War-related ocular injuries in Damascus during the Syrian Crisis

Background. Ocular injuries constitute a major cause of visual morbidity, and they have a significant socioeconomic impact worldwide. We aimed to document the types and causes of Syrian War related ocular injuries in Damascus, Syria.Methods. Medical records were retrospectively reviewed to evaluate all patients in Al-Mouwasat University Hospital and Damascus Hospital, whose ocular injuries were caused by war-related activities during the period extending between January of 2016 and December 2017.Results. 150 eye injuries in 127 patients were reviewed, in which 46 (31%) were bilateral and 87 (58%) were open globe injuries. The leading cause of the observed ocular injuries was improvised explosive devices (IED) [37 eyes (41%)]. The majority of patients presented with an initial best corrected visual acuity (BCVA) of “light perception” (LP) to “hand movement” (HM) [51 eyes (34%)]. Information on the final BCVA was available for 69 injured eyes only, and it was “no light perception” (NLP) in 20 eyes (29%).Conclusion. Explosive weaponry is the main culprit in most war-related ocular injuries in Syria. The high incidence of open globe injuries caused many of the cases to be severe in nature. Education on the precautionary measures that protect the eyes such as the use of combat eye protection during wartimes ought to be enforced, so that future ocular injuries can be prevented.     

Visual outcome of unilateral traumatic cataract

Objective: To evaluate the visual outcome of a series of patients presenting with unilateral traumatic cataract. Study Design: Observational study. Place and Duration of Study: Ophthalmology Department, Liaquat University Hospital, Hyderabad, from July 2007 to June 2010. Methodology: Analysis included data of 41 patients (31 males and 10 females) with unilateral traumatic cataract. Data regarding demographics, causative agent, clinical course and outcome in terms of best corrected visual acuity (BCVA) was retrieved from the patients' files in hospital record. Data was expressed as frequencies, percentages, mean and standard deviation. Results: There was a male predilection with a male to female ratio of 3.1:1. The age group more frequently affected was 5 - 14 years (58.5%). Commonest causative agent was trauma with wooden stick in 13 eyes (31.7%) followed by thorn in 9 eyes (22%) and stone in 7 eyes (17.1%). Pre-existing posterior capsular defects were observed intraoperatively in 6 eyes. Posterior capsular opacification was evident in 10 eyes (24%). Best corrected visual acuity of 6/18 or more at 6 months was achieved in 29 eyes (70.8%). Duration between injury and cataract surgery did not affect the final visual outcome of traumatic cataract patients. Conclusion: Patients with traumatic cataract if managed appropriately can have best possible visual outcome. Young males are commonly affected. Taking protective measures in sports and work as well as patient education can avoid ocular trauma and traumatic cataract formation.     

Clinical spectrum and functional outcome of firearm pellet-related eye injuries: A prospective follow-up study

PurposeTo determine the prognostic significance of various clinical features and surgical techniques concerning anatomical and visual outcomes in shotgun pellet-inflicted ocular trauma.MethodsThis prospective follow-up study was done at a tertiary care institute in Kashmir, India. Six hundred sixty-four eyes of 643 patients with firearm pellet-related ocular trauma were followed up for 6 months.ResultsOcular injury involved one eye in 622 (96.7%) patients and both eyes in 21 (3.3%) patients. Open globe injury (OGI) occurred in 451 (67.9%) eyes with perforating injury being the commonest type (248 eyes, 54.9%). For perforating injuries, entry wounds in the cornea and limbus had the worst prognosis. Closed globe injury (CGI) occurred in 213 (32.1%) eyes.An anatomical success rate of 66.3% (n = 250) was achieved for 56.8% (377/664) eyes requiring an average of 2.8 (SD 0.5) surgeries per eye. OGI was associated with poor outcomes in 259 (57.4%) and CGI with good outcomes in 200 (93.9%) eyes. The visual outcome had a significant association with grade and zone of injury both in OGI and CGI, and with the type of injury in OGI (p < .0001 each). Ocular trauma score (OTS) had a significant association with the degree of vision impairment (p < .0001). WHO category 0 visual impairment was seen in 270 (40.7%) eyes, category 1 in 85 (12.8%), category 2 in 35 (5.3%), category 3 in 30 (4.5%), category 4 in 172 (25.9%), and category 5 in 72 (10.8%) eyes irrespective of type of injury at 6 months post-treatment.ConclusionsThe perforating injury was the commonest type of injury caused by shotgun pellets. The site of the entry wound in perforating injury had prognostic significance. The outcome was generally poor in OGI and good in CGI.     

