Showing papers on "Eye injuries published in 2002"

Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries

Abstract: Lacking a standardized terminology of eye injury types, it is impossible to fulfill a very basic requirement in medicine: that all communications be unambiguous. Accurate interpretation of published research results, which plays an absolutely crucial role in determining how an individual patient with an eye injury is treated, becomes difficult. This article presents an internationally standardized system that finally allows accurate description of eye injuries of all types.

Nonpreserved human amniotic membrane transplantation in acute and chronic chemical eye injuries.

Abstract: Purpose To evaluate the safety and efficacy of nonpreserved amniotic membrane transplantation (AMT) with or without limbal autograft transplantation (LAT) in management of acute and chronic chemical eye injuries. Methods Amniotic membrane transplantation or AMT + LAT was performed on nine eyes of seven consecutive patients, five eyes with acute chemical burn and four eyes with limbal stem cell deficiency secondary to previous chemical burn. Nonpreserved amniotic membrane was used in all procedures. Results Five patients (71.5%) were men and two (28.5%) were women. The average age at the time of surgery was 32.7 +/- 10.9 years (range, 20-45). Mean follow-up after last surgery was 8.9 +/- 3.2 months (range, 6-14). The average epithelial healing time was 24.6 +/- 17.3 days (range, 3-45). At the end of the follow-up period, visual acuity improved in all eyes, inflammation subsided, and the subjective complaints decreased remarkably. Conclusion AMT with nonpreserved amniotic membrane promoted epithelial healing, reduced surface inflammation, increased patient comfort, and decreased the extent and severity of vascularization when used in patients with acute chemical burns. When used in limbal stem cell deficiency owing to past chemical burns, AMT alone or in combination with LAT aided in ocular surface reconstruction. Infectious, inflammatory, or toxic/allergic reactions were not encountered in any patient owing to the use of nonpreserved amniotic membrane. Further studies are required to establish the safety and efficacy of preserved and nonpreserved AMT in ocular surface reconstruction.

Four-year review of open eye injuries at the Royal Adelaide Hospital.

Abstract: Purpose: To review the epidemiology of penetrating eye injuries and ruptured globes presenting to the Royal Adelaide Hospital, South Australia. Methods: A retrospective case review over a 4-year period. Results: There were 109 penetrated or ruptured globes in 105 patients. The average age was 41 years and 80.2% were men. Over half were from rural areas. The commonest cause of injury was hammering metal followed by motor vehicle accidents. Falls in the elderly were the commenest cause of globe ruptures. A final visual acuity of 6/12 or better was found in 40% of eyes and no perception of light in 27%. Conclusions: At the Royal Adelaide Hospital, the predominant referral centre for serious ocular injury in South Australia, approximately 25 open globe injuries are encountered a year. Although the epidemiology of these injuries was found to be similar to those previously reported in Victoria and rural New South Wales, differences were thought to reflect to the ageing population of South Australia. Rupture of an old, healed large-incision cataract extraction wound was the commonest cause of ruptured globe. An effective preventive strategy to reduce the incidence of severe ocular trauma has yet to be implemented. The concept of a national population-based severe ocular trauma database is considered.

Leading causes of blindness worldwide.

Abstract: The main causes of blindness and visual disabilities, as described in documents published by the World Health Organization (WHO), are discussed.

