Search

Vivek Paulbuddhe,1 Sujit Addya,1 Bharat Gurnani,2 Dheerendra Singh,3 Koushik Tripathy,4 Rohan Chawla5 1Department of Vitreoretina, ASG Eye Hospital, Guwahati, 781006, Assam, India; 2Department of Cornea, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, 605007, Puducherry, India; 3Department of Retina, ASG Eye Hospital, Bhopal, 462016, Madhya Pradesh, India; 4Department of Vitreoretina, ASG Eye Hospital, Kolkata, 700058, West Bengal, India; 5Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, 110029, IndiaCorrespondence: Koushik TripathyDepartment of Vitreoretina, ASG Eye Hospital, 149, BT Road, Kolkata, 700058, West Bengal, IndiaTel +913325632222Email koushiktripathy@gmail.comAbstract: Sympathetic ophthalmia is a rare bilateral diffuse granulomatous panuveitis that usually results from surgical or penetrating trauma to one eye. The symptoms range from impaired near vision to pain, photophobia, and loss of visual acuity. Anterior segment manifestations include bilateral acute uveitis with mutton-fat keratic precipitates and posterior segment findings include vitritis, multifocal neurosensory retinal detachment, choroiditis, optic nerve edema, and Dalen–Fuchs nodules. The diagnosis is clinical. Ancillary investigations include fundus fluorescein angiography, indocyanine green angiography, optical coherence tomography (OCT), ultrasound B scan, and autofluorescence imaging. The management options include corticosteroids (topical and systemic) as the first line along with immunomodulatory therapy started at the presentation of the disease. Recent advances include imaging with OCT-angiography, enhanced depth imaging-OCT (EDI-OCT, choroidal vascular index/CVI), targeting IL-23/IL-17 pathway, and use of biologics for the management of this rare entity. Recent advances in early diagnosis and prompt treatment has led to improved final visual outcomes in both the sympathizing and exciting eye. This review is aimed at giving a comprehensive overview of sympathetic ophthalmia along with a special emphasis on current treatment strategies and recent advances.Keywords: ocular trauma, inciting eye, exciting eye, corticosteroids, open globe injury, infliximab, adalimumab

Sympathetic ophthalmia is a rare bilateral diffuse granulomatous panuveitis that usually results from surgical or penetrating trauma to one eye. The symptoms range from impaired near vision to pain, photophobia, and loss of visual acuity. Anterior segment manifestations include bilateral acute uveitis with mutton-fat keratic precipitates and posterior segment findings include vitritis, multifocal neurosensory retinal detachment, choroiditis, optic nerve edema, and Dalen–Fuchs nodules. The diagnosis is clinical. Ancillary investigations include fundus fluorescein angiography, indocyanine green angiography, optical coherence tomography (OCT), ultrasound B scan, and autofluorescence imaging. The management options include corticosteroids (topical and systemic) as the first line along with immunomodulatory therapy started at the presentation of the disease. Recent advances include imaging with OCT-angiography, enhanced depth imaging-OCT (EDI-OCT, choroidal vascular index/CVI), targeting IL-23/IL-17 pathway, and use of biologics for the management of this rare entity. Recent advances in early diagnosis and prompt treatment has led to improved final visual outcomes in both the sympathizing and exciting eye. This review is aimed at giving a comprehensive overview of sympathetic ophthalmia along with a special emphasis on current treatment strategies and recent advances.

Purpose: To report the first case of Curtobacterium endophthalmitis within 6 hours after open globe injury, with extensive phlebitis and secondary subretinal neovascularization. Case summary: A 53-year-old man with hypersensitivity to beta-lactam antibiotics was admitted due to visual disturbance in the left eye experienced while working in a rural area. Fundus examination was impossible due to a full-layer corneal laceration and traumatic cataract in the left eye. B-scan ultrasonography and orbital computed tomography showed no shadowing of retained intraocular foreign bodies. After a corneal scraping smear, primary closure, lensectomy, and vitrectomy were performed. Organic material was observed in a focal area of pale macula, accompanied by extensive retinal phlebitis in the mid-periphery. After diagnosing acute bacterial endophthalmitis, intravitreal vancomycin and dexamethasone were injected. Curtobacterium pusillum was cultured on an automated microbial identification system. Intravenous vancomycin and oral clarithromycin were administered for 2 weeks. After 3 months, endophthalmitis had not recurred, and the visual acuity reached 20/100. However, subretinal neovascularization was newly detected under the damaged macula. No complications of neovascularization were observed until 6 months after primary closure. Conclusions: Curtobacterium pusillum can induce acute endophthalmitis through direct penetration in cases of ocular trauma, and may be accompanied by extensive phlebitis and secondary subretinal neovascularization. In cases of open globe injury sustained in rural areas, acute endophthalmitis caused by a rare Gram-positive bacillus, such as Curtobacterium species, should be considered.

Purpose To evaluate and compare the accuracy of axial versus coronal computerized tomography (CT) scan in detection of open globe injury. Method In this retrospective study, records of 61 patients with open and 72 patients with closed globe injury were reviewed. One experienced ophthalmologist and one neuroradiologist read the orbital CT scans and accuracy of the axial and coronal planes in detecting open globe injuries were compared. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated and compared for axial and coronal planes. Result The most common CT finding reported by the readers through the interpretation chart was scleral irregularity (70%), followed by dislocation of the crystalline lens (54%) and vitreous hemorrhage (51%). The sensitivity of axial, coronal and combined CT planes were 74%, 65%, and 79%, respectively. There was no significant difference between axial and coronal CT scans for detecting open globe injuries (P value=0.075), independent of the type and the location of the globe injury. For posterior injuries and sharp trauma, the sensitivity of coronal plane in detecting open globe injury was significantly lower, compared to axial and combined readings (P value=0.012 and 0.015, respectively). There was a near perfect agreement between readers for all CT scan readings with a Kappa value of 0.9. Conclusion Axial CT reading may be as adequate as a multiplanar reading in detection of open globe injury in emergency setting, where timely diagnosis matters. Without clinical and surgical findings, CT cannot provide adequate accuracy for detecting open globe injuries.

We report and compare 2 cases of open globe injury with foveal damage incurred while mowing. Case 1 is a healthy 67-year-old man presenting with an intraocular metallic foreign body and eye pain in his right eye after using a mower. The foreign body perforated the cornea’s inferior area and damaged the foveal centralis, leading to central scotoma and decreased visual acuity. 27G pars plana vitrectomy was performed, and the final corrected decimal visual acuity was 0.1, but the visual field was preserved, except for the central scotoma. Case 2 is a healthy 50-year-old man presenting open globe injury with an intraocular metallic foreign body while using a mower. The foreign body damaged the fovea and triggered extensive retinal detachment. One month after surgery, proliferative vitreoretinopathy occurred, requiring additional surgery. The final corrected decimal visual acuity dropped to 0.05, resulting in an extensive visual field defect. Both cases of eye trauma were caused by mower injury, but the visual function outcomes differed with the size of the foreign body and the injury severity at the time of onset. Mower eye trauma is preventable, and efforts to educate users on safety measures are needed.

