Clinical Characteristics, Visual Outcomes, and Prognostic Factors of Open Globe Injuries

Background and Objectives: Open globe injuries (OGI) remain an important cause of visual impairment and loss, impacting all ages. A better understanding of the factors influencing visual outcomes is important in an attempt to improve the results of the treatment of OGI patients. The author aimed to contribute to this knowledge with the analysis of clinical characteristics, prognostic factors, and visual outcomes of their cohort of OGI patients. Materials and Methods: A retrospective medical record review was performed for 160 patients (161 eyes) who sustained an open globe injury between January 2015 and December 2017 and presented to the Hospital of Lithuanian University of Health Sciences. Data analyzed included age, sex, type, cause, place of OGI, initial visual acuity (VA), final best-corrected visual acuity (BCVA), and tissue involvement. Open globe injuries were classified using the Birmingham Eye Trauma Terminology (BETT) and Ocular Trauma Classification System (OTCS). Univariate analysis was conducted to evaluate the prognostic factors. Results: The mean age of the patients was 41.9 years. The male-to-female ratio was found to be 8.4:1. The home was the leading place of eye injury (59.6%), followed by an outdoor environment (14.3%) and workplace (11.8%). Penetrating injury accounted for 43.5%, followed by intraocular foreign body injury (39.1%) and globe rupture (13%). Overall, 19.5% of patients regained a good final vision of ≥0.5, but for 48.1% of them, eye trauma resulted in severe visual impairment (BCVA ≤ 0.02). In the univariate analysis, a bad visual outcome of less than 0.02 was correlated with bad initial VA, iris dialysis, hypotony, vitreous hemorrhage, and vitreous prolapse at presentation. Phthisis bulbi was correlated with eyelid laceration, iris prolapse, iris dialysis, hyphema, vitreous prolapse, vitreous hemorrhage, and choroidal rupture at initial examination. Conclusions: Open globe injury remains an important preventable cause of ocular morbidity. This study provides data indicating that open globe injuries are a significant cause of visual impairment in our research group.

Aphakic Pupillary Block by an Intact Anterior Vitreous Membrane after Total Lens Extraction by Phacoemulsification

An 85-year-old Japanese woman with acute primary angle closure in her right eye underwent cataract extraction. Because of the weakness of the Zinn’s zonules, all of the lens tissue including the lens capsule was removed by phacoemulsification. Because of the absence of vitreous prolapse into the anterior chamber, vitrectomy was not performed. Nine days postoperatively, acute angle closure due to pupillary block by an anterior vitreous membrane developed. To resolve the pupillary block, anterior vitrectomy was performed on the same day. Postoperatively, her symptoms resolved, the anterior chamber deepened, and the intraocular pressure normalized. Although rare, acute angle closure due to pupillary block by an anterior vitreous membrane can occur after total lens extraction with phacoemulsification. If no vitreous prolapse occurs with total lens extraction, an intentional hyaloidotomy using an anterior vitreous cutter or iridectomy should be considered to avoid secondary angle closure.

Endophthalmitis and Retinal Detachment after Ocular Injury by Animal Inoculation Needle

Purpose: To report a case of endophthalmitis and retinal detachment after injury caused by an animal inoculation needle. Case summary: A 39-year-old man received an injury to his left eye with an animal inoculation needle while vaccinating a pig came to the hospital due to decreased visual acuity. At initial presentation, the best-corrected visual acuity in the left eye was “counting fingers,” and slit lamp examination revealed corneal lacerations, anterior capsule rupture, and traumatic cataract. Ultrasonography showed no specific findings in the vitreous and retina. Primary corneal suture, phacoemulsification, anterior vitrectomy due to rupture of the posterior capsule and vitreous prolapse, intraocular lens implantation, and intravitreal antibiotic injection were performed. On day 1 postoperatively, vitrectomy, anterior chamber irrigation, intravitreal antibiotic injection, and silicone oil injection were performed as signs of endophthalmitis, such as hypopyon and retinal tear, and focal retinal detachment were observed during surgery. Silicone oil removal was performed 7 months after the operation and the best-corrected visual acuity was 0.6. There has been no recurrence during follow-up. Conclusions: This is the first report in Korea of ocular injury caused by an animal inoculation needle. If the fundus is not observed in such injuries, there is a possibility of endophthalmitis and retinal detachment and early vitrectomy should be considered.