Pattern of pediatric ocular trauma in India

Abstract: Objective : The aim of the study is to identify the causes, demographic and clinical profile and evaluate final visual outcome of pediatric ocular injuries.Methods : Two hundred and four children aged fourteen years or less presenting to the emergency services of a tertiary care centre with ocular injury were included. Demographic data, nature and cause of injury, duration between injury and presentation to an ophthalmologist and the diagnosis were recorded. Evaluation of visual acuity, anterior segment and fundus were done. All patients were appropriately managed and followed up on days 1, 7,1 month, 3 and 6 months.Result : Majority of injuries occurred in children of 5 years and older (87.7%). There were 133 (65.1%) boys and 71 (34.9%) girls. Forty-nine (24%) cases presented within 6 hours of injury while 70 (34.3%) presented after more than 24 hours after trauma. Most common cause of injury was bow and arrow (15.2%) followed by household appliances (14.3%). Closed globe injuries accounted for 42.2% injuries, open globe for 53.9% and 3.9% were chemical injuries. Best corrected visual acuity of 6/12 or better was achieved in 79 eyes (91.86%) in closed globe group. However, only 17 eyes (15.45%) in open globe group could achieve this.Conclusion : Most ocular injuries in children are preventable and occur from unsupervised games like bow and arrow and firecracker, which can lead to significant visual loss.

The Effect of Frontal Air Bags on Eye Injury Patterns in Automobile Crashes

Abstract: Objective To investigate eye injuries resulting from frontal automobile crashes and to determine the effects of frontal air bags. Methods The National Automotive Sampling System database files from January 1, 1993, through December 31, 1999, were examined in a 3-part study that included an investigation of 22 236 individual crashes that occurred in the United States. A new 4-level eye injury severity scale that quantifies injuries based on recovery time, need for surgery, and possible loss of sight was developed. Results Of all occupants who were exposed to an air bag deployment, 3% sustained an eye injury. In contrast, 2% of occupants not exposed to an air bag deployment sustained an eye injury. A closer examination of the type of eye injuries showed that there was a statistically significant increase in the risk of corneal abrasions for occupants who were exposed to an air bag compared with those who were not ( P = .03). Of occupants exposed to an air bag deployment, 0.5% sustained a corneal abrasion compared with 0.04% of occupants who were not exposed to an air bag. Conclusions Using the new injury levels, it was shown that although occupants exposed to an air bag deployment had a higher risk of sustaining minor eye injuries, the air bag appears to have provided a beneficial exchange by reducing the number of severe eye injuries.

The Epidemiology and Diagnosis of Penetrating Eye Injuries

Abstract: UNLABELLED It is estimated that there are 3.1 penetrating eye injuries per 100,000 person-years in the United States. OBJECTIVES To evaluate the epidemiology of penetrating eye injuries and to identify physical examination findings that facilitate the diagnosis and ophthalmologic referral of patients with these injuries. METHODS This was a retrospective chart review of emergency department patients with penetrating eye injuries seen for evaluation from July 1987 to January 1999. The setting was a tertiary referral, university hospital. Three hundred eighty-four patients with 390 penetrating eye injuries were enrolled; 56% were transferred from outlying hospitals. RESULTS Penetrating eye injuries were seen almost three times per month. Eighty percent of the injuries occurred in males, and the mean age was 29 years. Twenty-five percent of the patients had used alcohol in the period immediately preceding the injury. Final visual outcome was 28% with enucleation, "no light perception" (NLP) in 10%, light perception to 20/200 in 24%, and light perception of 20/200 or better in 38%. Poor visual outcome was associated with poor initial visual acuity, alcohol use, and delayed presentation (p = 0.036, 0.025, 0.036, respectively). Gun-related injuries caused 33% and motor vehicle crashes (MVCs) caused 21% of the worst outcomes (enucleation or NLP). In MVCs where seat belt use was reported, 71% of injured patients were unrestrained. The most common initial physical findings were hyphema (76%), abnormality of the pupil or uvea (94%), and initial visual acuity worse than 20/200 (77%). All patients had at least one of these findings. Complications occurred in 25% of cases, most commonly traumatic cataract or infection. Complications occurred more commonly in those patients transferred than in those presenting directly (p = 0.002). CONCLUSIONS Penetrating eye injuries are relatively common, occur predominantly in young males, and often result in poor visual outcome in the affected eye. Motor vehicle crashes, alcohol use, and fire-arm use are associated with more severe injuries.