Characteristics of open eye injuries in the Beirut Port explosion

IntroductionOn the 4^th of August 2020 an ammonium nitrate explosion took place at the Port of Beirut in Lebanon. The aim of this study was to present the open eye injuries caused by the Beirut Port blast, and to describe their characteristics and visual outcomes at 6 months.MethodsPatients who suffered from open globe injuries during the Beirut port explosion were recruited. Characteristics of the ocular injuries and best corrected distance visual acuity (BCVA) were recorded at presentation and at 6 months.ResultsAll included eyes (23 eyes of 19 patients) suffered from penetrating open globe injuries secondary to glass material and were operated by globe exploration + primary repair. Four of the 19 patients suffered from bilateral injuries none of whom suffered from legal blindness. BCVA at presentation was hand motion or worse in 21 of 23 eyes (91%). Seven of 23 eyes (30%) had expulsive loss of intraocular tissue, 4 of 23 eyes (17%) had retinal detachment and 4 of 23 eyes (17%) had traumatic cataracts. Ocular trama score (OTS) had a mean +/- standard deviation (SD) of 61 +/- 12. Eleven of 23 eyes (48%) had zone 2 ocular injuries and 10 of 23 eyes (43%) had zone 3 ocular injuries. At 6 months follow-up 15 of 23 eyes (65%) had a BCVA of less than 20/200. All patients with Grade 2 OTS, zone 3 injuries, expulsive loss of intraocular tissue and retinal detachment had BCVA of less than 20/200 at 6 months.ConclusionOpen eye injuries secondary to explosions occur most frequently due to glass fragments. Most of the victims were indoors, near windows and less than 500m away of the explosion site at the time of the blast. The majority of victims have very low BCVA, a low OTS and a high ocular ZOI at presentation which reflects the danger of open globe injuries secondary to blasts. A high ZOI, a low OTS, the expulsive loss of intraocular tissue and retinal detachment seem to be predictors of worse VA at 6 months.     

Visual outcome after fireworks injuries

BACKGROUND: The epidemiology and prognosis of fireworks-related injuries treated at a tertiary eye care center in less developed nations remain unknown. METHODS: We conducted a prospective observational study that enrolled all consecutive eyes with fireworks-related ocular injury visiting our trauma clinic during a 1-year period. Eyes were graded by ocular trauma classification and followed for 6 months at least. Best corrected visual acuity (BCVA) at 6 months was considered the final visual outcome. Data were analyzed. RESULTS: Twenty-five (96%) of a total of 26 patients enrolled during study period were male patients and 13 (50%) were younger than 15 years. The type of fireworks involved was a bottle rocket in 38.5%. Factors significantly associated with better final visual outcome were better BCVA at presentation (p = 0.041), absence of bottle rocket injury (p = 0.028), closed globe injury (p = 0.028), absence of relative afferent pupillary defect (p = 0.019), absence of intraocular foreign body (p = 0.026), and absence of endophthalmitis (p = 0.006). Besides poor visual outcome, bottle rocket injuries were more frequently associated with facial lacerations, intraocular foreign body, and endophthalmitis development. CONCLUSION: Fireworks-related ocular injuries commonly affect young male subjects of northern India. Visual outcome is better in eyes having better initial BCVA or closed globe injury and if relative afferent pupillary defect, bottle rocket injury, intraocular foreign body, and endophthalmitis are absent.     