Purpose: We investigated the effect of the time of secondary intraocular lens (IOL) implantation on final visual acuity and other causes affecting visual prognosis in cases left aphakic after open globe injury.Methods: The study included 62 eyes of 62 patients left aphakic after the repair of open globe injury between 2012 and 2019. Demographic characteristics, trauma zone, ocular trauma score, type of injury, time of secondary IOL implantation, final best-corrected visual acuity (BCVA), and complications were recorded for each patient.Results: The mean follow-up time of 62 patients was 25.05 ± 12.59 months. The preoperative BCVA was found to be 2.40 ± 0.86 logarithm of the minimum angle of resolution (logMAR), while the postoperative final BCVA was found to be 0.53 ± 0.70 logMAR (p < 0.01). The mean interval timing of secondary sulcus foldable IOL implantation was determined to be 3.79 ± 4.04 months. No correlation was observed between secondary IOL implantation time and final BCVA (r = 0.140, p = 0.319). Furthermore, when only pediatric patients were taken, an excellent positive correlation was found between the secondary IOL implantation time and final BCVA logMAR (r = 0.895, p < 0.01). Multiple linear regression on final BCVA with age, revealed a significant model explaining 48.0% of the variability with younger age and better final BCVA with as significant coefficients (p = 0.007).Conclusions: Although time interval between primary repair and secondary IOL implantation to correct aphakia does not effect final BCVA in adult patients, earlier surgery should be considered for amblyopia management in pediatric patients.

Traumatic ocular injury is an uncommon yet leading cause of monocular blindness among the working-age group. Retained intraocular foreign body (IOFB) are associated with 41% of open globe injuries. Pars plana vitrectomy is often required for posterior segment IOFB removal. Advances in vitreoretinal surgical techniques and instrumentation have resulted in better treatment outcomes with reduced ocular morbidity. We report a case of modified ILM forceps with perfluorocarbon liquid-assisted non-magnetic IOFB removal in a young man after a motor vehicle accident with zone one open globe injury and a large glass IOFB in the right eye. We describe the use of perfluoro-N-octane to slide the IOFB extramacularly and reorient the IOFB plane for stable and safe retrieval by ILM end-gripping forceps. The modified design of the ILM end-gripping forceps with adjunctive use of perfluorocarbon liquid in pars plana vitrectomy reduces slippage during IOFB extraction and prevents collateral iatrogenic retinal injury.

Background Eye injury is a serious worldwide public health problem that may cause blindness. In children, blindness has functional impact and psychosocial implications. As indicated in many worldwide studies, identification of risk factors associated with the socio-cultural context may prevent eye injuries. The objetive of the study is to describe the sociodemographic and epidemiological characteristics of pediatric eye injury and its effects on ocular structures in a public hospital from Colombia. Method A retrospective cross-sectional study was carried out between January 1, 2015, and December 31, 2017, in a tertiary public hospital of a medium-sized city located in the Northeast of Colombia. Children under 15 years old with trauma to the eyeball or its adnexa were included. The Birmingham Eye Trauma Terminology System (BETTS) was used. Eye burns and Ocular adnexa were also included. Results 61 cases of eye injuries were recorded, 67.21% (41 cases) of which were males. 57.37% (35 cases) corresponded to closed-globe injuries both contusion and lamellar laceration. Visual acuity fluctuated between 20/20 and 20/40. 14.75% (9 cases) were open-globe injuries while 50% (4 cases) were penetrating trauma. 27.86% of the injuries (17 cases) did not directly compromise the eyeball, 58.82% (10 of these cases) of which corresponded to eyelid wounds, and neither of those had visual acuity information. Conclusion The study showed that the majority of eye injuries in children under 15 years old, from a public hospital in the Northeast of Colombia, are closed globe, caused by blows, and occur in males.

Asad F Durrani,1 Peter Y Zhao,1 Yunshu Zhou,1 Michael Huvard,2 Lyna Azzouz,3 Jason M Keil,3 Stephen T Armenti,1 Vaidehi S Dedania,4 David C Musch,1,5 David N Zacks1 1Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA; 2Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA; 3University of Michigan Medical School, Ann Arbor, MI, USA; 4Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA; 5Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USACorrespondence: David N ZacksDepartment of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USATel +1 734-232-8404Email Davzacks@med.umich.eduBackground/Aims: To determine the rate of endophthalmitis and assess risk factors for development of endophthalmitis following open globe injury (OGI).Methods: A retrospective chart review of all patients treated for OGI at the University of Michigan from January 2000 to July 2017 was conducted. Exclusion criteria included intravitreal injection or intraocular surgery in the 30 days prior to injury or less than 30 days of follow-up. A total of 586 out of 993 open globe injuries were included in the study. The main outcome measure was the rate of endophthalmitis.Results: In this study, 25/586 eyes (4.3%) had endophthalmitis. Of these, 12/25 eyes (48.0%) presented with endophthalmitis and 13/25 eyes (52.0%) developed endophthalmitis after globe closure. Multivariate analysis identified time to globe repair (OR 4.5, CI 1.9– 10.7, p = 0.0008), zone I injury (OR 3.6, CI 1.1– 11.0, p = 0.0282), and need for additional surgery (OR 5.5, CI 1.5– 19.7, p = 0.0092) as factors associated with increased risk of developing endophthalmitis. Subconjunctival antibiotic injection at the time of globe closure (OR 0.3, CI 0.1– 0.7, p = 0.0036) was associated with decreased risk of developing endophthalmitis.Conclusion: Prompt globe closure and subconjunctival antibiotics may reduce the risk of endophthalmitis in OGI. Furthermore, our practice of a one-time dose of systemic prophylactic antibiotics, and intravitreal antibiotics if intraocular foreign body (IOFB) removal is delayed, was not found to increase the rate of endophthalmitis.Keywords: endophthalmitis, intraocular foreign body, ocular trauma, open globe injury

A penetrating corneoscleral injury case with the development of bilateral phacoanaphylactic inflammation of a sympathetic ophthalmia kind in a 59-year-old woman is described. The case reveals a difference between bilateral phacoanaphylactic inflammation and classical sympathetic ophthalmia. Unlike the latter, the clinical case showed on the “healthy” eye a sluggish inflammation of anterior uveitis type with a slowly progressing lens opacity, for which local and systemic corticosteroid therapy proved insufficiently effective. The morphological picture showed that the inflammation was located in the anterior part of the eye around the damaged lens with the formation of a macrophage-neutrophil abscess, which is typical for phacoanaphylactic inflammation, and the absence of granulomatous inflammation in the ciliary body, where plasmacellular infiltration prevailed.Conclusions. Phacoanaphylactic inflammation and sympathetic inflammation are autoimmune in their nature having different autoantigens. In phacoanaphylactic inflammation, autoantigen is the lens protein, while in sympathetic inflammation it is the uveoretinal antigen. The only method of treating phacoanaphylactic inflammation is to remove the cataract-altered lens. Our patient underwent phacoemulsification in her single eye, after which the symptoms of uveitis with hypertension disappeared completely and her vision was restored.