Intraocular foreign bodies.

Abstract: The most important rule in treating patients with an intraocular foreign body is that the primary goal of the intervention, while typically including foreign body removal, is comprehensive anatomical reconstruction of the injured eye so that the best possible visual outcome can be achieved. If the ophthalmologist is unable to perform such surgery, the patient should be referred to a facility where the expertise and personnel are available to address all treatable tissue lesions. If the foreign body is in the posterior segment, vitrectomy is usually necessary. With appropriate management, most eyes have a good chance of regaining and maintaining useful vision.

Fungal keratitis caused by Scedosporium apiospermum: report of two cases and review of treatment.

Abstract: Purpose We report our experience in treating two cases of Scedosporium apiospermum keratitis and provide a review of basic scientific and clinical data regarding the treatment of this visually devastating disease. Method We present a case report and literature review. Results A 35-year-old woman and a 73-year-old man both reported pain, redness, and a foreign body sensation in the eye after trauma. They were initially treated with antibacterials. When cultures were positive for S. apiospermum, the first patient was treated with fluconazole and amphotericin with good results. The second was treated with fluconazole and natamycin, but the infection persisted and the eye was eventually enucleated. Review of the literature showed variable responsiveness of S. apiospermum to antifungal treatment. Conclusions It is difficult to predict how S. apiospermum keratitis will respond to treatment, but miconazole appears to be useful in conjunction with other antifungals. Voriconazole shows promise as an effective alternative.

Eye health of industrial workers in Southeastern Nigeria.

Abstract: A cross-sectional ophthalmological survey to determine the ocular health in Nigerian industries was undertaken in four randomly selected industrial establishments in Enugu State of Nigeria. The industrial establishments studied were the cement factory, coal mine, saw mill and iron/steel works where motor spare parts are fabricated. Of the 646 workers, 184 (28.5%) had a history of industrial accidents, 81 (12.5%) of which affected the eye. Eye injury was most commonly caused by metal chips, cement dust, fragments of wood, pieces of coal stone and welders' arc rays all of which could be prevented by wearing appropriate protective eye coverings. Contusion injury was the most common type of injury reported. Eye accident rate varied from factory to factory as also did the wearing of protective eye devices. overall, the percentage of workers using protective eye cover was 16.7% but there was a significant difference between the factories in this respect, protective eye wear being more often used in factories with higher eye accident rates. A total of 646 technical workers had detailed ophthalmological examination. The types and frequencies ofvisual disorders seen as well as the nature and causes of eye injuries were determined. Five hundred and twenty-eight workers (81.7%) had eye disorders. Presbyopla was responsible for 203 (31.4%) of these disorders while 169 (26.2%) were refractive errors. Of the others, pterygium and pingueculum together numbered 179 (27.7%) while cataract was found in 79 (12.2%) subjects. The results showed a high frequency of eye injuries among industrial workers and a low level of use of protective eye cover while at work. It is recommended that legislation requiring the use of protective devices in high-risk industries should be vigorously enforced to improve the eye health of Nigerian industrial workers.

Relation of ocular trauma to cortical, nuclear, and posterior subcapsular cataracts: the Beaver Dam Eye Study

Abstract: Background: The consequences of minor ocular trauma in the general population are unclear. The relation of self reported ocular trauma to cortical, nuclear, and posterior subcapsular cataracts is described in a defined population. Methods: Population based, cross sectional study involving all people aged 43 to 86 years, living in Beaver Dam, Wisconsin (n=4926). Ocular trauma was ascertained by interview and cataract was graded from lens photographs. The relation of ocular trauma to cortical, nuclear, and posterior subcapsular cataracts was examined. Results: People with a history of ocular trauma were more likely to have cortical (odds ratio (OR): 1.5; 95% confidence interval (CI): 1.0 to 2.2) and posterior subcapsular (OR: 1.7; 95% CI: 1.0 to 3.1) cataracts, compared to people without a history of trauma. These associations were stronger for people with previous trauma caused by a blunt object (OR: 3.3; 95% CI: 1.6 to 6.9 for cortical cataract, and OR: 4.1; 95% CI: 1.5 to 10.8 for posterior subcapsular cataracts). However, in analyses comparing the frequencies of cataract between traumatised and non-traumatised eyes among people with unilateral ocular trauma, the ocular trauma association for cortical cataract was no longer present, although the association for posterior subcapsular cataract persisted (OR: 2.4; 95% CI: 0.8 to 7.8). Conclusion: The data provide evidence of a possible association between self reported ocular trauma and posterior subcapsular cataract.

