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Purpose: To assess whether near infrared autofluorescence (NIR-AF) imaging is a useful imaging modality in the diagnosis of handheld laser retinal injuries., Design: Retrospective observational case series., Methods: Twelve patients identified to have handheld laser retinal injuries were included at 2 academic centers. Patients underwent ophthalmic assessment and retinal imaging including fundus photography, optical coherence tomography (OCT), conventional blue autofluorescence (B-AF), and NIR-AF imaging., Results: In all cases, lesions consistent with retinal laser injury were detected by NIR-AF imaging. The lesions showed a characteristic appearance with central hyperfluorescence and surrounding hypofluorescence, although the number and extent of lesions varied between patients. Findings using other imaging modalities were variable: on color fundus photography these included localized pigmentary changes and on OCT imaging an ellipsoid zone interruption or outer nuclear layer changes. Only subtle changes were evident on B-AF imaging. Other macular conditions, such as poppers retinopathy or solar maculopathy, which may have similar findings on OCT imaging as laser damage, can be differentiated using NIR-AF imaging., Conclusion: An increased incidence of retinal injuries secondary to handheld lasers has been reported in recent years. We show that the diagnosis and full extent of retinal laser injuries is best demonstrated by NIR-AF, as other modalities give variable results. We propose that NIR-AF should be included when investigating patients suspected of macular injury secondary to exposure to handheld lasers., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: To present 6 cases of orbital trauma, diplopia and strabismus after functional endoscopic sinus surgery (FESS)., Design: Retrospective observational case series., Methods: The medical charts of suitable patients were reviewed for information on medical examination, imaging studies, the type of corrective surgery, and surgical outcomes., Study Population: All patients with diplopia and strabismus after undergoing FESS who were treated or consulted at our institution between 2008 and 2017 were included., Main Outcome Measures: The presence and extent of strabismus and double vision at the end of follow-up., Results: Six patients complained of diplopia after FESS; all of them had proven orbital trauma. In Cases 1-5, patients suffered medial rectus (MR) muscle transection and subsequent exotropia. Their prognosis was guarded despite prompt surgical intervention, and ranged from large exotropia when direct recovery of the MR was attempted, to primary gaze orthotropia but with minimal adduction capacity, during which vertical recti transposition was attempted. Patient 6 sustained transient diplopia, although all of his extraocular muscles appeared intact on imaging. His eye position and movement were completely resolved with conservative measures only., Conclusions: Our experience was that immediate recovery procedures to reattach the muscle in cases with proven transection of the MR muscle are futile, and that definitive corrective strabismus surgery (ie, vertical muscle transposition) has a better chance to achieve favorable results., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To investigate the accuracy of echography with a 20-MHz probe for evaluation of posterior lens capsule in traumatic cataract before surgery., Design: Prospective interventional case series., Methods: This study consisted of 43 eyes with traumatic cataract that were scheduled to undergo surgery. In all cases, cataract was dense enough to prevent visualization of the posterior lens capsule. Echography was performed using a 20-MHz probe to detect rupture of the posterior lens capsule. All patients subsequently underwent cataract extraction and intraoperative findings of the posterior lens capsule were compared with the preoperative echographic findings., Results: This study included 43 eyes of 43 patients (38 men and 5 women) with a mean age of 35.6 ± 15.3 years (range, 4-68 years). The trauma was either blunt (4 eyes) or sharp (39 eyes); there was closed globe injury in 2 eyes and open globe injury in 41 eyes. By 20-MHz echography, posterior border of the crsytalline lens was clearly visualized in all 43 eyes. By 20-MHz echographic imaging, rupture of the posterior lens capsule was identified in 17 eyes (39.5%). During cataract surgery, it was noted that 14 eyes (32.6%) had rupture of the posterior lens capsule. Sensitivity, specificity, positive predictive value, and negative predictive value were 93%, 86%, 76%, and 96%, respectively, for 20-MHz echography to detect rupture of the posterior lens capsule. Also, the positive likelihood ratio, negative likelihood ratio, and odds ratio were 6.7, 0.08, and 81, respectively., Conclusion: Echography with 20-MHz probe is an accurate imaging modality for detection of posterior lens capsule rupture in traumatic cataract preoperatively. This technique helps ophthalmologists have an appropriate surgical plan before operating., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Purpose: To report a rare case of blindness and rectus muscle damage from ocular compression after spinal surgery., Design: Observational case report., Methods: A 16-year-old girl underwent scoliosis surgery in the prone position. After surgery, she complained of visual loss in the right eye. Examination showed no perception of light, periorbital bruising, corneal haze, fixed dilated pupil, and loss of adduction beyond the midline., Results: Orbital computed tomography scan showed a swollen medial rectus with no other orbital pathology. The muscle swelling can be explained by ischemia from compression of the globe against the medial wall of the orbit. Ocular compression also caused retinal and optic nerve ischemia, resulting in loss of vision. Medial rectus function recovered with time, but the patient continues to have no light perception., Conclusions: Blindness after spinal surgery is a rare but devastating complication, and all precautions to avoid ocular compression must be taken.

