%). Conclusion: The long-term results suggest that posterior IFIOL implantation is a safe and effective method for correction of aphakia and can be used for a wide range of indications in eyes without adequate capsule support. It may be considered an easier and faster alternative with minimal manipulation to anterior segment structures in paediatric and post-traumatic aphakic eyes.

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Transscleral Fixation of Black Diaphragm Intraocular Lens in Complete Aniridia and Aphakia Due to Posttraumatic Eye Rupture: A Pilot Study

Journal of Clinical Medicine ◽

10.3390/jcm8010046 ◽

2019 ◽

Vol 8 (1) ◽

pp. 46

Author(s):

Tomasz Chorągiewicz ◽

Katarzyna Nowomiejska ◽

Dariusz Haszcz ◽

Dominika Nowakowska ◽

Teresio Avitabile ◽

...

Keyword(s):

Intraocular Lens ◽

Anterior Segment ◽

Case Series ◽

Functional Restoration ◽

Long Term Outcomes ◽

Ahmed Valve ◽

Post Traumatic ◽

Valve Implantation

Introduction: To assess long-term outcomes of implantation of black diaphragm intraocular lens (BD IOL) in post-traumatic aniridia and aphakia due to eye rupture. Methods: This is a retrospective consecutive case series of 14 eyes with post-traumatic complete aniridia and aphakia treated with scleral fixation BD IOL. Measurements included ophthalmological comorbidities, best corrected visual acuity (BCVA), complications, and postoperative interventions. The average postoperative follow-up period was 36 months. Results: BCVA improved in 6 cases, was stable in 6 cases and worsened in 2 cases. The lens was well centered in 13 cases. Glaucoma was diagnosed in six cases developed, and three of them required Ahmed valve implantation. One lens developed opacity. The cornea was decompensated in 6 cases, while two of them required penetrating keratoplasty. Conclusion: Implantation of BD IOL in eyes with severely traumatized eyes enables reconstruction of the anterior segment and some functional restoration, although many complications may arise during the longitudinal follow-up.

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25-Gauge Vitrectomy in Open Eye Injury with Retained Foreign Body

Journal of Ophthalmology ◽

10.1155/2017/3161680 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

G. Sborgia ◽

N. Recchimurzo ◽

A. Niro ◽

L. Sborgia ◽

A. Sborgia ◽

...

Keyword(s):

Visual Acuity ◽

Foreign Body ◽

Clinical Status ◽

Case Series ◽

Eye Injury ◽

Retained Foreign Body ◽

Open Globe ◽

Open Globe Injuries ◽

25 Gauge Vitrectomy

Purpose. Ocular trauma with retained foreign body is an important cause of visual impairment in working-age population. Clinical status impacts on the timing and planning of surgery. In the last year small gauge vitrectomy has become safer and more efficient, extending the range of pathologies successfully treated.Aims. To evaluate the safety and outcomes in patients with open eye injury with retained foreign body that underwent early 25-gauge vitrectomy.Methods. In this retrospective, noncomparative, interventional case series, we performed 25-gauge vitrectomy on 10 patients affected by open globe injuries with retained foreign body, over 3 years. We analyzed age, wound site, foreign body characteristics, ocular lesions correlated, relative afferent pupillary defect, visual acuity, and intraocular pressure. Follow-up evaluations were performed at 1, 3, and 6 months. According to the clinical status we performed other procedures to manage ocular correlated lesions.Results. The median age of patients was 37 years. The foreign body median size was 3.5 mm (size range, 1 to 10 mm). 25-gauge vitrectomy was performed within 12 hours of trauma. Foreign body removal occurred via a clear corneal or scleral tunnel incision or linear pars plana scleral access. Visual acuity improved in all patients. Endophthalmitis was never reported. Only two cases reported postoperative ocular hypertension resolved within the follow-up. Retinal detachment recurred in one case only.Conclusions. 25-gauge vitrectomy could be considered as early approach to manage open globe injuries with a retained posterior segment foreign body in selected cases with good outcomes and low complication rate.