Ocular Surface Disease in Breast Cancer Patients Using Aromatase Inhibitors

Aromatase inhibitors (AIs) are widely used as adjuvant hormonal therapy in postmenopausal women with hormone receptor‐positive breast cancer. The purpose of this study was to investigate the potential impact of AIs on the anterior segment of the eye and especially the ocular surface. Participants in our study were 41 hormone receptor‐positive early stage breast cancer patients (80 eyes), treated with AIs, while 80 eyes of 40 age‐ and gender‐matched healthy controls, not previously used AIs for any purpose, were also evaluated. All participants underwent a complete ophthalmological examination, including best corrected visual acuity (BCVA) assessment, slit‐lamp biomicroscopy, and dilated fundus examination. Ocular surface disease‐related symptoms and signs were also recorded. The most common symptom was found to be blurred vision, while other symptoms included foreign body sensation, tearing, redness, and photophobia. Slit‐lamp examination revealed blepharitis and meibomian gland dysfunction in 75% and 42.5% of patients, respectively. Superficial punctate keratitis and conjunctival injection were also present. Our results demonstrated a high prevalence of ocular surface disease‐related symptoms and signs in patients receiving AIs compared to healthy controls. This study may raise a flag regarding the use of AIs. However, further and larger prospective longitudinal studies are needed to examine the possible effect of AIs alone or in combination with chemotherapy in the eyes of breast cancer patients.     

360-degree retinectomy for severe ocular rupture

Ocular rupture, with severe complications and poorprognosis, is a serious eye injury and hard todeal with. It remains a significant surgicaldilemma and frustrates many ophthalmologist. With thelatest improvement in vitreoretinal surgery, treatmentmodalities for severe ocular rupture have beendeveloped. Therefore, many patients with severeocular rupture can reserve their eyes and restore somevisual function. Between January 1999 and January2002, 78 consecutive patients with ocular rupture were…     

Characteristics of pediatric traumatic cataract and factors affecting visual outcomes

PurposeTo evaluate the clinical characteristics, surgical approach and visual results in pediatric traumatic cataract.Material and methodsData of pediatric and adult traumatic cataract patients were retrospectively analyzed. Age, gender, cause and zone of trauma, additional clinical findings, initial and final visual acuity (VA) were analyzed and compared between groups.ResultsThe mean age of 18 patients in the pediatric group was 9.4(SD 5.7); 18 patients in the adult group was 47.8(16.2) years. There was a male predominance in both groups (12/16 male, respectively). The most common cause of trauma was sharp metal objects (50%) in the pediatric group and wooden and traffic accidents (33%) in the adult group. The initial mean VA of the patients were 0.03(0.09), 0.09(0.1) in the pediatric and adult groups, respectively, (p: 0.34). The mean ocular trauma score (OTS) was 51.4(16.4) and 59.6(10.5) in the pediatric and adult groups, respectively (p: 0.09). Simultaneous surgery was performed in 5 (28%) eyes in both groups. Subsequent lens extraction and IOL implantation were performed in 10 of pediatric and 13 of adult patients. The final VA was 0.3(0.7), 0.3(0.4) in the pediatric and adult group, respectively (p: 0.94). Final VA was correlated with OTS in both of the groups and the presence of additional surgery in the pediatric group.ConclusionTraumatic cataract is a major cause of visual loss in children. Lower OTS and presence of additional surgery were the prognostic factors for poor final VA in the pediatric cases. Optimal timing and accurate management of traumatic cataract are important in the pediatric population.     

In situ myopic keratomileusis results in 30 eyes at 15 months

In situ myopic keratomileusis was performed in 30 eyes of 17 patients to correct high myopia. Mean follow-up was 460 days. Mean preoperative myopia was -15.66 D. The mean myopic decrease was 13.34 D, 85% of the total presurgery myopia. Postoperatively, 8 eyes (27%) were within +/- 1.00 D; 19 eyes (63%) within +/- 2.00 D; and 27 (90%) were within +/- 6.00 D. Preoperatively, 10 eyes (33%) had 20/40 or better visual acuity with spectacle correction. Postoperatively, 2 eyes (7%) had 20/40 or better without correction. Four eyes lost 2 or more Snellen lines of spectacle corrected visual acuity. Many eyes had an improved corrected visual acuity. The major complications were tear of lenticule (1 eye), epithelial implantation (4 eyes), transitory glaucoma (1 eye), irregular astigmatism (7 eyes), and undercorrection (24 eyes). Four of the latter underwent radial keratotomy.     