Background Open globe injury (OGI) is one of the most devastating form of ocular trauma. The aim of the study is to identify the epidemiology and predict visual outcomes in traumatic open globe injuries using ocular trauma score (OTS) and correlate with final visual acuity (VA) at 3 months. Methods Patients older than 5 years, presenting to B.P. Koirala Lions Centre for Ophthalmic Studies (BPKLCOS) from March 2016- March 2017 with OGI that met inclusion criteria were evaluated. Patient profile, nature and cause of injury, and time to presentation were recorded. Patients were managed accordingly and followed up to 3 months. An OTS score for each patient was calculated and raw scores were categorized accordingly. The VA after 3 months were compared to the predicted OTS values. Results Seventy-three eyes of 72 patients were examined. 76 % were male, and the mean age was 26.17 years (median, 23.5 years). The mean time from injury to presentation was Conclusions OTS can be an accurate predictive tool for final visual acuity even with a short follow up period of 3 months; with poor presenting visual acuity, delayed presentation, posterior zones of injury, need for intravitreal injections, endophthalmitis, and globe rupture associated with poorer prognosis.

Purpose: To evaluate the ocular manifestations and visual outcomes of ocular injury by arecanut. Methods: We analysed cases with ocular injury by arecanut from August 2018 to December 2019, retrospectively. Mode of injury, visual acuity and ocular manifestations of trauma were recorded. Results: Out of the 40 cases, closed globe injuries were seen in 97.5% of cases. All the injuries were due to the direct impact of arecanut during harvesting. The mean age was 45.15 ± 12.84 years. The mean best-corrected visual acuity (BCVA) at presentation was 20/40. A significant number of cases (35%) required surgical intervention. Mean BCVA at final follow-up was 20/30 but 16.66% of cases had BCVA of

AIM: To demonstrate prognostic factors for poor visual outcome in patients with post-traumatic endophthalmitis (PTE) following open globe injury. METHODS: A retrospective study was conducted on 66 patients (66 eyes) with PTE following open globe injury from 2005 to 2015. Potential factors accounting for good and poor visual outcome were statistically analyzed by Chi-square test and Logistic regression model. RESULTS: In 66 cases, 39 cases (59%) had a poor visual outcome. Univariate and multivariate Logistic regression analysis identified retained intraocular foreign body (IOFB) as the only factor significantly associated with poor visual outcome [adjusted odds ratio, 4.62; 95% confidence interval (1.04-20.53); P=0.04]. The most common causative agents were gram-positive organisms (83%), of which Bacillus cereus (33%), was the most common pathogen. All cases received intravitreal antibiotic injections. Oral ciprofloxacin was the most used systemic antibiotic (33%). Pars plana vitrectomy was performed in 83% (55/66) of cases. At 6mo follow-up, mean BCVA was 1.74±0.72 logMAR units. CONCLUSION: In patients with PTE following open globe injury, the only predictor of poor visual outcome is the presence of IOFB. Bacillus cereus is the most isolated microorganism.

Christian S Mayer,1,* Isabella Baur,1,* Julia Storr,2 Alexander Markard,1 Ramin Khoramnia1 1Department of Ophthalmology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany; 2Department of Ophthalmology, Technical University Munich, Munich, Germany*These authors contributed equally to this workCorrespondence:Christian S MayerDepartment of Ophthalmology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, GermanyEmail Christian.Mayer@med.uni-heidelberg.dePurpose: Patients with traumatic aniridia, aphakia and retinal complications can require silicone oil endotamponade. In the absence of compartmentalization, there is a risk of silicone oil migrating to the anterior chamber which can cause long-term complications. We report a two-step procedure in trauma cases, using sutures for silicone oil retention in primary care and subsequently prior to secondary artificial iris (AI) and intraocular lens (IOL) implantation, to achieve a reconstruction of the anterior and posterior chamber.Material and Methods: Seven patients with loss of the iris-lens-diaphragm after an ocular trauma and the need for silicone oil endotamponade underwent a primary intervention including wound closure, placement of silicone oil retention sutures and silicone oil filling. Four of those underwent secondary reconstruction with silicone oil removal and AI and IOL implantation and could be included in this retrospective observational study. All main outcome measures were evaluated after the first and after the second surgery. The main outcome measures were morphological findings, subjective impairment from glare, subjective cosmetic disfigurement, patient satisfaction and intraocular pressure (IOP) as well as best-corrected distance visual acuity and objective refraction.Results: The retention sutures could effectively prevent silicone oil migration into the anterior chamber in the first surgery. Silicone oil emulsifications in the anterior chamber were observed in one patient. In two patients, pigment deposition at the sutures was seen. Subjective impairment from glare and subjective cosmetic disfigurement could be reduced after the second surgery compared to the evaluation after the first surgery. IOP and best-corrected distance visual acuity remained stable. No eye needed silicone oil refilling after the secondary reconstruction surgery.Conclusion: Our two-step approach is viable and provides good functional and aesthetic results. We observed a high patient satisfaction.Keywords: aniridia, aphakia, trauma, open globe injury, retinal detachment

BACKGROUND Open globe injuries are ocular emergencies which require appropriate surgical treatment. We analyzed the presenting clinical characteristics, factors affecting the final visual outcome of open globe injuries over a 12 months period in a tertiary eye care center. METHODS This is a prospective observational non comparative interventional study, analysing 112 eyes of 111 patients admitted with open globe injuries at Regional Institute of Ophthalmology, South Kerala, India, from March 2018 to February 2019. Detailed history of trauma, eye examination, and visual assessment were done at the time of admission. Major outcome measure was final best corrected visual acuity (BCVA) at the end of follow up period of 6 months and important factors affecting final visual outcome. Role of additional clinical signs like presence of hyphaema, traumatic cataract, vitreous haemorrhage, retinal detachment, and prolapse of intraocular contents at the time of presentation were noted and these factors were separately analysed with final BCVA. RESULTS Mean age of presentation was 39.8 ± 20.5 years. 79.5 % patients (89 eyes) were males and 20.5 % (23 eyes) were females. 38.4 % patients (43 eyes) had injuries at work place, and 61.6 % (69 eyes) were non-work related but happened outdoor. Remaining 38.4 % of the injuries (43 eyes) occurred at home. Most common agent causing injury was metal piece in 34.8 % (39 eyes). 57.1 % of the patients (64 eyes) had BCVA of more than 6 / 18 Snellen’s vision, 12.5 % had (14 eyes) BCVA ranging 6 / 18 - 6 / 60, 19 patients (17 %) had final vision between 6 / 60 - 3 / 60. Fifteen eyes (13.4 %) had vision less than 3 / 60 which is equivalent to legal blindness as per WHO (World Health Organization) classification. Among them, 10 eyes lost vision completely and ended up with no perception of light (NO PL). CONCLUSIONS Majority of the patients with open globe injuries were young males in productive age group and open globe injuries are a major cause for morbidity in these groups. As per our observations in this study injuries happen equally at home and work place. Major poor prognostic factors deciding final visual outcome were presence of additional clinical features including hyphaema, vitreous haemorrhage, retinal detachment and prolapse of intraocular contents at the time of presentation. Based on our observations in this study, we recommend better implementation of health education and awareness campaigns, appropriate preventive and prophylactic measures with regular monitoring of adequate use of protective goggles and shields at work place for high risk group.