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Clinical Features and Surgical Outcomes of Posterior Segment Intraocular Foreign Bodies in Children in East China

Journal of Ophthalmology ◽

10.1155/2018/5861043 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Ting Zhang ◽

Hong Zhuang ◽

Keyan Wang ◽

Gezhi Xu

Keyword(s):

Clinical Features ◽

Care Center ◽

Tertiary Care ◽

Case Series ◽

Visual Outcome ◽

Posterior Segment ◽

Poor Visual Outcome ◽

Long Term Follow Up ◽

The Mean

Purpose. To report the long-term follow-up results of posterior segment intraocular foreign body (IOFB) removal in children and to determine the prognostic factors for visual outcome. Methods. Design: retrospective, noncomparative, interventional case series; a single tertiary care center study. Participants or samples: eleven eyes (11 patients) under 16 years of age with posterior segment IOFB injuries from May 2014 to November 2017. Main outcome measures: clinical features of injury, visual acuity, and complications. Results. The mean age was 6.8 years, and the mean follow-up was 20.2 months. The main IOFB sources were accidental penetration of the eye by materials in the playground (6 cases) or by pencil lead at school (4 cases). The mean IOFB size was 3.8 (range 1–6) mm. At the last visit, the visual acuities were 20/40 or better in 40.0% of patients and better than 20/200 in 70.0%. Poor visual outcome was correlated with intraoperative rhegmatogenous retinal detachment (P=0.0083). Postoperative complications included elevated transient intraocular pressure, retinal redetachment, and secondary glaucoma. Conclusions. The clinical features of pediatric posterior segment IOFBs suggest insufficient awareness of such injuries both on the playground and at school. Visual outcomes from surgical treatment were relatively favorable in this series.

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Long-term outcome of primary intraocular lens implantation in bilateral congenital cataract in infants with a median age of 35 days at surgery: a case series

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2021-000836 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000836

Author(s):

Mari Kathrine Sand ◽

Symira Cholidis ◽

Kjartan Rimstad ◽

Elise Dees Krekling ◽

Olav Kristianslund ◽

...

Keyword(s):

Intraocular Lens ◽

Congenital Cataract ◽

Intraoperative Complications ◽

Case Series ◽

Visual Outcome ◽

Secondary Glaucoma ◽

Long Term Outcome ◽

Iol Implantation

ObjectiveTo evaluate the long-term visual outcome and safety after bilateral cataract surgery with primary intraocular lens (IOL) implantation in infants with visually significant cataract at birth operated before 12 weeks of age.Methods and analysisMedical records of infants with congenital cataract who had bilateral surgery with primary IOL implantation before 12 weeks of age at Oslo University Hospital between 2007 and 2016 were retrospectively reviewed. Fifteen infants (30 eyes) were enrolled for a prospective study examination in 2017. Corrected distance visual acuity (CDVA) and intraocular pressure (IOP) were assessed. Visual axis opacification (VAO) was defined as opacification on the anterior or posterior surface of the IOL, capsular phimosis or fibrinous membrane. Secondary glaucoma was evaluated according to international guidelines.ResultsMedian age at the time of primary surgery was 35 days (range, 15 to 70 days). There were no serious intraoperative complications, and all eyes had the IOL implanted in the capsular bag. After a median follow-up of 6.1 years (range, 1.5 to 10.2 years), the CDVA was 0.5 logMAR (range, 1.2 to 0.04). All eyes had surgery for VAO and the median number of surgical procedures was 2.0 (range, 1 to 5). The cumulative incidence of secondary glaucoma was 10% after 5 years of follow-up.ConclusionPrimary IOL implantation before 12 weeks of age gave a satisfactory visual outcome, and the incidence of secondary glaucoma was similar to that reported after primary IOL implantation in older infants. However, the risk of VAO was high.

