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Purpose: To analyse the clinical ocular characteristics and determine prognostic factors for functional recovery in eyes presenting with no light perception (NLP) after open globe ocular trauma., Materials and Methods: In this retrospective study were included all the patients with no light perception after open globe trauma who presented to Amiens University Hospital between October 2014 and June 2018., Results: Fifteen eyes of 15 patients were included in this study. The main mechanism of the trauma was globe rupture (80 %, n=12). The most common location was zone III (66 %, n=10). The wound size was greater than 10mm in 9 patients (60 %). The ocular lesions included expulsion of the crystalline lens or posterior chamber intraocular lens, hyphema, retinal detachment, vitreous hemorrhage and ciliochoroidal lesions. Damage to the ciliary body was a negative prognostic factor for functional recovery (P=0.04). Nine patients remained with no light perception, whereas 6 patients experienced an improvement in visual acuity (2.3 logMAR in 3 patients, 0.7 logMAR in 1 patient, 0.4 logMAR in 1 patient and 0.2 logMAR in 1 patient). These 6 patients had undergone posterior vitrectomy due to vitreoretinal involvement (P<0.001)., Conclusion: In the case of open globe trauma with no light perception on presentation, a functional recovery is possible if there is no irreversible anatomical damage., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Ocular perforations require an action depending on the findings observed. Additionally, the closeness of the orbit to the nasal cavity and the anterior cranial fossa requires any collateral damage in these spaces to be ruled out. The presence of a penetrating ocular injury associated with ipsilateral rhinorrhoea in which the presence of β2-transferrin -a highly specific and sensitive marker to identify cerebrospinal fluid- is detected, obliges to suspect and locate any possible leakage. A case is presented in which this unbound protein is detected in post-traumatic rhinorrhoea with an origin in the eyeball, making the diagnosis of a CSF leak into a false positive., (Copyright © 2019. Publicado por Elsevier España, S.L.U.)

Competing Interests: There are no conflicts of interest.

Purpose: To describe the long-term ocular effects of airsoft gun pellet injuries., Methods: The present study extends by 7-10 years the results of a 2010 study on the acute ocular findings related to airsoft gun pellet injuries in 59 patients, wherein we found a variety of anterior and posterior segment injuries, including hyphema (66%), corneal edema (61%), corneal erosions (59%), and traumatic mydriasis (25%), as well as retinal edema in (22%), retinal hemorrhages and mild vitreous hemorrhage in (2.1%), and, in 1 patient, elevated intraocular pressure and traumatic cataract., Results: Of the 59 patients in the original study, up-to-date medical records were available for 26 (44%; 20 males). The mean follow-up time was 8 years (range, 7.2-10.3 years); the mean age, 17.1 years. Persistent abnormal findings included traumatic cataract in 3 cases (11.5%) and iris dialysis in 1 case (3.8%). In all traumatic cataract cases, cataract was not present at the time of initial examination after injury. Final mean best-corrected visual acuity was 0.92 (range 0.67-1.0), logMAR 0.03 (range 0.18-0)., Conclusions: While most acute airsoft gun-related ocular injuries are transient, some patients may develop significant and potentially sight-threatening ocular damage, even in the absence of significant pathologic findings at the time of the injury. Long-term follow-up on these patients is advisable., (Copyright © 2018 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Purpose: To analyze the data of patients who underwent vitreoretinal surgery due to intraocular foreign body (IOFB) injuries that occurred in the Syrian civil war., Methods: Seventy-eight eyes of 78 patients who underwent vitreoretinal surgery due to IOFB injuries that occurred during the Syrian civil war were analyzed., Results: Forty-four eyes (56.4%) had traumatic cataract, 44 (56.4%) had retinal tears, 42 (53.8%) had vitreous hemorrhage, 18 (23%) had retinal detachment, 12 (15.3%) had endophthalmitis, and eight eyes had hyphema (10.2%). IOFBs consisted of metal in 62 eyes (79.4%), stone in eight eyes (10.2%), organic material in four eyes (5.1%), and glass in four eyes (5.1%). Approximately 86% of the eyes had initial VAs of 4/200 or worse. However, VAs improved in 64 eyes (82%) after the surgeries., Conclusions: Despite delays in treatment and the severity of injuries, 82% (64/78) of the eyes had an improvement in VA after the surgeries.

