Infectious keratitis in Vietnam: etiology, organisms, and management at Vietnam National Eye Hospital

AIM: To report the etiologies, risk factors, treatments, and outcomes of infectious keratitis (IK) at a major Vietnamese eye hospital. METHODS: This is a retrospective review of all cases of IK at Vietnam National Eye Hospital (VNEH) in Hanoi, Vietnam. Medical histories, demographics, clinical features, microbiological results, and treatment outcomes were reviewed. RESULTS: IK was diagnosed in 1974 eyes of 1952 patients, with ocular trauma being the greatest risk factor for IK (34.2%), frequently resulting from an agriculture-related injury (53.3%). The mean duration between symptom onset and presentation to VNEH was 19.3±14.4d, and 98.7% of patients had been treated with topical antibiotic and/or antifungal agents prior to evaluation at VNEH. Based on smear results of 1706 samples, the most common organisms identified were bacteria (n=1107, 64.9%) and fungi (n=1092, 64.0%), with identification of both bacteria and fungi in 614 (36.0%) eyes. Fifty-five of 374 bacterial cultures (14.7%) and 426 of 838 fungal cultures (50.8%) were positive, with the most commonly cultured pathogens being Pseudomonas aeruginosa, Streptococcus pneumonia, Fusarium spp., and Aspergillus spp. Corneal perforation and descemetocele developed in 391 (19.8%) and 93 (4.7%) eyes, respectively. Medical treatment was successful in resolving IK in 50.4% eyes, while 337 (17.1%) eyes underwent penetrating or anterior lamellar keratoplasty. Evisceration was performed in 7.1% of eyes, most commonly in the setting of fungal keratitis. CONCLUSION: Ocular trauma is a major risk factor for IK in Vietnam, which is diagnosed in almost 400 patients each year at VNEH. Given this, and as approximately one quarter of the eyes that develop IK require corneal transplantation or evisceration, greater emphasis should be placed on the development of prevention and treatment programs for IK in Vietnam.

Profile of ocular injuries amongst various trauma patients presenting to tertiary care centre of Punjab

To study the epidemiology and clinical profile of ocular trauma patients presenting to tertiary care centre. Prospective study. All patients of ocular trauma in OPD/Emergency were assessed for detail between 1/1/17 to 31/6/18 and data on demographic profile was established as per guidelines of Ocular Trauma Society of India. Patients were categorized in different segments and assessed/followed for visual impairment in particular. A total of 246 cases were examined out of which 87% were males. The most common mode of ocular injury was Road Traffic Accidents. Pediatric eye trauma constituted 16.7% of the total cases. 26.8% cases arrived to our centre between 4-24 hours and 62.6% cases presented after 24 hours. Amongst 131 cases of Road Traffic Accidents, none of them were using protective measures like helmets or goggles. Of these, 17.1% were under the influence of alcohol. 28.5% were involved in medicolegal proceedings. Majority of the cases comprised of monocular trauma (78.1%). Closed globe injuries constituted 88.94% of the total cases of which most cases presented with lid edema and ecchymosis. Chemical injuries were reported in 4.5% cases. 9 patients lost vision completely and 71 cases had vision from light perception to 6/18. Ocular trauma is one of the common causes of ocular morbidity. It has been seen predominantly in male population. Public needs to be educated about safety measurements and education about prompt need to specialised care to reduce ocular trauma related visual morbidity.

Role of B-scan in management of ocular trauma

The present study aimed to study the effectiveness of B scan in assessing the posterior segment in patients with ocular trauma, so that further treatment plan can be decided and prognosis can be improved. The study was conducted as a cross-sectional study at tertiary care centre during the study period of 1 year on 42 patients presenting with history of ocular trauma. Patients were subjected to detailed history and ocular examination followed by B scan ultrasonography for ruling out posterior segment pathology. Mean age of 42.7±20.2 years and 45.2% patients belonged to 41 to 60 years of age. About 54.8% cases were females. About 50% cases had one or the other posterior segment finding. Retinal detachment followed by vitreous hemorrhage were the most common findings, observed in 19% and 11.9% cases respectively. Avulsion of optic nerve was the least common finding (2.4%). B scan ultrasonography plays an important role in management of patients with ocular trauma for the detection of hidden posterior segment lesions. B scan must be performed routinely in all the cases of ocular trauma for early diagnosis and appropriate management of each case and to reduce the ocular morbidities.

COVID-19 Changed Prevalence, Disease Spectrum and Management Strategies of Ocular Trauma

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the health of people around the world and has reshaped social behaviors and clinical practice. The purpose of this perspective is to provide epidemiologists and clinicians with information about how the spectrum of ocular trauma diseases changed, as well as to optimize management for improving patient prognosis during this crisis. Analysis of current studies revealed that the prevalence of eye trauma decreased overall, with a trend of delayed medical treatment during the COVID-19 era. Irregular epidemic prevention and control measures, unprotected home activities, and unusual mental states are the main causes of ocular trauma. Strategies for reducing morbidity are also discussed, including popularizing the use norms of prevention and control supplies, taking heed to the safety of family activities, highlighting the special status of child protection, and paying attention to previous case data to implement region-specific precautions. The procedure of ophthalmological emergency and outpatient management should also be optimized, and mental health should be emphasized during this pandemic.