Ten years experience with a conservative approach to radial keratotomy

This retrospective study reports the results of radial keratotomy surgery on 225 eyes of 135 patients by one surgeon. Fifty-one percent of the eyes had four incisions and 45% had eight as the initial procedure. Fifteen percent of the eyes repeated surgery. The mean preoperative spherical equivalent refraction was -5.10 diopters (SD 1.90, range 1.20 to 11.60 D) and at 3 months to 1 year, the mean was -0.60 D (SD 1.00, range -4.80 to +3.40 D). For the entire series, 69% of the eyes achieved an uncorrected visual acuity of 20/40 or better, 73% were corrected to within +/- 1.00 D of emmetropia, and 3% were overcorrected by more than +1.00 D. For eyes with low preoperative myopia (-3.00 D and less), 100% achieved an uncorrected visual acuity of 20/40 or better, 97% were corrected to within +/- 1.00 D of emmetropia, and 3% were overcorrected by more than +1.00 D. For eyes with moderate myopia (-3.1 to -5.9 D), 73% achieved an uncorrected visual acuity of 20/40 or better, 81% were corrected to within +/- 1.00 D of emmetropia, and 3% were overcorrected by more than +1.00 D. For eyes with higher preoperative myopia (-6.0 to -11.60 D), 47% achieved an uncorrected visual acuity of 20/40 or better, 45% were corrected to within +/- 1.00 D of emmetropia and 3% were overcorrected by more than +1.00 D. One hundred eyes with a follow-up of 2 years or greater were studied for stability; 77% changed by less than 1.00 D from the 1 year value; 17% changed by 1.00 D or more in the hyperopic direction; 6% changed by 1.00 D or more in the myopic direction. There were no vision threatening complications and only one eye had a postoperative best spectacle corrected visual acuity of less than 20/40.     

Ocular morbidity following renal transplantation

Background. Long-term visual outcome following renal transplantation is poorly documented in medical literature. The purpose of this study was to determine the ocular morbidity in a group of renal transplant patients receiving immunosuppressive therapy. Methods. Patients who had undergone renal transplantation were identified from the renal outpatient register, and patients who were at least 8 years post-transplantation were included in the study. Ocular examination was on average 14.6 years post-surgery. There were 43 males and 28 females, with ages ranging from 29 to 74 years. The patients had undergone renal transplantation between March 1968 and September 1986. The ophthalmic examinations were carried out over a 15-month period in a research clinic. Results. Visual acuity was greater than or equal to 6/9 in 75% of the eyes. 10% of eyes had visual acuities of less than 6/24. Four eyes had central/branch retinal-vein occlusions; four eyes had posterior subcapsular lens opacities; three eyes had optic atrophy; one eye had complications of proliferative diabetic retinopathy; one eye had diabetic maculopathy and one eye had a central retinal artery occlusion. Only five eyes had irreversible visual loss resulting in visual acuities of less than 6/60. Conclusion. The incidence of sight-threatening complications in long-term survivors of renal transplantation was low. The results indicate that long-term prognosis for normal vision in patients who have undergone renal transplantation is good. Regular ophthalmic examinations are recommended for early detection of sight-threatening complications. Keywords. eye disease; renal transplantation; visual outcome      

Transsphenoidal approach to pituitary adenomas with suprasellar extension

During the past six years, we have operated upon a total of 59 pituitary adenomas with suprasellar extension. Of 26 patients treated by transsphenoidal operations, 54% (19 of 35 eyes) recovered normal visual acuity; improvement was noted in another 37% (13 of 35 eyes). The visual field was corrected in 84% (41 of 49 eyes). In about 60% (31 of 51 eyes) of the patients who underwent frontal craniotomy, visual improvement occurred. Endocrinologic cure of hypersecreting adenomas with suprasellar extension was difficult, although visual impairment improved. We suggest that in most cases the transsphenoidal approach is the method of choice in pituitary adenomas with suprasellar extension. With this approach there has been excellent visual improvement and fewer operative complications.     

