Horseshoe-like macular tear following recurrent branch retinal vein occlusion

Background A macular hole can develop as a late complication secondary to a branch retinal vein occlusion (BRVO). We report about an atypical horseshoe-like tear occurring in the fovea after recurrent BRVO. Methods An interventional case report. Results In 1997, a 53-year-old man was seen with an occlusion of macular part of inferior temporal vein of the retina on the left eye. After experiencing several recurrent BRVO in this eye, 6 years later he presented with a horseshoe-like tear in the fovea. Visual acuity was 20/200. The patient underwent standard three-port vitrectomy and installation of C3F8 16%. Intraoperatively, massive traction of the vitreous was detected on the edges of the tear. Six months after the operation, the tear remained attached. The visual acuity was 20/200. Conclusions The uniqueness of the presented case is the occurrence of a macular tear following recurrent BRVO, its horseshoe-like shape and foveal location. To the best of our knowledge, this is the first report on a horseshoe-like tear seen in the fovea secondary to BRVO. We assume that chronic macular edema and retinal ischemia following BRVO were additional factors beside the vitreous traction, contributing to the formation of the macular tear. Anatomical closure of the tear and stabilisation of visual acuity can be achieved by vitreoretinal surgery. There is no financial interest to declare. No grant has been received in relation to this case. Presented as a poster at the 102nd meeting of the German Ophthalmologic Society, 2004 Berlin.     

Chorioidales Effusionssyndrom nach Embolisation einer indirekten Sinus-cavernosus-Fistel über die V. ophthalmica superior

Embolization of a cavernous sinus fistula (SCF) via the superior ophthalmic vein (SOV) was reported to be an almost uncomplicated procedure, even after ligature of the vein at the end of the procedure. We report about a complication of this therapy. A 58-year-old female had a successful embolization of a right indirect cavernous sinus fistula via the SOV. At the end of the operation the SOV was ligated because of the danger of bleeding. Directly after surgery she experienced general worsening of the right eye with signs of venous congestion and marked effusion syndrome. The patient underwent total heparinization to achieve an opening of venous collaterals. Under local therapy with atropine 1% eye drops a decrease of the intraocular pressure was observed. The effusion syndrome was completely resolved within 1 month. If embolization of a cavernous sinus fistula is performed via the SOV, the ligature of the vein at the end of the procedure leads to thrombosis, which can reduce the venous stream from the eye and orbit. A secondary effusion syndrome with ocular hypertension because of a ciliolenticular block situation is possible and requires appropriate therapy. It is not possible to assess the capacity and time of opening of the venous collateral system before surgery. Therefore a transient outflow disturbance should be considered.     

Pediatric Eye Trauma in the Republic of Tajikistan: More Than Meets the Eye

Purpose: Pediatric eye injury (PEI) is the leading cause of preventable monocular vision loss in children, with an estimated prevalence of 5.7 million cases. Epidemiological information on PEI is rare, skewed towards high-income countries, and commonly overlooked by non-governmental ophthalmological organizations. This study aims to quantitatively and qualitatively determine incidence of PEI in the Republic of Tajikistan.

Methods: Data were collected from all pediatric eye injury records (N = 454) admitted to three pediatric ophthalmology hospitals in two regions of Tajikistan between 2010 and 2012.

Results: A review of the records revealed a cumulative annual incidence of 12.8 PEI cases/100,000, with marked inter- and intra-regional differences. Mean age was 7.0 years (95% confidence interval, CI, 6.7–7.4), and male to female ratio was 2.5:1. PEI occurred predominantly outdoors (63%), in rural settings (76%) during unsupervised play, and typically resulted from the eye being hit (53%) by a pointed object (51%), resulting in an open-globe injury (56%). Median time-to-presentation was 24 hours (range 9.6 hours–10 days) and median duration of hospitalization was 15 days (range 2–29 days). Of the 454 cases, 111 (25%) resulted in a blind eye, 62 (14%) in severe visual impairment, and 45 (10%) in moderate visual impairment.

Conclusions: PEI is a major cause of pediatric monocular visual impairment in Tajikistan, with a high rural incidence of severe blinding injuries. Potential risks and outcomes relate to Tajikistan’s cultural, historical, and physical settings. We anticipate that the information provided by this study will facilitate development of culturally derived strategies to reduce PEI in Tajikistan.