Blast-induced axonal degeneration in the rat cerebellum in the absence of head movement

Blast exposure can injure brain by multiple mechanisms, and injury attributable to direct effects of the blast wave itself have been difficult to distinguish from that caused by rapid head displacement and other secondary processes. To resolve this issue, we used a rat model of blast exposure in which head movement was either strictly prevented or permitted in the lateral plane. Blast was found to produce axonal injury even with strict prevention of head movement. This axonal injury was restricted to the cerebellum, with the exception of injury in visual tracts secondary to ocular trauma. The cerebellar axonal injury was increased in rats in which blast-induced head movement was permitted, but the pattern of injury was unchanged. These findings support the contentions that blast per se, independent of head movement, is sufficient to induce axonal injury, and that axons in cerebellar white matter are particularly vulnerable to direct blast-induced injury.

Etiology, presentation and treatment of ocular trauma in paediatric population.

Objective: To determine the etiology, presentation and treatment of ocular trauma in paediatric population. Study Design: Cross Sectional Study. Setting: Institute of Ophthalmology, Liaquat University Hospital Jamshoro. Period: January, 2020 to December 2020. Material & Methods: Data was collected using a questionnaire having age, sex, cause of injury and time at presentation to the emergency. It also focused on which structures were damaged due to injury, investigations being used, and treatment performed. Results: In our study we found 80 cases of ocular trauma in pediatric population visiting the ophthalmology department. Gender distribution of the study group which includes 72.5% (n=58) males and 27.5% (n=22) females. It was found during playing 86.3% of children had ocular trauma followed by injury due to domestic stuff like glass, bleach cleaners in 7.5% of the study group. The most frequently occurring ocular trauma was found to be corneal tear occurring in 25% of the study group. Conclusion: Ocular trauma in children can be prevented by simple measures like supervising children and educating parents and teachers for potential hazard substances. It is important to address like healthcare issue as ocular trauma can lead to lifelong blindness along with psychological and financial burden for the caretaker and children themselves.

Clinical profile of ocular trauma in a tertiary care hospital of Southern Rajasthan

Background: Ocular trauma is a major cause of preventable visual impairment and blindness leading to permanent loss of vision and deterioration of quality of life. 90% of the injuries are preventable. Aim of the current study was to study the clinical profile of patients with ocular trauma at a tertiary care hospital in Southern Rajasthan. Current study was a cross- sectional, observational study was conducted at Geetanjali medical college and hospital, Udaipur.Methods: After taking a well-informed consent a generalized detailed history of 108 cases (123 injured eyes) was obtained. Assessment of best corrected visual acuity, near vision, intraocular pressure, slit-lamp evaluation and dilated fundus examination was carried out. Then injury was classified as per BETTS classification. Patients with corneal foreign bodies and chemical injuries were recorded separately. Imaging modalities like ultrasound B-scan, CT-scan and MRI were employed wherever required. Results: Number of males (98) was much higher than females (9) in our study. Male: female ratio was found to be 10.8:1. The most commonly affected age group was 21-30 years, this highlights the alarmingly high incidence of ocular injuries in economically active young males. Farming is the primary occupation across India, hence it deserves a special mention. 22% of injury cases in our study were farm- work related injuries. Farmers need to be educated and provided eye protective equipment during high-risk activities. Laws regarding agricultural code of practice should be implemented and followed.Conclusions: In our study, not a single case out of 108 had used eye protection at the time of injury. Every effort should be made to create awareness regarding use of safety measures during driving and engaging in high-risk occupations. This will help prevent sight-threatening complications of ocular trauma and the deleterious impact on quality of life.

Outcomes of a Foldable Capsular Vitreous Body Implantation: A Retrospective Study

Background. The vitreous body is an important part of the ocular body fluid. A foldable capsular vitreous body (FCVB) is designed to treat chronic adverse complications in severe ocular trauma and silicone oil-dependent eyes. This study is aimed at investigating a method for implanting an FCVB, its postoperative efficacy, and clinical value. Methods. A retrospective analysis was performed on data from 18 patients who underwent vitrectomy and FCVB implantation for severe ocular trauma and silicone oil-dependent eyes between March 2019 and May 2020. All treated eyes underwent clinical examinations involving the best-corrected visual acuity, intraocular pressure, FCVB position, anterior segment photography, and wide-angle fundus photography regularly after surgery. Results. Eighteen eyes from 18 patients were enrolled in this study. A total of 2.00–4.20 ( 3.46 ± 0.78 ) ml of silicone oil were injected into the FCVB during surgery. The patients were followed up at 1, 2, and 4 weeks and 3, 6, and 12 months after surgery. Twelve months after surgery, visual acuity improved in 7 (38.89%) eyes. In contrast, 10 (55.56%) eyes showed no obvious improvement, and 1 (5.56%) eye had decreased vision. Intraocular pressure at 12 months was 10.13 ± 3.52 mmHg, which was comparable to that before the surgery ( t = 0.38 , P = 0.71 ). The anterior chamber depth examined by slit lamp was 2.00–3.00 cornea thickness (CT) in 7 eyes, 1.00–2.00 CT in 2 eyes, and <1.00 CT in one eye. The anterior chamber disappeared in eight eyes. There were eight eyes with clear cornea, four eyes with localized opacity, and two eyes with obvious gray-white opacity. There was no case of severe FCVB deflection, rupture, or exposure during the observation period. Conclusion. FCVB implantation is an effective and safe treatment for eyes with severe ocular trauma and silicone oil-dependent eyes. It may support retinal reattachment, slow down eyeball atrophy, reduce the risk of chronic adverse complications such as corneal endothelial decompensation, and maintain intraocular pressure and preoperative visual function.