Two patients presented to the University of Illinois at Chicago Eye and Ear Infirmary within 1 year with penetrating eye injuries caused by similar collapsible cloth and wire laundry hampers. Penetrating eye injuries in children are relatively rare but can result in poor visual outcomes and multiple vision-threatening complications. Both injuries at the University of Illinois resulted in an eye laceration as well as retinal complications similar to those reported with a high velocity injury. This now represents a significant pattern of eye injury and suggests that there exists a nontrivial risk for all children in households with this type of collapsible laundry hamper. Parents should receive a warning of the risks of these hampers.

Purpose: To evaluate the role of cryopexy or laser therapy versus observation for management of accidental globe perforation during strabismus surgery in an experimental animal model., Methods: An S-24 needle was passed through the sclera and into the vitreous cavity in both eyes of 42 rabbits. Cryopexy was performed in 22 eyes, and laser therapy was applied in 20 other eyes; the 42 untreated fellow eyes served as controls. The incidence of complications was compared between treated and untreated eyes., Results: Cataracts were observed in 7 eyes (8.3%) and corneal opacity in 1 eye (1.2%) vitreous hemorrhage occurred in 28 eyes (33.3%), leading to vitreous opacity in 1 eye (1.2%). Transient localized subretinal fluid accumulation around the retinal break developed in 1 eye (1.2%). There were no cases of endophthalmitis or retinal detachment. There was no significant difference in the rate of complications among the 3 groups., Conclusions: Vision-threatening consequences of globe perforation during strabismus surgery were uncommon in this rabbit model. Simple observation without intervention may have similar results as prophylactic cryopexy or laser therapy., (Copyright © 2011 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.)

Purpose: The purpose of this study was to investigate the effect of intravitreal bevacizumab on an experimental rabbit model of penetrating posterior ocular injury., Methods: The right eyes of 40 white New Zealand rabbits were included in a penetrating posterior ocular injury model that was consisted of a 5-mm circumferential incision placed 8 mm behind the limbus at the supratemporal quadrant. They were randomly divided into two groups. The rabbits in Group 1 (n = 20) received 1.25 mg (0.05 mL) of intravitreal bevacizumab via pars plana injection and those in Group 2 (control group, n = 20) received 0.05 mL of intravitreal balanced salt solution. On Day 28, the eyes were enucleated and evaluated by gross inspection and light microscopy. Clearance time of vitreous hemorrhage, presence of fibrous proliferation or retinal detachment, greatest linear dimension of fibrosis, and grade of fibrous extension were regarded as outcome measures. Nominal variables were evaluated by the chi-square or the Fisher's exact test; continuous variables were evaluated using the Mann-Whitney U test., Results: At the end of the surgery, all the eyes had moderate (n = 9 and 7 in the case and control groups, respectively) or severe vitreous hemorrhage (n = 11 and 13 in the case and control groups, respectively) (P = 0.52). Average clearance time of vitreous hemorrhage was 3.42 ± 2.71 and 6.47 ± 3.58 days in bevacizumab and control groups, respectively (P = 0.01). The incidence of ophthalmoscopically visible fibrous proliferation was 31.6% in the bevacizumab group and 63.2% in the control group (P = 0.05). The greatest linear dimension of fibrosis was 0.91 ± 1.14 mm in the bevacizumab group and 2.00 ± 1.58 mm in the control group (P = 0.02). Retinal detachment rate was 11% (n = 2, all rhegmatogenous) and 21% (n = 4, 2 rhegmatogenous and 2 tractional) in the bevacizumab and control groups, respectively (P = 0.66). Choroidal congestion, optic disk edema, and macular edema were seen in 1 eye (5.5%) of the bevacizumab group, whereas they were found in 4 (22%), 4 (22%) and 3 (16.5%) eyes of the control group, respectively. These differences, however, did not reach statistical significance., Conclusion: This study showed that intravitreal injection of bevacizumab may reduce the extent of fibrovascular and/or fibrocellular proliferation and may accentuate the clearance of vitreous hemorrhage after an experimental model of posterior penetrating ocular injury in rabbits. These alterations may affect the long-term anatomical and/or functional success rate of posterior segment surgeries in these eyes.