Objective: To predict the severity and visual outcomes following treatment in patients sustaining eye trauma using ocular trauma scale. Study Design: Retrospective case series. Place and Duration of Study: Armed Forces Institute of Ophthalmology Rawalpindi, from Jan 2015 to Jan 2017. Methodology: A total of 50 patients with eye trauma were included. Injuries were classified according to 'Birmingham Eye Trauma Terminology System‟. „Ocular trauma scale' was used to predict the visual outcome. We analyzed the data by using Statistical Package for Social Sciences version 22. Results: Patients‟ mean age was 30 ± 5.632 years. Forty-nine (98%) had open globe injury and 01 (2%) had closed globe injury. Primary & secondary repair was performed and pars plana vitrectomy in 28 (56%), patients was most commonly performed procedure. Based on best-corrected visual acuity vision of 4 (8%) patients significantly improved. Twenty (40%) were bilaterally blind while 16 (32%) were unilaterally blind in right eye and 10 (20%) were blind in left eye. Conclusion: Open globe injuries of grade IV and V on Ocular trauma scale were found to be severe with the worst visual and anatomical outcomes. Use of protective eye equipment in high-risk individuals including welders, and sportsmen etc would have an invaluable role in reducing the incidence of ocular trauma and its severity.

Purpose: The objective of our project is to use the National Inpatient Sample Database to identify risk factors for endophthalmitis in cases of open-globe injury (OGI). Methods: This is a cross-sectional observational study of 48 627 cases of OGI from the National Inpatient Sample Database. We performed regression analysis using IBM SPSS Statistics 23. Codes from the International Classification of Disease, Ninth Revision were used to identify ocular findings and conditions. Variables with P values less than .05 on univariate analysis were included in the multivariable regression model; Bonferroni correction was applied to these results. Results: Of the 48 627 cases of OGI, 37 440 (77.0%) occurred in the adult group (21 years and older). Overall, 1018 (2.1%) cases developed posttraumatic endophthalmitis, with 74.5% cases in the adult group. Endophthalmitis developed in 293 (4.5%) eyes with an intraocular foreign body (IOFB). Results of binary logistic regression showed the clinical findings of traumatic cataracts, hypopyon, vitreous inflammation, corneal ulcers, or IOFBs were associated with an increased risk of developing endophthalmitis after OGI. Conversely, orbital fractures, rupture-type injuries, and intraocular tissue prolapse were associated with a decreased likelihood of being diagnosed with endophthalmitis. Conclusions: Endophthalmitis developed in 2.4% of pediatric OGIs and 2.0% of adult OGIs. Traumatic cataract, hypopyon, vitreous inflammation, corneal ulcer, keratitis, retinal detachment, IOFB, and diabetes increased the risk of post-open-globe endophthalmitis.

Aim To evaluate the predictive value of pediatric penetrating ocular trauma score (POTS) on the visual outcome in children with open globe injury. Methods A retrospective study in 90 children (60 males and 30 females) aged 1-15y (average, 7.48±2.86y) with penetrating ocular trauma was performed. Each patient's POTS was calculated. The effects of POTS on final visual acuity (FVA) were examined. Correlation between factors affecting POTS and the FVA was established. Results All patients presented with single-eye trauma. The follow-up time was 3-21mo (average, 10.23±3.54mo). Among the 90 cases of penetrating wounds, 71 eyes (78.89%) were injured in Zone I (wound involvement limited to the cornea, including the corneoscleral limbus), 17 eyes (18.89%) were injured in Zone II (wound involving the sclera and no more posterior than 5 mm from the corneoscleral limbus), and 2 eyes (2.22%) were injured in Zone III (wound involvement posterior to the anterior 5 mm of the sclera). Analysis of POTS and FVA showed important correlation between them (r=0.414, P=0.000). Initial visual acuity (P=0.00), age (P=0.02), injury location (P=0.002), traumatic cataract (P=0.00), vitreous hemorrhage (P=0.027), retinal detachment (P=0.003), and endophthalmitis (P=0.03) were found to be statistically significant factors for the FVA outcome. Conclusion Ocular trauma presents serious consequences and poor prognosis in children. The POTS may be a reliable prognostic tool in children with open globe injury.

Significance Cyclodialysis clefts can potentially develop secondary to open globe injury. The swept-source anterior segment optical coherence tomography (SS-AS-OCT) may be a valuable diagnostic tool for the identification and estimation of the circumferential extent of cyclodialysis clefts. It could be considered an alternative when ultrasound biomicroscopy cannot be performed successfully. Purpose The purpose of this study was to report a case of open-globe injury associated with cyclodialysis cleft and the utility of SS-AS-OCT in its diagnosis. Case report A 12-year-old boy presented to the clinic because of penetrating ocular trauma to his left eye with a projectile stone. He was diagnosed with limbal perforation with uveal tissue prolapse and cataract. He underwent limbal repair with cataract extraction and posterior chamber intraocular lens implantation. However, even at the 6 weeks' post-operative period, he did not gain vision and had persistent hypotony with hypotonic maculopathy. Gonioscopy showed a 2-clock-hour superonasal cyclodialysis cleft. However, on SS-AS-OCT, it was discovered that the cleft extended along 5 clock hours, involving both superonasal and inferonasal quadrants. Recognizing the large extent of the cleft, endocyclopexy by modified sewing-machine technique was planned and performed. An IOP spike and improvement in vision were noted on the next post-operative day. The SS-AS-OCT confirmed cleft closure. Conclusions Although rare, cyclodialysis can occur in cases of open globe injury. The SS-AS-OCT is a useful diagnostic tool to study the circumferential extent of cyclodialysis and may unravel detachments hidden behind intact anterior ciliary body face.

The most common cause of unilateral blindness in paediatric age groups, especially in developing countries, is ocular trauma. Trauma to the eye is very debilitating to the patient; hence, managing various types of penetrating and blunt injury to the eye provide a challenge to the ophthalmologist. It is simply preventable by the supervisionof the parents and caregivers. We will be discussing one such case and our experience in dealing with a fish hook injury to the eye in a 12-year-old boy—the challenges we faced and the precautions we took to give a good visual outcome.

