Change in vitreous collagen after penetrating injury

Following controlled ocular penetrating injuries in rabbits, autologous blood was injected into the vitreous. All animals were examined with ultrasonography, ophthalmoscopy and photography. After 3 weeks the animals were sacrificed and serial histologic sections were made on the enucleated globes. Fibroblasts and collagen were found in the vitreous. In additional eyes, the altered vitreous was removed and examined by gel electrophoresis following limited pepsin digestion. Type I collagen was an important component of vitreous fibrosis. In contrast, only type II collagen was detected in normal vitreous. The collagen formation after hemorrhagic injury may follow a similar process of wound healing in other tissues.     

眼球穿通伤75例显微手术分析

目的:探讨眼球穿通伤在显微镜下手术的处理原则、方法及显微手术的优点。方法:对75例(77眼)眼球穿通伤病例进行回顾性分析。结果:眼球穿通伤以儿童、学生、青壮年为多,常见的致伤物为刀、剪、针及铁器伤;常见的受伤部位是角膜,角巩膜;常见的并发症是:虹膜脱出、外伤性白内障和前房、玻璃体积血。本组病例非手术治疗6眼(8%),手术治疗71眼(92%)。结论:精细的显微手术避免了以往肉眼术式的缺点,从而提高了手术成功率,降低了患者的致盲率。     

Incidence of sympathetic ophthalmia after penetrating eye injury and choice of treatment

Introduction: Sympathetic ophthalmia, a diffuse bilateral granulomatous panuveitis, is a serious potential complication after penetrating eye injury. Many surgeons recommend enucleation within two weeks of trauma to prevent this condition. We retrospectively reviewed the medical records of patients with penetrating ocular injuries who had either evisceration or enucleation to determine the incidence of sympathetic ophthalmia and to evaluate the surgical interventions and their complications. Age at surgery, time after penetrating trauma, surgery technique, follow-up period, ophthalmic examination of the fellow eye, and surgical complications were evaluated. Results: In total, 217 patients were included in the study with a mean follow-up period of 10.3 ± 6.6 years. The longest time between the trauma and time of surgery was 43 years. Postoperative uveitis was observed in only one patient (0.5%) who had primary repair after injury. Histopathological review did not reveal typical sympathetic ophthalmia. Complications after enucleation were significantly higher than after evisceration. Conclusion: There was no histopathologically supported sympathetic ophthalmia in our series. Sympathetic ophthalmia is very rare even when the injured eye is retained. With this in mind, the first choice of treatment may not be enucleation. Furthermore, evisceration may be the procedure of choice if primary repair cannot be performed or for patients who have panophthalmitis.     

Management of retinal detachment after penetrating eye injury

Between December 1981 and April 1989 the authors operated on 61 eyes presenting with retinal detachment after penetrating eye injury. Air or expanding gases were used for retinal tamponade. The follow-up between complete gas absorption and last examination ranged from 8 months to 8 years (mean, 29 months). Retinal reattachment was achieved in 50 eyes (81.9%). Anatomic success was achieved by a single operation in 43 eyes (70.5%). A postoperative visual acuity of 20/40 or better was achieved in 46% of the eyes. The factors found to influence the postoperative outcome adversely include (1) association of severe blunt trauma (P<0.05), (2) anterior proliferative vitreoretinopathy (PVR) involving two or more quadrants (P<0.01), and (2) retinotomies (P<0.007). Offprint requests to: M. Bonnet     