Surgical approaches to the management of epithelial cysts.

Abstract: PURPOSE: The purpose of this study was to review management strategies for treatment of epithelial cysts. STUDY DESIGN: Retrospective consecutive interventional case series. METHODS: Charts of patients treated for epithelial ingrowth over a 10-year period by a single surgeon (J.A.H.) were reviewed. Cases of epithelial cysts were identified and the following data were recorded: details of ocular history, preoperative and postoperative visual acuity, intraocular pressure (IOP), ocular examination findings, type of surgical intervention, and details of subsequent procedures performed. RESULTS: Seven eyes with epithelial cysts were identified. Patients ranged in age from 1 1/2 years to 53 years at presentation. Three patients were children. Four cysts were due to trauma, one was presumably congenital, one developed after corneal perforation in an eye with Terrien's marginal degeneration, and one developed after penetrating keratoplasty. Three patients were treated with vitrectomy, en bloc resection of the cyst and associated tissue, fluid-air exchange, and cryotherapy. Four patients were treated with conservative strategy consisting of cyst aspiration (three cases) or local excision (one "keratin pearl" cyst) and endolaser photocoagulation of the collapsed cyst wall or base. In all cases, the epithelial tissue was successfully eradicated; one case required a second excision (follow-up, 9 months to 78 months; mean, 45 months). Two eyes required subsequent surgery for elevated IOP, two for cataract extraction, and one for a second penetrating keratoplasty. Final visual acuity ranged from 20/20 to hand motions, depending on associated ocular damage. Best visual results were obtained in the more conservatively managed eyes. CONCLUSION: Epithelial cysts can be managed conservatively in selected patients with good results. This strategy may be particularly useful in children, in whom preservation of the lens, iris, and other structures may facilitate amblyopia management.

Open eye injuries in the pediatric population in Kuwait.

Abstract: Objective: To report the epidemiological characteristics of pediatric open globe injuries and to discuss treatment, management and outcomes of such injuries. Materials and

Eye injuries in women's lacrosse players.

Abstract: Objective To determine the prevalence of eye injuries among intercollegiate women's lacrosse players as well as the level of play, specific play settings, and particular mechanisms associated with these injuries. Design Anonymous, retrospective, survey. Setting Intercollegiate lacrosse tournament. Participants Collegiate and postcollegiate women's lacrosse players. Main Outcome Measures Self-reports of eye injuries, injury circumstances, treatment received, playing time missed, and continuing problems were recorded. Results Surveys were collected from 667 players from 34 teams (83% of players listed on rosters). A total of 125 injuries were reported among 84 players (12.6%). Injuries occurred equally in high school and college. Athletes were injured most frequently in games (41 injuries) and practices (38 injuries), with 17 players injured during the off-season. Several mechanisms of injury were noted. Fifty-three women sustained injuries requiring medical attention. Of those athletes injured, 23 missed 1–5 days and 9 players missed more than 5 days. Four athletes (4.8%) reported residual problems from an eye injury sustained while playing lacrosse. Conclusions Eye injuries are occurring more frequently than current surveillance data suggest. Because injuries are seen at all levels of play, in many different situations, and by multiple mechanisms, mandatory eyewear is needed to prevent serious eye injuries in women's lacrosse.