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Effect of time to primary repair on final visual outcome after open globe injury

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311559 ◽

2019 ◽

Vol 103 (10) ◽

pp. 1491-1494 ◽

Cited By ~ 5

Author(s):

Richard J Blanch ◽

Jonathan Bishop ◽

Hedayat Javidi ◽

Philip Ian Murray

Keyword(s):

Visual Acuity ◽

Primary Repair ◽

Demographic Data ◽

Case Series ◽

Visual Outcome ◽

Final Visual Acuity ◽

Visual Outcomes ◽

Open Globe ◽

Final Visual Outcome ◽

Open Globe Injuries

Background/AimHistoric data suggest that open globe injuries should be repaired within 12–24 hours to reduce the risk of endophthalmitis. However, endophthalmitis is uncommon when systemic antibiotic prophylaxis is given. It is not clear whether delayed primary repair impacts visual outcomes in other ways or what is the optimum time to repair. We aimed to examine the effect of time to primary repair on visual outcomes.MethodsThis is a retrospective comparative case series including all open globe injuries presenting to the Birmingham Midland Eye Centre between 1 January 2014 and 15 March 2016. Presenting features, mechanism of injury, visual acuity at 6–12 months and demographic data were examined.Results56 open globe injuries were repaired, of which sufficient data for analysis were available on 52 cases. The mean time to primary repair was 1 day after injury (range 5 hours to 7 days). Final visual acuity at 6–12 months was related to the presenting visual acuity and the Ocular Trauma Score and to the time between injury and primary repair, with a reduction in predicted visual acuity of logarithm of the minimum angle of resolution of 0.37 for every 24 hours of delay (95% CI 0.14 to 0.6).DiscussionOpen globe injuries should be repaired promptly. Presenting visual acuity remains the strongest predictor of outcome; however, delay to primary repair also reduced final visual acuity, and any significant delay from injury to repair is likely to negatively impact final visual outcome.

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Surgical rehabilitation of terror-related open globe injuries in the Turkish Military: long-term results

BMJ Military Health ◽

10.1136/jramc-2019-001306 ◽

2020 ◽

pp. jramc-2019-001306

Author(s):

Soner Guven

Keyword(s):

Visual Outcome ◽

Long Term Results ◽

Factors Affecting ◽

Secondary Purpose ◽

Open Globe ◽

Vitreous Prolapse ◽

Preoperative Factors ◽

Open Globe Injuries

IntroductionThe purpose of this study is to evaluate the factors affecting multiple surgeries, worse visual outcome, eye removal (ER) and vitrectomy requirement in terror-related open-globe injuries (OGI) in the Turkish Military. Secondary purpose is to specify surgery and injury characteristics of terror-related OGI.MethodsA total of 372 eyes of 251 patients with OGI that occurred during terroristic attacks between January 1996 and January 2016 were included in the study. A retrospective investigation of the preoperative variables associated with further surgeries, visual outcome, vitrectomy requirement and evisceration/enucleation was achieved.ResultsA total of 1118 separate operative sessions with a median of 2 (1–14) surgeries were performed to 372 eyes. Preoperative factors predicting follow-up surgery included visual acuity (VA) <20/200, lens injury, vitreous haemorrhage (VH), presence of vitreous prolapse. Baseline VA <20/200, initial retinal detachment and ruptured globe injury were the independent factors of worse visual result. Ruptured globe injury (p:0.000) and initial vitreous prolapse (p:0.001) were significantly linked to ER surgery. Patients required vitrectomy significantly tend to have VH (p:0.000) and zone 3 injury (p:0.000) compared with non-vitrectomy group. Single surgery cases tend to have significantly better baseline (p:0.000) and final VA (p:0.007) and shorter follow-up period (p:0.000) compared with multiple surgery group.ConclusionsTerror-related OGI necessitate remarkable surgical follow-up and multiple surgery sessions with a relatively higher evisceration/enucleation rate than other types of OGI. A comprehensive surgical approach with multiple surgery types is needed to treat terror-related OGI.