Purpose: To compare the strength of the relationship between the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio(PLR) results of patients with or without open globe injury (perforation and penetration) in the acute period of orbital trauma. Materials and Methods: Forty patients with open globe injuryand twenty-five patients without open globe injury in the acute period of orbital trauma were enrolled in this retrospective study. Complete blood count measurement results of all subjects were assessed. Results: There was a significant difference in neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio between orbital trauma with open globe injury group and without open globe injury group (p=0.001, p=0.006). Conclusion: Our results of the blood count measurements suggest that the NLR and PLR at first three hours may predict ocular perforation/penetration and the clinicians have to alert are a risk factor of open globe injury.

Purpose: Facial dog bites often cause periorbital trauma; however, the globe is rarely damaged. Most globe injury following dog bites results from unusual circumstances and typically presents with concomitant periorbital and ocular adnexal injuries. Observations: The case presented is a rare presentation of isolated globe rupture without orbital trauma following facial dog bite in a child without history or evidence of decreased blink reflex, mental deficiency, or substance use. Conclusions and importance: Ophthalmic investigation is warranted in all pediatric periorbital dog bite injuries, even in the setting of minimal or absent periorbital trauma. As additional blunt trauma to the globe in the immediate recovery period resulted in a second open globe injury, the critical importance of protective eyewear, activity restriction, and judicious corneal suture removal postoperatively following repair of open globe injury is discussed.

Importance Open globe injury is a frequent and preventable healthcare problem with an annual incidence of 3.5/100,000 worldwide. Management and treatment methods aim to ensure globe integrity. Unfortunately, it is not possible to achieve globe integrity in some of the cases, and these can result in poor visual outcomes. Purpose To evaluate the usability of lamellar scleral graft in the repair of ocular perforations. Methods This was a retrospective review of 11 patients who underwent lamellar scleral graft surgery for ocular perforation between June 2015 and June 2020. Due to the failure of the repairs when other techniques were used, the perforation zones were sealed with lamellar scleral autografts. The primary measures of the outcomes were globe integrity, postoperative best corrected visual acuity, and intraocular pressure (IOP). Visual acuity was determined using the Snellen eye chart, and IOP was measured using the automated pneumatic tonometry during standard examination. Results The participants enrolled in this study included 11 patients who underwent lamellar scleral patch graft between 2015 and 2020. The mean age of the patients was 58.81 +/- 16.6 years (range, 16-77), and the mean follow-up period was 12.5 +/- 3.8 months (range, 8-20). During the surgery, the perforation zone was treated and no leakage was observed. IOP significantly increased, and visual acuity improved in almost all eyes. The factors that made it necessary to use scleral grafts in patients were star-shaped wounds, delayed presentation, lost corneal / scleral tissue. Conclusion Lamellar scleral graft is a method that can be used in the treatment of defective ocular perforation with acceptable complications and provides adequate functional and structural stability. Scleral patch grafting can be considered as an alternative option for surgeons treating a variety of ocular conditions that cause tectonic imbalance or poor cosmesis.

Background Every year, 3.3 to 5.7 million eye injuries occur worldwide in children. Open globe injury is a common type of trauma that leads to blindness in all age groups. This study aimed to review and discuss the epidemiology, causes, and clinical outcome of pediatric open globe injury. Methods A retrospective chart review of all pediatric open globe injuries presented to King Fahad Hospital of the University and Dhahran Eye Specialist Hospital was conducted between 2010 and 2020. Data analyses were done to identify factors predicting ultimate visual acuity. Results The overall number of cases was 502, of which 120 cases were children and of the documented 118 cases, around 82 (69.5%) were males with an average age of 5.1 years. The traumatic object was sharp in 90 (89.1%) cases. The most common object was glass, presented in 18 (18.4%) cases. Most injuries were accidental (68.9%) and 48 (71.6%) cases out of 67 occurred inside the house. The factors associated with better visual outcome (20/40 or better) were sharp injuries, absence of hyphema, absence of vitreous hemorrhage, trauma with intraocular foreign body, undergone one operation, and absence of cataract at presentation. Conclusion The ultimate visual outcome post open globe injury could be predicted from the severity of the presenting signs. Also, the household environment carries the highest risk, hence it is not always a safe haven for children. Thus, childproofing the house and adult supervision is advisable.

A 45-year-old male presented with a slowly progressive, painless swelling in his right eye for the past 6 months. He had undergone an open globe injury repair 10 years back and an eventful cataract surgery 5 years back. The presenting visual acuity in the affected eye was perception of light with inaccurate projection of rays. The intraocular pressure was 44 mm Hg with advanced glaucomatous cupping. The swelling was identified to be a communicating sub-tenon cyst secondary to scleral wound dehiscence from secondary angle closure glaucoma. Wound re-suturing, cyst excision and diode laser cyclophotocoagulation was performed in a single sitting, with explained poor visual prognosis.

In a national database, 8.9% of patients with acute open globe injury suffered a concurrent orbital floor fracture, an association significantly impacted by demographics, classification of globe injury, medical history, and status of globe preservation.

A devastating ocular injury can be caused by durian, the “king of fruits.” We report a case of open globe injury secondary to a durian fruit fall. A 54-year-old unfortunate male was accidentally hit by a durian fruit that fell from a tree. The fruit hit directly his right face and eye. He experienced a transient loss of consciousness. He sustained extensive corneal and multiple scleral lacerations with total hyphema, iridodialysis, posterior dislocation of the lens, and retinal detachment. There were also multiple sites of a puncture wound on the right side of the face and right upper lid laceration. Primary suturing of corneal and scleral laceration with anterior chamber washout was performed. The right visual acuity remained poor postoperatively. Durian fruit injury to the eye may lead to severe devastating ocular complications that lead to blindness. The prognosis depends on the severity of the injury.

Complicated corneal and scleral injuries have been shown to be a significant proportion of annual emergency room visits worldwide. In this chapter, the types and definitions of these injuries were described. Furthermore, important clinical signs, examinations, diagnosis of these complicated ocular injuries, as well as their management and postoperative complications, were discussed in detail.

Open globe injury (OGI) is defined as a full-thickness defect of the cornea or sclera. Depending on the severity of the trauma, the involvement of vitreoretinal lesion varies, and examination may be difficult. Therefore, to better understand the patient’s severity before surgery, various examination methods such as computed tomography, B-scan ultrasonography, gonioscopy, and anterior segment optical coherence tomography should be appropriately used. In most cases of OGI, the primary suture is performed immediately after the trauma, and the secondary surgery is planned. In this chapter, we reviewed the retinal detachment, choroidal detachment, and cyclodialysis that could accompany open globe injury and summarized the diagnosis, treatment and postoperative complications.