Primary repair and intraocular lens implantation after perforating eye injury

Abstract: Purpose To evaluate the clinical outcome after primary treatment of lens injuries with corneal or corneoscleral trauma. Methods Ten eyes of 10 patients were retrospectively evaluated. There were no foreign bodies in any eye. After primary repair, an anterior chamber maintainer (ACM) was introduced through the inferotemporal corneal quadrant. Sodium hyaluronate 1.4% (Healon GV®) was injected, and the anterior capsule was stained with trypan blue 0.1% vital stain (Vision Blue®) under the viscoelastic substance. After a capsulorhexis was created, the lens material was aspirated. The nucleus was delivered from the scleral tunnel, which was opened from the superior/superotemporal corneal quadrant. A conventional 21.0 diopter poly(methyl methacrylate) intraocular lens (IOL) with a 5.5 mm optic and overall diameter of 12.5 mm (Dr. Schmidth®, Hannan Kibbutz) was implanted through the scleral tunnel. The scleral tunnel was not sutured, and the corneal entry sites were closed with stromal hydration. Results The final best spectacle-corrected visual acuity (BSCVA) was better than 20/100 in all patients, and 6 patients had a BSCVA of 20/20. The IOL was in the capsular bag in all patients at the last follow-up. The mean follow-up was 12.3 months (range 7 to 25 months). The main visually limiting factors were corneal scar, irregular astigmatism, and traumatic maculopathy. Conclusions Primary IOL implantation in carefully selected patients with penetrating corneoscleral lens injury may yield visually rewarding results. The use of a vital stain to increase the visibility of the injured anterior capsule and of a closed scleral tunnel system with an ACM increased the surgical safety.

Mechanical eye (globe) injuries in children.

Abstract: PURPOSE: The epidemiology of mechanical eye injuries in children was studied to identify the agents of injury and their contribution to the severity of visual loss and to suggest preventive measures. METHODS: The mode, type, and severity of injury were correlated with the visual acuity 6 months after the injury in all children with mechanical eye injuries between January 1994 to January 1999. RESULTS: Of the 68 children with mechanical eye injuries, the mode of injury was host (child) related in 12 (17.65%) patients, agent related in 40 (58.82%) patients, and environment related in 16 (23.53%) patients. Mild injuries were seen in 22 (32.35%) patients, 31 (45.59%) patients had moderate injuries, and 15 (22.06%) patients had severe injuries. None of the patients with host-related injuries had a severe injury. Six (66.67%) patients with host-related injuries had a good visual outcome and none had a poor outcome. Among patients with agent-related injuries, 11 (25%) had a good outcome, 14 (40%) patients had a fair outcome, and 10 (22.5%) patients had a poor outcome. Of the patients with environment-related injuries 3 (33.33%) each had good, fair, and poor visual outcomes. CONCLUSIONS: Agent and environment-related injuries had a far worse outcome than host-related injuries. This epidemiological classification directly suggests practical preventive measures that can be adopted at home or at school to reduce the incidence and severity of ocular injuries. The other predictors of the final visual outcome were the severity of the injury at presentation and the necessity for a secondary surgical procedure. Language: en

Ocular emergencies in Kinshasa (Democratic Republic of Congo).