Delayed vitreous prolapse after cataract surgery: clinical features and surgical outcomes

This study investigates the etiology and clinical features of delayed vitreous prolapse after cataract surgery and evaluates the long-term surgical and visual outcomes. Consecutive patients with vitreous prolapse into the anterior chamber occurring ≥ 3 months after cataract surgery at two hospitals between December 2006 and June 2020 were retrospectively reviewed. The primary outcome was associated ophthalmological events that triggered delayed vitreous prolapse. Secondary outcomes included long-term visual and subjective symptom changes after treatment. Among 20 eyes (20 patients), all had visual symptoms, the most common being blurry vision (12 patients; 60%). Five (25%) were detected after YAG laser capsulotomy, three (15%) had a history of intraocular lens(IOL) implantation in sulcus due to intraoperative posterior capsular tears, three (15%) had prolapsed vitreous alongside dislocated IOLs, and three (15%) were aphakic after previous cataract surgeries. After surgical treatment, the mean corrected distance visual acuity improved from 20/50 to 20/31(P = 0.02) and the mean preoperative intraocular pressure (IOP) that was 26.4 mmHg decreased to 15.6 mmHg, remaining stable until the last follow-up. All reported symptoms were relieved. YAG laser capsulotomy or a history of defective posterior capsule from iatrogenic causes may trigger delayed vitreous prolapse. The long-term outcomes were favorable, particularly after posterior vitrectomy, with improved IOP control and symptom resolution.

Eye hydrodynamics indicators in children with congenital cataract, aphakia and pseudophakia

Purpose. To determine the specificity of functional and tonographic parameters of the eyeball in children with cataract, aphakia and pseudophakia. Material and methods. A comparative analysis of eye hydrodynamics indices was made according to a simplified procedure, using the Friedenwald nomogram, on 75 children aged 2 to 17 years with cataract (24 eyes), aphakia (21 eyes), pseudophakia (15 eyes), and IOL dislocation (15 eyes), as well as 12 healthy children.Results. In pseudophakia, true IOP was found to fall to 10.00 ± 0.01 mm Hg due to a decrease in aqueous humor production (to 0.10±0.01 mm3 / min) and increase of its outflow (to 0.75 ± 0.02 mm3/min / mm). IOL dislocation led to an increase in true IOP (24.40±1.0 mm Hg) due to an increase in aqueous humor production (4.09±0.05 mm3/min) and a decrease in its outflow (0.010 ± 0.002 mm3/min/mm). In these eyes, clinical manifestations of secondary pseudophakic glaucoma were noted, which are explained by factors obstructing aqueous humor outflow (vitreous prolapse and partial vitreous block) and considered an indication for re-operation.Conclusion. Statistically significant changes of hydrodynamic eye parameters in children with pseudophakia have been detected: increased true IOP in IOL dislocation, and, conversely, reduced true IOP in case of the normal IOL location. The authors believe that eye “hypotension” in case of pseudophakia requires further study.