Purpose: To report eight cases of spontaneous closure of traumatic macular hole., Design: Consecutive observational case series., Patients and Methods: In a consecutive series of 18 eyes of 18 patients with traumatic macular hole, eight patients achieved spontaneous closure of traumatic macular hole. Clinical records of the eight eyes of eight patients were reviewed, together with the results of optical coherence tomography performed in three eyes., Results: All eight patients with spontaneous closure of traumatic macular hole were males, with a mean age of 14.6 years (range, 11-21 years). The major cause of blunt trauma was sports-related accidents. Six eyes developed visual symptoms immediately after trauma and two eyes 10 to 12 days later. In all eight eyes, contact lens biomicroscopy revealed a small, full-thickness macular hole not complicated by epiretinal membrane, cuff of subretinal fluid, or posterior vitreous detachment. The macular hole closed spontaneously 1 week to 4 months after trauma. All eight eyes had visual acuity improvement with the final best-corrected visual acuity of 0.5 or better in four (50%) eyes. Optical coherence tomography in three eyes revealed two distinct abnormalities. Two eyes presented with acute foveal dehiscence without involvement of the posterior vitreous cortex. The remaining eye showed at presentation perifoveal vitreous detachment with residual vitreous adhesion to the edge of updrawn fovea and developed release of the vitreofoveal adhesion at the time of hole closure., Conclusions: Spontaneous closure of traumatic macular hole is not uncommon. An observation for a period of up to four months may be a management of choice for traumatic macular hole. There may be clinically and pathogenetically two distinct mechanisms of traumatic macular formation; one type that causes immediate visual loss due to primary dehiscence of the fovea, and the other type that leads to delayed visual loss due to dehiscence of the fovea secondary to persistent vitreofoveal adhesion.

Purpose: To report a case of a tear in the trabecular meshwork caused by an airsoft gun, a toy that propels a plastic bullet., Methods: Case report., Results: A 7-year-old Japanese boy sustained an ocular injury to the right eye from an airsoft gun. Ophthalmic examination 1 hour after the injury showed a best-corrected visual acuity in the injured eye of hand motion, corneal abrasion and edema, hyphema, and commotio retinae. Gonioscopy 6 days after the injury revealed a tear in the trabecular meshwork as well as an angle recession. Ultrasound biomicroscopy (UBM) strongly suggested that the tear extended into Schlemm's canal. Corneal abrasion and edema, hyphema, and commotio retinae resolved over 10 days, and best-corrected visual acuity improved to 20/15. Two months after the injury, the trabecular meshwork had not healed., Conclusion: Airsoft guns can cause a full-thickness tear in the trabecular meshwork, which may contribute to development of late-onset glaucoma. UBM is useful to evaluate the tomographic features of the disrupted trabecular meshwork. The potential force of airsoft guns to cause substantial ocular injuries should be recognized. Wearing ocular protection should be mandatory while playing with airsoft guns.

Purpose: To describe displacement of the globe into the ethmoid sinus after an orbital trauma., Method: Case report. A 58-year-old man sustained trauma of the left eye and orbit, which resulted in displacement of the globe into the ethmoid sinus. One day after injury, surgery was performed to restore the intact globe into position within the orbit., Results: After operation, the globe held in its anatomical site, and 10 months after surgery the visual acuity was 20/100, slight pallor of the optic disk was present, and there was no limitation of the horizontal and vertical ductions., Conclusions: To our knowledge, this is the first case of traumatic displacement of the globe into the ethmoid sinus with satisfactory restoration of normal globe position and preservation of vision.

Purpose: To elucidate details of the pathologic changes in the ciliary epithelium associated with atopic dermatitis and blunt ocular trauma., Methods: We examined prospectively 52 eyes of 42 patients with detachment of the nonpigmented epithelium of the ciliary body associated with atopic dermatitis and blunt ocular trauma. All the eyes underwent ultrasound biomicroscopic examination as an adjunct to binocular indirect ophthalmoscopy with scleral depression and slit-lamp biomicroscopy., Results: Of the 52 eyes examined, high-resolution ultrasound biomicroscopy and conventional diagnostic methods (that is, binocular indirect ophthalmoscopy with scleral depression and slit-lamp biomicroscopy) disclosed breaks at the anterior vitreous base border in 40 eyes, at the pars plicata of the ciliary body in 27 eyes, and at the white midline (that is, the line located in the mid pars plana anterior to the anterior vitreous base border) in four eyes. In 40 eyes the breaks at the anterior vitreous base border could be detected with conventional methods but in only 28 eyes could they be diagnosed with ultrasound biomicroscopy. Conversely, in 27 eyes the breaks of the pars plicata could be observed with ultrasound biomicroscopy but in 25 eyes they were detected with conventional methods. In 21 eyes with breaks only at the anterior vitreous base border, the detachment of the nonpigmented ciliary epithelium was limited posterior to the white midline. In all 27 eyes with the nonpigmented ciliary epithelial detachment anterior to the white midline, the breaks of the pars plicata were identified by ultrasound biomicroscopy., Conclusion: Because of the minimum deformation of the globe during examination, ultrasound biomicroscopy contributed to the diagnosis of detailed structural change in the ciliary body associated with atopic dermatitis and blunt ocular trauma in relation to the white midline. In our sample of patients, the white midline may act as a barrier against ciliary nonpigmented epithelial detachment, and detachment of the nonpigmented epithelium anterior to the white midline indicated the presence of the pars plicata break in most cases.

A 24-year-old woman sustained a blow-out fracture of the orbital floor with prolapse of the globe into the maxillary sinus. This was treated by replacing the globe in the orbit surgically and reconstructing the orbital floor. Postoperatively, the eye retained normal visual acuity.

We used computed tomography to detect and localize foreign bodies in two unusual cases of penetrating injury to the eyes. In one case, a large broken twig appeared to have penetrated the globe and the inferior rectus muscle; in the other, the globe was ruptured by many glass shards . In the first case surgery showed the computed tomographic impression to be incorrect. The globe and the inferior rectus muscle were intact and vision and motility were normal postoperatively. In the second case, swelling made direct visualization impossible, and computed tomography was used to locate the foreign bodies.