The prevalence of vision loss due to ocular trauma in the Australian National Eye Health Survey

BackgroundTo determine the prevalence of vision loss due to ocular trauma in Australia.MethodsThe National Eye Health Survey (NEHS) is a population-based cross-sectional study that examined 3098 non-Indigenous Australians (aged 50–98 years) and 1738 Indigenous Australians (aged 40–92 years) living in 30 randomly selected sites, stratified by remoteness. An eye was considered to have vision loss due to trauma if the best-corrected visual acuity was worse than 6/12 and the main cause was attributed to ocular trauma. This determination was made by two independent ophthalmologists and any disagreements were adjudicated by a third senior ophthalmologist.ResultsThe sampling weight adjusted prevalence of vision loss due to ocular trauma in non-Indigenous Australians aged 50 years and older and Indigenous Australians aged 40 years and over was 0.24% (95% CI: 0.10, 0.52) and 0.79% (95% CI: 0.56, 1.13), respectively. Trauma was attributed as an underlying cause of bilateral vision loss in one Indigenous participant, with all other cases being monocular. Males displayed a higher prevalence of vision loss from ocular trauma than females in both the non-Indigenous (0.47% vs. 1.25%, p = 0.03) and Indigenous populations (0.12% vs. 0.38%, p = 0.02). After multivariate adjustments, residing in Very Remote geographical areas was associated with higher odds of vision loss from ocular trauma.ConclusionsWe estimate that 2.4 per 1000 non-Indigenous and 7.9 per 1000 Indigenous Australian adults have monocular vision loss due to a previous severe ocular trauma. Our findings indicate that males, Indigenous Australians and those residing in Very Remote communities may benefit from targeted health promotion to improve awareness of trauma prevention strategies.     

干扰素治疗慢性丙型肝炎患者所致视网膜病变的特征性分析

目的观察使用干扰素治疗的慢性丙型肝炎（HCV）患者出现视网膜病变的特征。方法接受干扰素治疗后出现视网膜病变的患者共24例纳入研究。所有患者均进行矫正视力、裂隙灯显微镜、散瞳间接检眼镜、眼底彩色照相检查。眼底检查由具有丰富经验的眼底病医生完成。观察所有患者的眼底病变特征。结果本研究24例患者中男性16例,女性8例,男女比例为2：1;年龄21～78岁,平均年龄（48士14）岁。24例患者中有35只眼眼底异常,双眼发病13例,单眼发病11例。12例患者使用后出现视物模糊。眼底检查中：35只患眼中17例23只眼,占患眼的65．7％;眼底表现为单纯棉绒斑,单纯视网膜出血2例2只眼,占忠眼的5．7％;棉绒斑合并视网膜出血8例10只眼,占患眼的28．6％。棉绒斑及出血多位于视盘旁颞上或颞下血管附近,少数可散布于全后极部血管旁;其出血部位多位于棉绒斑旁,表现为后极部火焰状、点状出血或Roth斑。结论干扰素所致眼底视网膜病变最常见的特征为棉绒斑,使用后建议定期随访。     

Ocular injuries caused by plastic bullet shotguns in Switzerland

Five patients with blunt ocular trauma due to hard plastic shotguns used by police forces during riots presented to the Ophthalmology Department of University Hospital in Zurich, Switzerland, between December 2000 and May 2001. All five eyes suffered ocular concussion. Three of five eyes presented with severe damage to the anterior segment of the eye, two of these eyes showed combined involvement of the anterior and posterior segments. Two patients completely recovered their visual acuity in the injured eye, two reached a final visual acuity of 6/12 and in one case the injured eye was legally blinded. Three of the patients claimed to have been uninvolved bystanders at the riots. The theoretical probability of hitting the head/neck area or one of the two eyes for each shot fired at a person from different operational distances is calculated and ophthalmological and technical aspects of this special type of plastic bullet shotgun used in Switzerland are discussed.     