Prognosis of corneal transplantation after penetrating eye injury

BACKGROUND: The success of penetrating keratoplasty (PKP) after penetrating eye injuries is often worse than in keratoplasty with Fuchs' endothelial dystrophy. However, comparable investigations are rare. Therefore, we have retrospectively analyzed the results and complication rates of PKPs in patients who experienced penetrating eye injuries. PATIENTS AND METHODS: Between 1990 and 1997 forty-four patients who received a corneal transplant at Kiel University Eye Hospital after penetrating eye injury (study group S) were analyzed. 29 patients were re-examined (visual acuity testing, slit lamp microscopy, applanation tonometry, stereo testing, corneal TMS topography, keratometry, endothelial microscopy, perimetry, indirect retinoscopy, testing of the retinal visual acuity and probatory contact lens fitting). Postoperative follow-up ranged between 1 and 6 years (median 3 years). The results were compared to a group of corneal grafts performed in patients with Fuchs' endothelial dystrophy (K, n = 18 patients, 25 eyes, median follow-up 2.8 years). RESULTS: 38males and 6 women had had a bilateral visual acuity of 0.8 or better before the accident, except for three cases. At the time of eye injury the patients' age ranged from 4 to 76 years. The eye trauma was caused by splinters of metal (45 %), glass (20 %), wood (16 %) or stone (11 %). In 73 % of the cases the injury was confined to the anterior segment of the eye (S1). The posterior part of the eye was involved in 27 % (S2). BCVA of S before keratoplasty (KP) was 1/15 on average (K 0.2), at least one year after KP 0.25 (K 0.4); post KP S1 was better than S2 (p = 0.0234), and K better than S (p = 0.0009). In group S 29 patients received a graft at random because of a central corneal scar, 14 patients received an HLA-typed graft with 2.3 mismatches on average. 93 % of the grafts (41 patients) were clear at the last examination, 8 patients showed rejection episodes, half of them were reversible. 5 patients received a second graft because of an irreversible rejection or endothelial decompensation. BCVA improved by at least one line in 84 % in S (K 92 %). BCVA was unchanged after KP in 6.8 % (K 8 %). In 9.1 % of S BCVA after KP was worse (K 0 %). 32 out of 44 patients had a BCVA of 0.1 or better after the last check-up, 13 out of 44 patients presented with a BCVA of 0.5 or better (K40 %). 15 out of 29 patients separately tested showed stereopsis compared to 8 preoperatively in S. In 48 % of the patients studied stereovision could not be restored. 82 % of the patients suffered from topographical irregular astigmatism in S, the superficial geometry of recipient's cornea seems relevant for astigmatism of the graft. Frequent postsurgical complications consisted of secondary glaucoma (S 27 %, K 4 %), immunological rejections (S 18 %, K 0 %), and amblyopia (S 14 %, K 0 %). CONCLUSION: Compared to patients with Fuchs' dystrophy the results of grafting after eye injuries are significantly worse. This relates to BCVA, astigmatism, frequency of secondary glaucoma and graft rejection.     

Effects of beta-aminopropionitrile after posterior penetrating injury in the rabbit

Beta-aminopropionitrile, an inhibitor of collagen cross-linking, effectively limited the degree of posttraumatic vitreous proliferation in rabbits three weeks after double perforating injury. Light microscopic examination of the sites of perforating injury after five weeks showed minimal intravitreal fibrous proliferation in treated animals. Electron micrographs of the cicatricial vitreous collagen showed fragmentation of collagen into smaller fibrils and disintegration into amorphous areas. Inhibition of collagen cross-linking may undermine the strength of the vitreous scaffold by making vitreous and cicatricial collagen more sensitive to tissue collagenases produced during inflammation. The failure of fibrovascular membranes to grow into the vitreous may be a secondary effect of weakened vitreous support.     

眼球穿孔伤后继发性青光眼的临床调查分析

目的探讨眼球穿孔伤后继发性青光眼的病因及早期诊断方法。方法回顾性分析36例(36眼)眼球穿孔伤后继发性青光眼的临床资料，探讨继发性青光眼的原因、发生时间及与眼外伤的关系。结果穿孔性眼外伤后继发青光眼与粘连性角膜白斑、晶状体损伤和晶状体异位有关，集中于晶状体虹膜隔的损伤，而引起小梁网明显的功能损伤。结论眼球穿孔伤的正确处理，长时间密切随访观察和及早预防对视力的损害。     

Endophthalmitis due to Sporothrix schenckii after penetrating ocular injury

A 13-year-old boy developed endophthalmitis from traumatic inoculation of vegetable material penetrating his right eye. Sporothrix schenckii was morphologically identified from the intraocular fluids. However, repeated attempts to culture the organism proved negative. Seventeen sporotrical endophthalmitis cases have so far been reported, and before this report, only one of them was secondary to trauma. This is the sole eye to our knowledge not only to have escaped enucleation after sporotrical endophthalmitis but to have achieved useful (20/50) vision.     

眼球穿通伤玻璃体切除术后低眼压的临床分析

目的:探讨眼球穿通伤玻璃体切除术后,低眼压的发生率和危险因素。方法:对64例70眼因眼球穿通伤而行玻璃体切除术的临床资料进行回顾性分析,低眼压的诊断标准为眼压<5mmHg,并随访时间>6mo。结果:64例70眼因眼球穿通伤而行玻璃体切除术后发生低眼压14眼(20%);其中术前有眼内炎和无眼内炎眼术后低眼压发生率分别为40%和9%,两组之间比较差异有显著性意义(χ2=9.73,P<0.05);行视网膜切开术和未行视网膜切开术后低眼压者发生率分别为58%和12%,两组比较差异有显著性意义(χ2=10.57,P<0.05);前部增生性玻璃体视网膜病变者和无前部增生性玻璃体视网膜病变者术后低眼压者发生率分别为50%和14%,两组比较差异有显著性意义(χ2=6.04,P<0.05)。结论:低眼压是眼球穿通伤玻璃体切除术后的一个并发症,术前有眼内炎,术中行视网膜切开以及严重的前部增生性玻璃体视网膜病变是发生低眼压的危险因素。     

Hemorrhagic detachment of the internal limiting membrane after penetrating ocular injury.