Unlabelled: We report a case of globe rupture associated with the use of post cataract-surgery protective eyewear. The patient had routine cataract surgery 3 months before presentation and had adapted his post cataract-surgery glasses to use on the tennis court. He experienced a large posterior globe rupture after falling directly onto his face during a match. Spectacle torsion is the suspected biomechanical process that led to the rupture. We conclude that although the glasses given to many patients after cataract surgery are protective for most low-impact injuries, patients should be aware they are not designed for activities with a risk for significant impact. Patients should also be counseled to use protective eyewear specifically designed and approved for the sport or activity in which they participate., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Published by Elsevier Inc.)

A 31-year-old woman presented with visual acuity of counting fingers and presumed bacterial endophthalmitis in the left eye 10 days after refractive surgery. During the procedure, a retrobulbar injection of balanced salt solution had been performed to assist with globe suction by the microkeratome. A perforation site was identified in the inferonasal retina. Following intravitreal antibiotic injection and surgical intervention, the visual acuity returned to 20/20. Retrobulbar injection to facilitate laser in situ keratomileusis carries risks. Careful monitoring for signs of infection is recommended if globe perforation is recognized.

Introduction: Local anesthesia for eye surgery was first described in 1884; later Knapp popularized retrobulbar anesthesia. To reduce risks, peribulbar anesthesia appeared in the 1970s. Still used today, periocular anesthesia is not without complications, in particular the risk of ocular perforation., Patients and Methods: Three patients were referred to our department for diagnosis and treatment of an intravitreous hemorrhage following cataract surgery. We report the clinical features, treatment, and visual outcome for these three patients., Results: The most common presentation was vitreous hemorrhage: the three eyes were found to have associated retinal detachment on initial assessment. One patient presented severe vitreoretinal proliferation with two postoperative recurrences; the globe was finally enucleated. The two other patients presented attached retina after surgery but had achieved very poor visual recovery., Conclusion: Inadvertent globe perforation during local ocular anesthesia is rare. Careful attention to risk factors, early recognition, and prompt referral for management are recommended to improve the visual prognosis. Surgical management must be adapted to the severity of the perforation (vitreous hemorrhage, retinal detachment, vitreoretinal proliferation). The problems treating these patients with severe, often recurrent, retinal detachment, with poor visual prognosis, in a tricky forensic context should be emphasized.

Background: To describe surgical management and establish anatomic and visual results of patients with explosive ocular trauma in terrorist attacks treated with extreme vitreoretinal surgery., Methods: Retrospective study of clinical records (6-month follow-up) of patients with visual acuity (VA) of light perception or better with posterior segment injuries [vitreous hemorrhage, retinal detachment (RD), intra-ocular foreign bodies (IOFB), perforating trauma (PT)] from explosive weapons who underwent vitreoretinal surgery. We reviewed the demographic characteristics, type of weapon, time between injury and surgery, VA at arrival and 6 months after surgery, and type of trauma according to the International Trauma Classification., Results: Fifty-seven out of 236 patients with ocular injuries from explosive weapons were included in the study; all of them were military men, average age 22 years (range 16-53 years). The average time between the blast and primary closing was 1 day, and 10 days between primary closing and vitreoretinal surgery. Open traumas by laceration accounted for 96% of cases and 4% were closed traumas; 76% of the eyes had IOFB, of which 18% involved PT; 5% had endophthalmitis. Contusion was the diagnosis for 100% of the closed traumas. Of the open traumas, 40% were localized at zone I, 44% at zone II, and 16% at zone III. Upon arrival, 98% of patients had VA 20/800-LP and 2% had >20/40. The patients with closed trauma had the injuries at zone III and presented VA 20/800-LP. All patients underwent posterior vitrectomy, scleral buckling, endotaponade and when required, lensectomy (82%), IOFB removal (72%), and/or retinectomy (25%). Postoperative VA improved in 43% of the patients, stabilized in 41% and evolved to NLP in 15% of the cases. Initial expressions of ocular trauma such as RD, PT and endophthalmitis suggest bad prognosis., Conclusions: We presented a series of patients with severe ocular trauma of the posterior segment from explosive weapons. These patients were treated according to our surgical protocol with extreme vitreoretinal surgery within the first 2 weeks after the blast; with our procedure we obtained stabilization or improvement of the VA for 84% of the cases.