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Combining flanged intrascleral IOL fixation with Glaucoma Surgery: Initial experience

European Journal of Ophthalmology ◽

10.1177/11206721211066390 ◽

2021 ◽

pp. 112067212110663

Author(s):

Vanita Pathak-Ray ◽

Aashish K Bansal ◽

Varun Malhotra

Keyword(s):

Anterior Segment ◽

Case Series ◽

Glaucoma Surgery ◽

Single Stage ◽

Initial Experience ◽

Additional Procedure ◽

The Cost ◽

Iol Fixation

Purpose To report the initial clinical outcomes of combining glaucoma surgery with flanged intrascleral intraocular lens (F-SFIOL) fixation as a single stage procedure. Methods Retrospective, non-comparative case-series of eyes which underwent combined surgery for glaucoma with F-SFIOL and had at least 6-months of follow-up. A fellowship-trained senior glaucoma surgeon managed all the cases. Results Twelve-eyes of 10 glaucoma patients (8 males, 2 females) underwent F-SFIOL; only 8 of these eyes were combined with a glaucoma procedure. Mean age of patients was 55.1 ± 16.1 years (95%CI [44.4,73.2], median 61 years) and were followed-up for a mean of 21.0 ± 9.5 months, 95% CI [13.1,28.9], median 18 months. F-SFIOL was combined with trabeculectomy ± Mitomycin C in 4 eyes, Ahmed Glaucoma Valve in 3 eyes and needling of a pre-existing bleb in 1. Each eye had controlled intraocular pressure (IOP) at last follow-up (pre-procedure 29.1 ± 13.4 mmHg, 95% CI [17.9, 40.3], median 27 mmHg to 14.5 ± 3.2 mmHg, 95% CI [11.8, 17.1], median 13 mmHg, p = 0.006) and decreased need for number of anti-glaucoma medication (AGM) (pre-procedure 3.7 ± 1.1, 95% CI [2.8,4.6], median 4 to 0.7 ± 0.7, 95% CI [0.1,1.3] median 1, p < 0.001). In all the eyes, best corrected visual acuity (BCVA) was either stable or improved; only 1 eye had astigmatism worse than that pre-existing. In 1 eye IOL was explanted, with an additional procedure to control IOP. No serious long-term complications occurred in any subject. Conclusion The initial experience of single-stage F-SFIOL along with glaucoma surgery, both being performed by the same anterior-segment surgeon, is promising, thereby avoiding the cost, specialised skill, and potential complications of a posterior approach. Glaucoma surgery combined with and adapted to suture-less, flap-less, glue-less intra-scleral IOL fixation is hitherto unreported.

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Evolution of Lightning Maculopathy: Presentation of Two Clinical Cases and Brief Review of the Literature

Case Reports in Ophthalmological Medicine ◽

10.1155/2021/8831987 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Simanta Khadka ◽

Raghunandan Byanju ◽

Sangita Pradhan ◽

Suchan Poon ◽

Rinkal Suwal

Keyword(s):

Anterior Segment ◽

Visual Outcome ◽

Ocular Injury ◽

Poor Visual Outcome ◽

Naturally Occurring ◽

Long Term Follow Up ◽

Lightning Injury ◽

Clinical Cases

Lightning is a naturally occurring atmospheric phenomenon. Though uncommon, it is a potentially devastating and underreported natural calamity. Lightning accounts for the second leading cause of weather-related death in most parts of the world. Among the survivors of lightning injury, more than half of the victims may suffer from some form of ophthalmic injury. The lightning-associated ocular injury varies from a range of anterior segment to posterior segment pathologies. We report on two clinical cases of ocular injuries among the survivors of lightning injury. Anatomical involvement is seen at different levels with presentation as uveitis, pupillary abnormality, maculopathy, and later development of lenticular opacification. Optical coherence tomography (OCT), a noninvasive diagnostic tool, is particularly useful in the evaluation of lighting maculopathy as well as to monitor its progression through the course of time. Visual prognosis depends upon the structures of the eyes affected in the injury. The presence of irreversible retinal damage as well as optic nerve damage often result in poor visual outcome in the absence of significant anterior segment pathology. This report highlights the evolution of maculopathy through the course of time and signifies the importance of long-term follow-up postlightning injury.

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Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.6.peds18716 ◽

2019 ◽

Vol 24 (5) ◽

pp. 549-557

Author(s):

Malia McAvoy ◽

Heather J. McCrea ◽

Vamsidhar Chavakula ◽

Hoon Choi ◽

Wenya Linda Bi ◽

...

Keyword(s):

Conservative Management ◽

Functional Outcomes ◽

Pediatric Patients ◽

Clinical Presentation ◽

Case Series ◽

Csf Leak ◽

Single Institution ◽

The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

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