Abstract: PURPOSE: To determine frequencies of ocular emergencies and identify their nature. DESIGN: Observational case series. METHODS: In a retrospective study, the records of all 118 consecutive patients seen in emergency room during an eleven-month period were reviewed. RESULTS: Ocular emergencies represented 4% of the 2917 new patients visiting the department of Ophthalmology during this time. There was a 2.1/1 male to female preponderance and a peak age of presentation between 11 and 30 years. The mean age was 26 years +/- 17. Ocular trauma (68 patients) accounted for over two-fourths (57.6%) of the total cases. Only 16% of patients presented within 48 hours. Fifty-one percent of injuries occurred to the left eye, 38% to the right, and 10% bilaterally. The commonest ocular injury problems were eyelid laceration (13 patients, 19.1%), post-traumatic iritis (12 patients, 17.6%), and corneal laceration and penetration (10 patients, 14.7%), accounting for 51% (35 patients) of the total. Home- and work-related ocular injuries accounted for 54% of all ocular injuries. Thirty-three percent of all ocular injuries were caused by assault and fight, and 15% were related to motor vehicle accident. For the non-traumatic ocular emergencies, the main aetiological factor was inflammation (18%). CONCLUSION: Our study showed that males account for the majority of eye injuries and this class is more prone to assault-related injuries. In our country prevention strategies must take account of these. Language: en

Eye injuries in the young in Ile-Ife, Nigeria.

Abstract: One hundred and seventeen children aged 0-17 years treated for eye injuries at the Obafemi Awolowo University Teaching Hospital Ile-Ife, Nigeria were studied. Seventy-five were males and 42 were females with a mean age of 10 years 4 months. Injuries occurred with increasing frequency after the age of 4 years and were commonly sustained by children at play (50.4%); during corporal punishment (10.3%); assault (9.4%) and street hawking (9.4%). Causative agents were mostly sticks and twigs, followed by missiles and fall. Visual prognosis was best in patients with contusion injuries (48.3%) and worst in those with perforating eye injuries (30.5%). Blindness of the injured eye occurred in one-third of the patients and another 17.5% had significant visual impairment. This study shows a variation in the aetiology and visual outcome of eye injuries in the young. Strategies for the prevention of eye injuries are mainly health education, improved supervision of children at play, change in the method of corporal punishment and provision of protective devices for adolescents at work. Early diagnosis and prompt management will improve visual prognosis. Language: en

Vitreous Floaters Following Use of Dermatologic Lasers

Abstract: background. Laser eye protection has been designed to protect operators and patients from severe eye injuries. objective. To describe two cases in which lasers used for cutaneous therapy may have been associated with the induction of vitreous floaters, a subacute eye injury, in physicians operating these devices, and to review the theoretical feasibility of such injuries, prior reports of the same, and strategies for minimizing risk. methods. Report of two cases and review of the literature. results. Given the circumstantial evidence, it is possible that subacute vitreous injuries may be sustained by the operators of dermatologic lasers. Ex vivo experiments and previous case reports have demonstrated the possibility of laser-induced vitreous injury, including changes in vitreous conformation and vitreous hemorrhage, in the absence of permanent retinal deficits. It may be speculated that vitreous floaters are a milder manifestation of such subacute injuries. conclusion. To the extent that vitreous floaters can multiply and presage the onset of severe retinal injury, the risk of their induction by dermatologic lasers should be minimized. Simple strategies and further research can help achieve this goal.

Anterior chamber abnormalities and cataract.

Abstract: Material occurring in the anterior chamber as a result of trauma may be of little or major significance. The most common finding requiring treatment is hyphema. Close observation and (often surgical) treatment is especially important in patients at high risk: those with sickle cell disease, rebleeding, and elevated intraocular pressure. Cataract is a common complication in eyes sustaining serious trauma, although its presence may be difficult to confirm during the initial repair. The diagnosis is especially crucial because of the significantly increased risk of endophthalmitis. If the surgeon is able to determine that cataract is indeed present and hinders visualization of the posterior segment, or may lead to rapid elevation of the intraocular pressure, primary lens removal should be considered because vitreoretinal injuries are expected in approximately one-half of eyes, and an early retinal examination is mandatory in all eyes with lens trauma. Because one out of two eyes have posterior capsule injury, vitrectomy methods of lens removal are commonly required. Preservation of the posterior capsule is less important than avoiding traction on the anterior vitreous, because alternative methods of intraocular lens placement offer similar functional results.

Traumatic rupture of the globe caused by cow horns.