Traumatic retinal detachments can result from blunt or penetrating trauma. Suprachoroidal hemorrhage is a painful condition often seen in association with trauma. Diagnosis of retinal and choroidal detachments often requires a Bscan ultrasonic examination as vitreous hemorrhage precludes the view of the posterior segment and thus the clinical diagnosis. The presence of a retinal detachment along with choroidal detachment in the case of open globe injury is an indication for early intervention.

Background and Objectives: Open globe injuries (OGI) remain an important cause of visual impairment and loss, impacting all ages. A better understanding of the factors influencing visual outcomes is important in an attempt to improve the results of the treatment of OGI patients. The author aimed to contribute to this knowledge with the analysis of clinical characteristics, prognostic factors, and visual outcomes of their cohort of OGI patients. Materials and Methods: A retrospective medical record review was performed for 160 patients (161 eyes) who sustained an open globe injury between January 2015 and December 2017 and presented to the Hospital of Lithuanian University of Health Sciences. Data analyzed included age, sex, type, cause, place of OGI, initial visual acuity (VA), final best-corrected visual acuity (BCVA), and tissue involvement. Open globe injuries were classified using the Birmingham Eye Trauma Terminology (BETT) and Ocular Trauma Classification System (OTCS). Univariate analysis was conducted to evaluate the prognostic factors. Results: The mean age of the patients was 41.9 years. The male-to-female ratio was found to be 8.4:1. The home was the leading place of eye injury (59.6%), followed by an outdoor environment (14.3%) and workplace (11.8%). Penetrating injury accounted for 43.5%, followed by intraocular foreign body injury (39.1%) and globe rupture (13%). Overall, 19.5% of patients regained a good final vision of ≥0.5, but for 48.1% of them, eye trauma resulted in severe visual impairment (BCVA ≤ 0.02). In the univariate analysis, a bad visual outcome of less than 0.02 was correlated with bad initial VA, iris dialysis, hypotony, vitreous hemorrhage, and vitreous prolapse at presentation. Phthisis bulbi was correlated with eyelid laceration, iris prolapse, iris dialysis, hyphema, vitreous prolapse, vitreous hemorrhage, and choroidal rupture at initial examination. Conclusions: Open globe injury remains an important preventable cause of ocular morbidity. This study provides data indicating that open globe injuries are a significant cause of visual impairment in our research group.

Open globe injuries are one of the major causes of visual impairment and blindness. Achieving useful visual acuity depends on several factors such as initial visual acuity, presence of relative afferent pupillary defect, mechanism and severity of injury, involvement of ocular structures and proper, prompt diagnosis and treatment. We present a case of a 48-year-old man with bilateral open globe injury to show that poor initial visual acuity does not exclude final useful acuity. In our case severity of the trauma and poor visual acuity were detrimental prognostic factors for visual acuity outcome. Within long-term follow-up with additional surgery procedures of both eyes we have reached a significant visual acuity improvement.

AIM: To investigate the patterns and outcomes of open globe injuries in the elderly population in Iran. METHODS: In this retrospective cross-sectional chart review, medical records of 248 patients (aged 60y and more) with the diagnosis of open globe injury from 2006 to 2016 were reviewed. Demographic features, type, and mechanism of open globe injury, ocular trauma score (OTS), visual acuity before and after treatment, the zone of injuries, and the associated injuries found at the presentation or thereafter were documented. RESULTS: A total of 248 eyes of 248 patients were included. The mean age was 69.2±5.8y (range: 60-90y). Male/ female ratio was about 3:1 (187 vs 61). The three most common causes of injury were falling (25.2%), sharp objects (18.9%), and tree branches (13.9%). Penetrating injury accounted for most of the geriatric ocular trauma (50.4%), followed by globe rupture (40.3%), intraocular foreign body (IOFB; 7.3%), and perforating injury (2.0%). The median raw OTS for the population was 60.5 and the most common OTS class was 3. The injuries tend to affect zone I more than zone II and zone III. The only predictor of final visual acuity was the class of OTS (P

BACKGROUND: Pediatric endophthalmitis after open-globe injury had its clinical features, microbiological profile different from those in aldults. In Viet Nam, there was no report on the clinical and microbiological characteristic of pediatric posttraumatic endophthalmitis. Therefore, we conduct this study. AIM: To describe clinical features, ultrasound results, gram stain and culture results of endophthalmitis in pediatric open globe injuries. METHODS: Prospective non-controlled study. Case series of 30 eyes presenting with post-traumatic endophthalmitis between 2015 and 2016 were reviewed. RESULTS: Mean age was 8.03 ± 3.99 years. Metallic and organic etiologies were most common causes for injuries (n = 11). 27 cases had penetrating corneal trauma. Dense opaque vitreous was seen in 25 eyes. Retinal necrosis < 1 quadrant and chorioretinal abscess > 1 quadrant were most common fundus lesions. Dense vitreous opacity on ultrasound was most common (n = 28). Gram stain bacteria positivity was 93.3%, gram-positive were isolated in 63.3%. Vitreous samples were more often positive than aqueous (P = 0,002). CONCLUSION: Posttraumatic endophthalmitis in children is more common in boys aged 6-10 years and most often caused by injury with metallic and organic matter. Culture results were very low. Vitreous samples were more often positive than aqueous. Gram-positive bacteria were the most common causative organism.

Orbital trauma, particularly with open globe injury, can have a wide range of visual outcomes, which can be difficult to predict at presentation. Clinical features on presentation may provide insight into visual prognosis. We hypothesized that patients with open globe injuries and concomitant orbital fractures have poorer visual outcomes than patients without orbital fractures.We reviewed the charts of 77 patients with isolated open globe injuries (OG) and 76 patients with open globe injuries and concomitant orbital fractures (OGOF). Multivariate regression analysis was performed to assess the relative influence of individual presenting historical and clinical features on visual outcome.OGOF patients were more likely to have sustained blunt trauma than a sharp, penetrating injury compared to OG patients. Ocular wound locations were more posterior and likely to involve multiple zones in OGOF compared to OG patients. Among OGOF patients, orbital floor fractures were the most common and roof fractures were the least common, but the latter was associated with presenting NLP vision and multiple zone involvement. The presence of an orbital fracture independently increased the odds of subsequent evisceration/enucleation (OR: 4.6, 95% CI 1.3-20.1,The presence of an orbital fracture independently confers a worse visual and ocular prognosis in patients with open globe injuries. Patients with open globe injuries in this category should be appropriately counseled.