Risk factors that associated with visual outcome of community based cataract surgery

Background: Cataract is one of the leading cause of blindness in Indonesia and worldwide. Meanwhile the ability to carry out cataract surgery was not balanced by the increasing of cataract backlog of ± 70,000 per year. In addition to increase the number of cataract operations, it is very important to maintain the quality of surgery results by auditing the result of surgery. This study aims to evaluate post-operative visual acuity in social services organized by the Cataract Blindness Prevention Section of IOA Malang Branch in 2015-2017.Methods: This study is a retrospective study based on medical record data of cataract patients underwent cataract surgery at a social service organized by the Cataract Blindness Prevention Section of IOA Malang Branch in January 2015 - December 2017 period. Data collected included demographic data, preoperative and postoperative visual acuity, type cataract surgery, and intraoperative complications.Results: Cataract surgery carried out from 2015-2017 was 1,662 surgeries with 965 male patients (58.06%). Visual acuity before surgery was 1/300 in 583 patients (35.08%). The most cataract surgery procedure performed was SICS (60.17%). Vitreous prolapse was the most common complication found. There was a significant association between age and type of cataract surgery, with postoperative vision (p <0.05, α = 5%). From the analysis, the progress of post-operative visual acuity was found in 85.93% of patients and the results were significant (p <0.05, α = 5%).Conclusions: Cataract surgery may provide significant visual improvement that elevates vision and quality of life for patients.

Ultrasound biomicroscopy evaluation of pseudophakic pupillary block by vitreous prolapse after Nd:YAG laser posterior capsulotomy

Intraocular pressure rise is a common complication after neodymium:yttrium-aluminum-garnet (Nd-YAG) laser posterior capsulotomy. Although in most cases it is related to an inflammatory response, there are other possible mechanisms such as misdirection syndrome and pupillary block. The authors report two cases of pupillary block by vitreous prolapse after Nd-YAG laser posterior capsulotomy evaluated by ultrasound biomicroscopy (UBM). UBM allows to differentiate possible causes of intraocular pressure rising after laser capsulotomy even in cases of corneal opacity. It also allows to detect intraocular lens dislocation, sometimes associated with this situation. This is the first report that describes the characteristics of UBM images of this complication.

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

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.

Perbandingan komplikasi antara fakoemulsifikasi dan manual Small-Incision Cataract Surgery (mSICS) pada operasi katarak massal: Sebuah penelitian kohort retrospektif

Cataract is the most common cause of reversible blindness, and its prevalence have been increasing in the community depend on the age. Phacoemulsification and manual Small-Incision Cataract Surgery (mSICS) were the techniques of cataract surgery that was frequently used in high-volume cataract surgery setting. This study aimed to compare the complications between phacoemulsification and mSICS in high-volume cataract surgery. This research was a retrospective cohort study with the data taken from the medical record of high-volume cataract surgery organized by Community Ophthalmology Division, Department of Ophthalmology Universitas Gadjah Mada (UGM) from January 2018 to November 2018. Cataract surgery was performed by consultant ophthalmologists, general ophthalmologist, and senior ophthalmology resident for phacoemulsification and by senior ophthalmology resident and junior ophthalmology resident for mSICS. Intraoperative and postoperative complications (i.e. posterior capsule rupture, vitreous prolapse, aphakia, iridodialysis, endophthalmitis) until four weeks of follow up were compared in both techniques. There were 483 patients who had been operated, 188 (38.9%) patients underwent phacoemulsification and 295 (61.1%) patients underwent mSICS. Intraoperative and postoperative complications in phacoemulsification and mSICS performed by senior ophthalmology resident were no statistically significant different (p > 0.05). Nevertheles, there was statistically significant different in the complication of posterior capsule rupture and aphakia in phacoemulsification based on the level of surgeon’s skill (p < 0.05). Most of them performed by senior ophthalmology resident in 11 (35.5%) cases and 5 (16.1%) cases respectively. However, complications in mSICS were no significantly different based on the level of surgeon’s skill performed by senior ophthalmology resident and junior ophthalmology resident (p > 0.05). Complications in phacoemulsification and mSICS performed by senior ophthalmology resident with relatively similar in the level of surgeon’s skill were not significantly different. However, the complication of posterior capsule rupture and aphakia in phacoemulsification was significantly different based on the level of surgeon’s skill.