Abstract: PURPOSE: We investigated the epidemiology, clinical findings and functional outcome of open-globe injuries caused by cow horns over a 50-year period in eastern Switzerland. METHODS: We retrospectively evaluated the files of cases with ruptures of the globe caused by cow horns between 1950 and 1999. RESULTS: We found 59 cases with ruptures of the globe by cow horns, accounting for 5% of all open-globe injuries. The incidence of these accidents did not change during the observation period. Twenty-two eyes (37%) were enucleated. Only 7 eyes (12%) retained a vision of > or = 0.1. Between 1950 and 1989 only 2/43 eyes (5%) reached a vision of > or = 0.1. In the 1990's, with the introduction of vitreous surgery 5/16 eyes (31%) had a vision of > or = 0.1. Four patients (7%) had blinding eye disease in the partner eye, and three (5%) had a second open-globe trauma. CONCLUSIONS: In rural regions, with cattle breeding, open-globe injuries by cow horns are relatively common and the frequency is still the same as 50 years ago. The visual prognosis of these eyes is still guarded, but functional results have improved with the introduction of vitreous surgery. Patients who have had a rupture of the globe appear to have an increased risk for partner eye trauma. Therefore, all efforts are justified to preserve even limited vision in severely injured eyes. Language: en

Superficial keratectomy, limbal autotransplantation and amniotic membrane transplantation in the treatment of severe chemical burns of the eye

Abstract: Kozak, I., A. Trbolova, Z. ·evaikova, T. Juhas, V. Ledeck˘: Superficial Keratectomy, Limbal Autotransplantation and Amniotic Membrane Transplantation in the Treatment of Severe Chemical Burns of the Eye. Acta Vet. Brno 2002, 71: 85-91. Alkali burns are the most serious of chemical injuries of the anterior segment of the eye. Their treatment is aimed at preservation and/or restoring limbal stem cells and reconstruction of the ocular surface. Autologous limbal transplantation is used in management of damaged limbal stem cells and amniotic membrane transplantation in reconstruction of the burnt ocular surface. The aim of this study was to clinically and histopathologically evaluate treatment of severe chemical eye injuries. Limbal autograft transplantation and transplantation of amniotic membrane were combined with superficial lamellar keratectomy. Fifteen New Zealand white male rabbits were used in the experiment. General anaesthesia was induced before 2.5 N NaOH solution was applied to one eye of each animal. The surgery of injured eye consisted of following steps: after keratectomy of necrotic cornea limbal graft from the contralateral eye was transferred on the injured eye and covered by amniotic membrane which was attached 5-7 mm from the limbus. In the post-operative period Infectoflam® eye drops (Novartis) were applied 4 times daily for 4-6 weeks. Clinical evaluation was done regularly at 2 and 4 weeks and 4 and 9 months after surgery. We evaluated corneal edema, vascularization, erosion, conjunctival hyperemia, limbal ischemia, blepharospasm, ocular discharge, tear film stability and symblepharon formation. Two eyes spontaneously perforated at the end of the first month. Corneal edema was most intense at 4 weeks and improved at the end of follow-up in 8 eyes (62%). Vascularization was most prominent at 4 weeks in all cases and after 9 months was local in 5 eyes (38%) and diffuse in 3 eyes (22%). Complete re-epithelization was achieved in 9 eyes (68%). Conjunctival hyperemia was present in all eyes at 2 weeks and in 2 eyes (15%) at 9 months. Limbal ischemia was present in all eyes at 2 weeks and in 5 eyes (38%) at the end of follow-up period. Blepharospasm was present in 2 eyes (15%) at 4 months and disappeared at the last control. Purulent discharge was most intense at 2 weeks (9 eyes - 69%), after 9 months we noticed only increased watering in 2 eyes (15%). Symblepharon was initially seen in 5 eyes (38%) and was noticed in 3 eyes (22%) at the end of follow-up period. Our results show that amniotic membrane transplantation after superficial keratectomy combined with limbal autograft transplantation after severe alkali burn significantly contributes to reparative process of the ocular surface. Chemical burns, experiment, limbal autotransplantation, amniotic membrane transplantation The integrity of the ocular surface is kept by corneal, limbal and conjunctival epithelia together with the presence of tear film. The proper function of these structures represents a universal protective mechanism of the anterior segment of the eye. When these structures and their functions are altered, ocular surface reconstruction becomes problematic. In alkali burns, the most serious chemical injuries, saponification of fatty acids in cell membranes occurs which enhances penetration of the noxious substance to deeper layers of the anterior segment of the eye. The most important prognostic factors in clinical evaluation of the chemical eye injuries is assessment of the corneal transparency and the status of the limbal stem cells. Based on these criteria chemical injuries are classified into 4 grades