Objective: Investigation of the effect of the globe injury site and the globe injury type on the postoperative results in the patients with a relatively softer open globe injury (OGI) was aimed. Methods: Medical records of the patients with OGI due to blunt or penetrating trauma were analyzed retrospectively. The patient cohort was divided into laceration and rupture groups. The location of injury was evaluated in zones (I-II-III). Presence and type of the complication (cataract, retinal detachment, etc.) were evaluated. Final best-corrected visual acuity (BCVA) was evaluated as the primary outcome measure. Results: Seventy eyes of 70 patients with OGI were included in the study. While 58 eyes (82.9%) had lacerations, 12 eyes (17.1%) had ruptures. Among the 52 patients with lacerations for whom there was an available BCVA data, 13 (25%) patients showed no change, 32 (61.5%) showed an increase, and 7 (13.5%) showed a decrease in BCVA. Among the 11 patients with ruptures, 2 (18.2%) patients showed no change and 9 (81.8%) showed an increase in BCVA. A complication was observed in 23 (44.2%) patients with laceration and 4 (33.3%) patients with rupture (p: 0.474). No difference was detected in terms of the complication rate between the patients having a different zone of injury. However, final BCVA was lower in those with Zone III injury in comparison to those with Zone II injury (p: 0.028). Conclusion: Although the injury type was thought to have an effect on the final BCVA of the patients with OGI, no difference was detected between the patients with laceration and rupture. Zone III injuries resulted in lower preoperative BCVA values. However, despite a significant difference between Zone II and III injuries, no significant difference was observed in terms of the final BCVA between the patients with Zone I and those with Zone III injuries.

To describe a case of inflammatory neovascularization of the lens after open globe injury.Case report.A 57-year-old man presented with severe inflammation, posterior synechiae with traumatic cataract, and thick neovascularization of the intralenticular and anterior lens capsule after open globe injury in the left eye. We administered an intravitreal bevacizumab injection and performed cataract surgery with synechiolysis 1 month later.Inflammation after open globe injury may present as intralenticular neovascularization. Before cataract surgery for traumatic cataract with intralenticular neovascularization, the use of intravitreal bevacizumab injection was ineffective.

Penetrating eye injuries caused by bird pecking are uncommon with less than 40 cases reported in the literature. In this article, we present a case of penetrating ocular injury caused by a bird along with pertinent literature review. An otherwise healthy 56-year old man presented to the emergency department complaining of right eye severe pain and decreased vision following trauma caused by a bittern bird. The patient was diagnosed with penetrating ocular injury & he underwent primary repair. On follow up, he was found to have traumatic cataract, which was operated, however, the surgery was complicated with IOL dislocation into the vitreous cavity. The patient was referred to retina service where he underwent pars plana vitrectomy with IOL repositioning in the sulcus. After two months, the patient’s uncorrected visual acuity improved from counting fingers at 2 feet to 20/30−2. This case serves as a reminder that bird pecking is one of the causes of penetrating eye trauma. Keywords: Penetrating eye injury, Open globe injury, Bird pecking, Bittern bird

Purpose: To detect the factors affecting the final visual acuity in open globe injuries. Material And Methods: Fifty eight eyes of 58 patients who were treated for open globe injuries were analysed prospectively. Factors which are deemed to have effect on visual prognosis were examined statistically. Results: Forty five patients (%77.6) were male, with a mean age of 29.6 ±19.4. Final visual acuity was 0.1 and lower in 28 (%48.3) cases. The prognostic factors predicting the final visual acuity were initial visual acuity, wound size, mechanism of the injury, presence of relative afferent pupillary defect (RAPD), zone of the injury, anterior chamber finding, lens injury, posterior segment finding, uveal injury and Ocular Trauma Score . According to multiple retrospective logistic regression analysis, those factors having the highest effect on final visual acuity were found to be presence of an RAPD, female gender, old age and large laceration respectively. Conclusion: Initial examination findings are helpful for predicting the visual outcome in open globe injuries. Therefore, standardization in classification of the initial examination findings is compulsory.

Background A few case reports have described accidental eye injuries caused by fish hooks. The severity of ocular injuries is dependent on the involved ocular structures. Severe ocular injuries due to fish hooks are rare. We describe open globe and penetrating eyelid injuries from fish hooks at the Baltic Sea. Methods Nine patients with traumatic ocular injuries caused by fish hooks were included. The following parameters were evaluated: severity of injury, best corrected visual acuity at admission and last follow-up, and surgical treatment. Results All nine patients were male. Age ranged between 7 and 51 years with a median of 13 years. Sixty-seven percent of the patients were children. Four of the nine patients were 9 years or younger. In 5 eyes (55%) the injury was limited to the eyelid. An open globe injury was found in 4 patients (45%). The mean follow-up was 16.7 ± 32.8 months. All patients required surgical treatment. The number of operations ranged from 1 to 3, with a mean of 1.4. At admission and last follow-up, patients with eyelid injuries showed a median best corrected visual acuity (BCVA) of logMAR 0.0. Patients with open globe injuries showed a median best corrected visual acuity of logMAR 1.5 at admission, and of logMAR 0.6 at last follow-up. Conclusions Nearly half of the patients suffered severe penetrating injuries. Especially children misjudge the risk potential of fishing due to their lack of experience. Fishing glasses should be worn not only for UV protection, but also as injury prevention strategy.

Purpose: To report the incidence, modes of injury, treatment, and short-term outcomes in eyes with post-traumatic elevated intraocular pressure (IOP). Methods: This was a 5-year hospital-based retrospective study of children ≤16 years who presented with open (OGI) or closed globe injury (CGI) and developed elevated IOP >21 mmHg. Those with a minimum follow up of 3 months were included. Analysis of various parameters such as influence of demographics, mode of injury, IOP, best-corrected visual acuity (BCVA), and effect of medical and surgical treatment on IOP and BCVA was done. Results: Out of 205 pediatric eyes with ocular trauma, 121 (59%) had CGI and the remaining 84 (41%) had OGI. Thirty-two eyes (15.6%) developed elevated IOP. The incidence of elevated IOP following CGI [25 eyes (20.6%)] was significantly higher than that following OGI [7 eyes (8.3%, P = 0.02)]. Hyphema (37.5%) and lens-related mechanisms (18.75%) were the most common causes of elevated IOP. The mean IOP at the time of diagnosis was 29.8 + 6.3 mmHg and reduced to 16.2 ± 2.2 mmHg at last follow up (P < 0.001). Surgical management was required in 12 eyes (37%) and significantly more eyes with CGI required trabeculectomy (24% in CGI vs. 0% in OGI, P = 0.03). Poor baseline vision and vitreoretinal involvement [0.67 line decrement, 95% confidence interval (CI) =0.1–1.25 lines, P = 0.025] increased risk of poor visual outcome. Conclusion: Post-traumatic IOP elevation occurred in 15% pediatric eyes, was more common with CGI compared to OGI and nearly one-fourth of eyes with CGI required glaucoma filtering surgery for IOP control. Overall, medical management was needed in 63% eyes and 37% required surgical management. Visual acuity was poor in eyes with OGI due to posterior segment involvement.