Ocular burns and related injuries due to fireworks during the Aidil Fitri celebration on the East Coast of the Peninsular Malaysia

This study aims to describe the epidemiology of ocular burns and related injuries due to fireworks during the Aidil Fitri celebration on the East Coast of the Peninsular Malaysia. A prospective analysis of all patients with ocular burns and related injuries due to fireworks attended three tertiary hospitals in East Coast of Peninsular Malaysia during Aidil Fitri, which was from 10 September to 17 October 2008. We observed the demographic and injury characteristics, extent of the injuries and presenting visual symptoms. Thirty patients with 34 eyes with ocular burns and related injuries were identified. Patients ranged between 2 and 43 years of age. 70.00% of the patients were 12 years old and below. Of the 30 patients, 29 (96.67%) were male and the left eye was affected in 14 (46.70%). Thermal injuries accounted for 60.0% of the injuries whereas 40.0% were due to exploding firework. Burns to the eyelid and cornea (35.29%) were the most common injuries noted. Fifteen patients (50%) were bystanders whilst a majority of patients (96.67%) had no eye protection. At presentation, 15 (44.12%) eyes had a visual acuity of 6/6 to 6/9 in the injured eyes, while 3 out of 34 eyes (8.82%) had vision acuity 6/60 or worse. In conclusion, fireworks cause serious preventable ocular burns and related injuries especially in children who are the most affected age group. It affects mainly eyelid and anterior segment structures which result in moderate visual loss on presentation. Health education, public awareness and tighter legislation are essential preventive measures to limit the effect of fireworks to the public.     

Five-year results of radial keratotomy

We present 5-year findings on 198 consecutive radial keratotomy surgeries. Follow-up was obtained on 134 (68%) of these eyes. Mean spherical equivalent (SE) was -4.3 diopters before surgery, average keratometry was 44.11 D, and 75% of eyes had uncorrected distance acuity of 20/400 or worse. Average SE was -0.52 D for eyes seen at 5 years, which compares with -0.78 D for eyes examined at 18 months. Seventeen percent of eyes show at least a 1-D change in refraction from 18 months to 5 years compared with 13% between 18 months and 3 years. Fifty-six percent of eyes are within 1 D of emmetropia at 5 years, compared with 66% at 18 months. Uncorrected visual acuity was at least 20/40 in 62% of eyes seen at 5 years and in 73% of eyes seen at 18 months. Ten percent of eyes have lost at least two lines of best-corrected visual acuity from before surgery to 5 years later. Factors are identified that relate to loss of uncorrected and best corrected acuity over 5 years. Average keratometry at 5 years is 40.7 D, as compared with 41.2 D at 18 months. Long-term keratometric results appear less stable than refractive results and a theory for this instability is presented. The results indicate radial keratotomy to be safe and effective for the vast majority of patients in this series for 5 years postoperatively.     

Comparison of epikeratoplasty and penetrating keratoplasty for keratoconus

We report the results obtained in two groups of 30 eyes surgically treated for keratoconus. The eyes in the first group underwent epikeratoplasty, and those in the second group, penetrating keratoplasty. All eyes had sutures removed and a follow-up period ranging from 3 to 6 years. In the epikeratoplasty group, mean postoperative uncorrected visual acuity was 20/52 +/- 0.25; spectacle corrected, 20/23 +/- 0.18; and contact lens corrected, 20/21 +/- 0.17. In the penetrating keratoplasty group, mean postoperative uncorrected visual acuity was 20/63 +/- 0.23; spectacle corrected, 20/22 +/- 0.11; and contact lens corrected, 20/20.5 +/- 0.07. In the epikeratoplasty group, astigmatism (2.18 +/- 1.48) and astigmatism reduction (-4.16 +/- 2.98) were comparable to the penetrating keratoplasty group (astigmatism; 3.16 +/- 1.43 and astigmatism reduction; -4.2 +/- 2.56). Among the advantages offered by epikeratoplasty were both the absence of immunologic complications and reduction of operative risk. Penetrating keratoplasty provided patients with higher reduction of the myopic defect and earlier improvement in both visual acuity and contrast sensitivity.