During surgery to remove an intraocular gunshot pellet, a loculated "preretinal" hemorrhage was identified. This provided an opportunity to evaluate the structural identity of the inner wall, presumably representing detached posterior vitreous. The preretinal membrane was excised and evaluated using lectin histochemical analysis. All lectins tested bound to the excised tissue, supporting the conclusion that the membrane was a hemorrhagic internal limiting membrane detachment resulting from direct penetrating ocular injury. During intraoperative biomicroscopic examination, this detachment was indistinguishable from a subhyaloid hemorrhage. Because there are no natural history studies on internal limiting membrane loss and damage to retinal visual function, caution is urged in the surgical management of these lesions.     

重度眼球穿孔伤视网膜光感受细胞损伤的实验研究

目的 观察兔重度眼球穿孔伤视网膜光感受细胞胀亡(oncosis)情况和核糖核酸(RNA)的表达,以及两者在重度眼球损伤中的作用.方法 健康新西兰白兔制作重度眼球穿孔伤模型,用甲基绿-派罗宁-马休黄(MG-P-MY)染色法和超高倍镜分别观察细胞胀亡情况及进行细胞RNA检测.结果 对照组和1 h组未见胀亡细胞,3 h组出现胀亡细胞,6 h组胀亡细胞数达高峰,12 h组有所下降.3 h组在内核层及神经节细胞层有少量RNA阳性表达,6 h内核层阳性表达增多,12 h阳性表达明显,24 h可见大量RNA阳性细胞.结论 眼球枪弹穿孔伤后,胀亡是视网膜细胞死亡的另一种主要方式.在视网膜细胞死亡过程中,胀亡和凋亡是其主要死亡方式.     

穿透性角膜移植术后继发性青光眼的影响因素及治疗

目的探讨穿透性角膜移植术(penetrating keratoplasty,PKP)后继发性青光眼的发病因素及防治措施。方法对120例(121眼)PKP患者的临床资料进行回顾性分析,探讨发生继发性青光眼患者其术前原发角膜病变的类型及术后主要临床表现,同时观察根据不同病因给予药物或手术治疗后的效果。结果 121眼中发生继发性青光眼者25眼,总发生率为20.66%;发生率较高的有角膜溃疡、排斥再移植、大泡性角膜病变,而单纯性角膜白斑、圆锥角膜、角膜营养不良或变性的发生率相对较低。术后引起继发性青光眼发生的相关因素早期主要由于黏弹剂滞留,严重眼前段炎症,术后发生虹膜前后粘连;晚期主要原因为角膜内皮失代偿,术后使用糖皮质激素未作定期随访,发生免疫排斥反应等。所有患者经分析病因后给予药物或联合手术治疗眼压均得到有效控制。结论 PKP术后继发性青光眼的发生率与术前角膜病变的类型有相关性,临床准确分析病因、给予对应处理可有效控制眼压。     

Long-term effects of topical cyclosporine A treatment after penetrating keratoplasty

PURPOSE: To evaluate the long-term outcome of topical 2% cyclosporine A (CsA) treatment as an adjunct to topical corticosteroid treatment of patients after penetrating keratoplasty (PKP). METHODS: We reviewed the records of 83 patients (86 eyes) who had undergone PKP and received topical CsA treatment postoperatively; also the records of 95 PKP patients (97 eyes) who received the same treatment, except for the 2% CsA eyedrops, and served as controls. The patients were also subdivided into high-risk and low-risk groups. The clinical outcome of PKP was evaluated by the rates of graft survival and rejection-free graft survival, using the Kaplan-Meier method, and compared with the log-rank test. RESULTS: In the high-risk patients, the rejection-free graft survival rate was 69.7% in the CsA group and 45.4% in the control group (P =.030), but there was no significant difference in the graft survival rate between the two groups. CONCLUSION: Topical cyclosporine treatment is effective in reducing the risk of allograft rejection in high-risk patients.     