Background To identify prognostic factors determining final visual outcome following open globe injuries. Methods Retrospective case series of patients presenting to Westmead Hospital, Sydney, Australia with open globe injuries from 1st January 2005 to 31st December 2017. Data collected included demographic information, ocular injury details, management and initial and final visual acuities. Results A total of 104 cases were identified. Predictors of poor final visual outcomes included poor presenting visual acuity (p p p = 0.003), lens expulsion (p = 0.003) and vitreous hemorrhage (p p = 0.013) and retinal detachment (p = 0.011) as being statistically significant for predicting poor visual outcomes. The presence of lid laceration (p = 0.197) and uveal prolapse (p = 0.667) were not significantly associated with the final visual acuity. Conclusions Poor presenting visual acuity, globe rupture and retinal detachment are the most important prognostic factors determining final visual acuity following open globe injury.

Purpose Binocular traumatic or atraumatic iris defects can lead to an increased sensitivity to glare and cosmetic disfigurement. Surgical iris reconstruction is one approach to alleviate these problems. We report the clinical outcomes after medically indicated bilateral implantation of an Artificial Iris prosthesis in three patients with binocular iris defects with different etiologies. Observations All three patients underwent binocular CUSTOMFLEX ArtificialIris (AI) (HumanOptics AG, Erlangen, Germany) implantation with simultaneous cataract surgery. Corrected distance visual acuity (CDVA), manifest refraction, Contrast sensitivity, endothelial cell density and subjective visual impairment as well as subjective cosmetic disfigurement were measured pre- and postoperatively. CDVA remained stable or improved in all three patients. We observed an increase in contrast sensitivity and reduction of glare sensitivity in two patients. All patients reported satisfaction with the cosmetical result after the implantation. Conclusions and importance The bilateral Artificial Iris implantation is an effective therapeutic option to reduce glare sensitivity and to achieve an aesthetically pleasing result also in selected patients with binocular traumatic or atraumatic iris defects.

Intraocular foreign bodies (IOFBs) are critical ophthalmic emergencies that require urgent diagnosis and treatment to prevent blindness or globe loss. This study aimed to examine the various clinical presentations of IOFBs, determine the prognostic factors for final visual outcomes, establish diagnostic protocols, and update treatment strategies for patients with IOFBs. We retrospectively reviewed patients with IOFBs between 2005 and 2019. The mean age of the patients was 46.7 years, and the most common mechanism of injury was hammering (32.7%). The most common location of IOFBs was the retina and choroid (57.7%), and the IOFBs were mainly metal (76.9%). Multivariate regression analysis showed that poor final visual outcomes (&lt, 20/200) were associated with posterior segment IOFBs (odds ratio (OR) = 11.556, p = 0.033) and retinal detachment (OR = 4.781, p = 0.034). Diagnosing a retained IOFB is essential for establishing the management of patients with ocular trauma. To identify IOFBs, ocular imaging modalities, including computed tomography or ultrasonography, should be considered. Different strategies should be employed during the surgical removal of IOFBs depending on the material, location, and size of the IOFB.

Purpose: To describe surgical management and establish visual outcomes of open globe injury (OGI) in pediatric patients requiring vitrectomy. Methods: Forty-eight eyes of 48 pediatric patients underwent vitrectomy for OGI with secondary vitreoretinal complications in the eye center of Jilin University were included. Characteristics of patients, details of ocular examination and operation, presenting and final visual acuity were recorded. Results: Presenting visual acuity less than 20/400 was found in 44 eyes (91.7%), which included no light perception (NLP) in four eyes. At last visit, there was no eyes with visual acuity of NLP, and 19 eyes (39.6%) had a vision recovery to 20/400 or better. Mechanisms of injury, intraocular contents prolapse, presence of hyphema, intraocular foreign body, vitreous hemorrhage, retinal detachment, and total time from injury to PPV > 2 weeks were significant predictors of visual prognosis. Logistic regression analysis showed that hyphema was a significant predictive factor for poor visual outcome. Conclusion: Visual acuity was improved in most of the patients with OGI in this study. Hyphema is an important presenting ocular sign in estimating the post-vitrectomy visual outcome for OGI in children. Proper timing of vitrectomy is suggested, and in this study patients may benefit more with early vitrectomy as less proliferative vitreoretinopathy (PVR) was found together with a better visual acuity.

Ocular trauma can be a common presentation in the emergency department. It is therefore important for a physician to be able to quickly recognize vision-threatening conditions and provide necessary medical management prior to consulting ophthalmology. This article describes the pertinent information that should be gathered during a focused ocular history in a patient with ocular injury, and also provides a systematic approach to evaluating ocular trauma. As an example, a case study of open globe injury is used to illustrate the appropriate pre-ophthalmologic management and common medical errors that must be avoided for a good prognosis. Additional ocular conditions such as traumatic hyphema, traumatic optic neuropathy, traumatic vitreous hemorrhage, orbital compartment syndrome, chemical burns, and eyelid lacerations are also described as differential diagnosis. Ultimately, the aim of this work is to provide medical students with a fundamental understanding in approaching ocular trauma in emergency clinics.

Christian S Mayer,1,* Isabella Baur,1,* Julia Storr,2 Alexander Markard,1 Ramin Khoramnia1 1Department of Ophthalmology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany; 2Department of Ophthalmology, Technical University Munich, Munich, Germany*These authors contributed equally to this workCorrespondence:Christian S MayerDepartment of Ophthalmology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, GermanyEmail Christian.Mayer@med.uni-heidelberg.dePurpose: Patients with traumatic aniridia, aphakia and retinal complications can require silicone oil endotamponade. In the absence of compartmentalization, there is a risk of silicone oil migrating to the anterior chamber which can cause long-term complications. We report a two-step procedure in trauma cases, using sutures for silicone oil retention in primary care and subsequently prior to secondary artificial iris (AI) and intraocular lens (IOL) implantation, to achieve a reconstruction of the anterior and posterior chamber.Material and Methods: Seven patients with loss of the iris-lens-diaphragm after an ocular trauma and the need for silicone oil endotamponade underwent a primary intervention including wound closure, placement of silicone oil retention sutures and silicone oil filling. Four of those underwent secondary reconstruction with silicone oil removal and AI and IOL implantation and could be included in this retrospective observational study. All main outcome measures were evaluated after the first and after the second surgery. The main outcome measures were morphological findings, subjective impairment from glare, subjective cosmetic disfigurement, patient satisfaction and intraocular pressure (IOP) as well as best-corrected distance visual acuity and objective refraction.Results: The retention sutures could effectively prevent silicone oil migration into the anterior chamber in the first surgery. Silicone oil emulsifications in the anterior chamber were observed in one patient. In two patients, pigment deposition at the sutures was seen. Subjective impairment from glare and subjective cosmetic disfigurement could be reduced after the second surgery compared to the evaluation after the first surgery. IOP and best-corrected distance visual acuity remained stable. No eye needed silicone oil refilling after the secondary reconstruction surgery.Conclusion: Our two-step approach is viable and provides good functional and aesthetic results. We observed a high patient satisfaction.Keywords: aniridia, aphakia, trauma, open globe injury, retinal detachment