Eye contusions caused by a bottle cap. A retrospective study based on the Erlangen Ocular Contusion Register (EOCR)

Abstract: BACKGROUND: Perforating ocular injuries due to exploding beverage bottles are well known. However, bottle caps alone may also induce severe ocular damage due to ocular contusions while opening carbon dioxide-containing beverage bottles. We studied this type of ocular contusion. PATIENTS AND METHODS: Retrospectively, we examined all findings, operations, and tension profiles of 400 consecutive patients with ocular contusion who had been hospitalized in the Department of Ophthalmology, University Erlangen-Nurnberg, using the Erlangen ocular contusion registry (EOCR). RESULTS: Seven patients were injured by bottle caps (1.8%) while attempting to open a beverage bottle. The bottle caps were screw caps in six patients and crown corks in one patient. The patient age was 34 +/- 22 years (range: 16-68 years). Four patients were female, three male. We found the following morphological changes: hyphema (seven patients), iridodialysis (two patients), traumatic cataract (two patients), vitreous prolapse (one patient), vitreous hemorrhage (two patients), and retinal detachment (two patients). Intraocular pressure was higher than 21 mmHg in three patients. Visual acuity was hand motion in two patients, lower then 0.4 in two, and 1.0 in three on the admission day. Five patients read 1.0 on the day of discharge. CONCLUSIONS: Bottle cap injuries are not as harmless as supposed. Bottle caps may induce severe ocular damage due to the high-impact energy.

Subepithelial corneal amyloid deposits in a case of congenital glaucoma: a case report.

Abstract: Purpose To report a rare association of subepithelial amyloid deposits in a long-standing case of congenital glaucoma. Methods A 5-year-old girl was brought to the emergency service with complaints of bleeding from the left eye after injury to the eye with the door handle. Parents gave history of enlarged black portion of the eye since birth with increasing white opacity from the age of 6 months. On examination under general anesthesia, the left eye showed a limbal tear extending from 7 to 3.30 o'clock position and uveal prolapse. The right eye showed corneal edema, megalocornea, central white raised plaque, and high intraocular pressure. A diagnosis of bilateral congenital glaucoma with open globe injury, left eye, corneal scarring with degeneration, right eye was made and was advised enucleation. The enucleated eye was submitted for routine histologic examination. At a 3-year follow-up, there was an increase in the corneal scarring, with no significant improvement in vision. The child refused keratoplasty and was referred to low vision centre for visual rehabilitation. Results The enucleated eye was distorted and filled with blood. The cornea showed confluent pink homogenous wavy deposits in the subepithelial region. These deposits appeared brick red with Congo Red stain and showed apple green birefringence when viewed under polarized filters, confirming the amyloid nature of the deposits. There was loss of ganglion cell layer in the detached retina. Conclusion The subepithelial amyloid deposits, presumably bilateral, in advanced case of congenital glaucoma were possibly secondary to the long-standing edema, scarring and vascularization. These secondary changes should be kept in mind as they could contribute to further deterioration in vision in advanced cases.