Corneal wedge excision in the treatment of high astigmatism after penetrating keratoplasty

PURPOSE: To report 5 cases of high astigmatism after penetrating keratoplasty (PK) treated with corneal wedge excisions. METHODS: We report our experience of 5 patients treated with corneal wedge excisions for high astigmatism after PK. A thin sliver of cornea measuring between 0.1 and 0.2 mm in thickness was excised from just inside the graft-recipient interface. The length of the incision centered at the axis of the flatter meridian of the cornea and was extended over a range of 60-90 degrees. The wound was closed with interrupted 10-0 nylon sutures placed every 15 degrees. We also report, for the first time, both pre- and postoperative corneal topography in 3 of our patients who underwent wedge excisions. RESULTS: The mean preoperative astigmatism was 15.2 D (range, 8.5-29.1 D). Postoperatively, after wedge excision, the mean astigmatism was reduced to 2.3 D (range, 1.9-3.7 D). The mean reduction in astigmatism was 12.9 D (range, 6.3-25.4 D). CONCLUSIONS: Corneal wedge resection is an effective treatment for high astigmatism after PK. It may prove particularly useful in cases of high astigmatism or where other treatments are not appropriate. We believe that there is still a role for wedge resection as one of many tools to be used in the treatment of high post-PK astigmatism.     

Traumatic cataract management in penetrating ocular injury

Eight patients with lens damage caused by penetrating ocular trauma underwent delayed cataract removal four to 30 days after the initial injury. All but one patient, who had a retinal detachment, achieved a visual acuity of 20/50 or better. A short delay in the treatment of the cataract as well as the use of intraocular lenses did not appear to have an adverse effect on the visual prognosis.     

Intravitreal cilia in phakic penetrating eye injury

Background: Intraocular cilia present clinical perplexity due to their radiolucency, the extremely variable ocular response to such cilia, and the inadvisability of using MRI in cases of suspected metallic intraocular foreign bodies (IOFB). Methods: Two cases of intravitreal cilia associated with phakic penetrating eye injury are described where preoperative CT scan revealed no retained IOFB. Results: B-scan ultrasonography detected intravitreal cilia in one patient and raised this suspicion in the other. One patient presented with endophthalmitis unresponsive to intravitreal antibiotics, the other with culture-negative anterior uveitis. Both underwent vitrectomy and removal of cilia. Conclusions: Intravitreal cilia should be considered in penetrating eye injuries even in phakic eyes with no radiological evidence of IOFB, especially if associated with endophthalmitis. B-scan ultrasonography may aid detection of intravitreal cilia and thus alter clinical management.     

角膜移植术后行白内障摘出人工晶状体植入对角膜植片的影响

目的探讨穿透性角膜移植术后白内障行白内障摘出联合人工晶状体植入术对角膜植片的影响。方法穿透性角膜移植术6个月后行白内障摘出联合人工晶状体植入术17例（17眼）,随访3～18个月,平均11个月,观察术后角膜水肿情况、角膜内皮细胞计数变化、眼压变化、免疫排斥反应和术后并发症,并进行分析。结果术后所有患眼裸眼视力≥0．3,最佳矫正视力≥0．5者8眼。术后角膜水肿3～7d内消退,角膜恢复透明。术前角膜内皮计数平均为（1547±111）个／mm2。术后3月内皮细胞数量稳定,平均为（1275±106）个／mm2,内皮细胞丧失率平均为4．92％。无其它不良反应。结论对穿透性角膜移植术后行白内障摘出联合人工晶状体植入术对角膜植片是安全的。     

超声乳化吸除联合人工晶状体植入治疗穿透性角膜移植术后白内障

目的:对穿透性角膜移植术后白内障进行超声乳化吸除术,分析其对角膜移植片内皮细胞的影响因素。方法:单纯穿透性角膜移植术后11眼,未出现排斥反应7眼,排斥反应控制后3mo以上3眼,角膜缝线已拆除。术前裸眼视力光感～0.1,术前及术后均检测角膜植片中央内皮细胞计数,晶状体核III～IV级。手术方式为超声乳化吸除联合人工晶状体植入术,术中平均超声能量14.82%±0.47%,流速26mL/min,负压180～200mmHg(U/SPower),200～210mmHg(U/SPulse)。超声时间1.5～2.5(1.95±0.47)min。术后常规抗生素及激素眼液点眼。结果:术后最佳矫正视力0.2～0.5,均较术前提高。术后2～3d,角膜植片少许内皮皱褶,术后4d角膜恢复透明。术前术后角膜移植片中央部位内皮细胞计数分别为:607～1998(1248.09±408.52)个/mm2和601～1899(1184.36±373.92)个/mm2,术后内皮细胞丢失率为5.11%,与术前比较采用配对t检验得t=3.6418,P<0.05,有统计学意义。随访3mo以上,角膜植片保持透明,内皮细胞稳定。未发现大泡样角膜病变。结论:穿透性角膜移植术后白内障,超声乳化术式安全有效。