Severe injuries of the posterior eye segment mostly occur during perforation or rupture of the globe. The first treatment includes primary surgical repair of the ocular wound and prophylactic scleral buckling in case of involvement of the posterior segment. Thereafter, a vitrectomy should be performed to remove vitreous hemorrhage and intraocular foreign bodies and to achieve a stable attachment of the retina. Therefore, temporary perfluorocarbon and permanent silicone oil tamponade are used. A predictor of poor visual outcome is the presence of retinal and choroidal injury. In our patients, the most important prognostic factor was the initial visual acuity after the injury. Vitrectomy can significantly reduce the incidence of enucleation. Currently, better visual outcome is achieved by advances in surgical techniques.

Purpose: To report a rare complication of retrobulbar anesthesia with ipsilateral globe penetration and transient contralateral amaurosis., Design: Interventional case report., Methods: A 63-year-old woman complained of vision loss in the right eye immediately following cataract surgery on the left eye., Results: Right eye vision decreased to no light perception with clear media and normal fundus. The vision recovered to baseline in 12 hours. Left eye vision was checked and demonstrated only light perception. Fundus examination disclosed preretinal and vitreous hemorrhage. During vitrectomy of the left eye, a penetrating wound below the optic disk with retinal detachment was found., Conclusion: The ipsilateral globe penetration wound depicts the mechanism of contralateral amaurosis following retrobulbar anesthesia of the case.

We report 3 cases of globe rupture after peribulbar anesthesia. We discuss the predisposing factors, presenting features, and visual outcome after this complication. Globe explosion is a severe complication of inadvertent intraocular injection during peribulbar anesthesia. Visual outcome after vitrectomy is generally poor; however, cases that do not develop a retinal detachment may achieve good results.

We report the clinical management of a patient who sustained scleral perforation and intraocular injection of local anesthetic agent during retrobulbar block. We discuss the management options for this rare complication of local anesthesia in cataract surgery.

Purpose: To report a case of globe perforation while initiating posterior subtenon's anesthesia., Methods: Case report. A 40-year-old man with a history of retinal detachment in both eyes presented for repair of a second retinal detachment in the LE., Results: Upon dissecting a space beneath the Tenon capsule with scissors, the globe was perforated., Conclusion: In patients with prior ophthalmologic surgery, thinned sclera, or excess scar tissue, increased caution should be employed during initiation of sub-Tenon anesthesia or an alternative method should be used.

A 45-year-old woman, originally scheduled for cataract surgery in the left eye, was referred for management of a globe perforation noticed after the retrobulbar injection of an anesthetic solution. There was a moderate degree of vitreous hemorrhage, and initial visual acuity was hand movement. A submacular blood clot of about 4-disc diameter was detected when the vitreous hemorrhage gradually cleared. One week after the incident, combined phacoemulsification, intraocular lens implantation, pars plana vitrectomy, and submacular clot removal using tissue plasminogen activator (tPA) as an adjunct were performed. Recovery was uneventful. At the last follow-up 6 months after surgery, best corrected visual acuity was 20/30.

Objective: The aim of this study was to assess the outcome of surgical treatment of war lesions to the posterior eye segment., Methods: During a 1-year period, 96 patients with severe eye lesions, 54 of them with intraocular foreign bodies (56.2%), were operated on at the Institute for Posterior Eye Segment Diseases and Trauma, Zagreb Clinical Hospital. Surgical procedures performed included high-quality primary microsurgery of the wound, extraction of intraocular foreign bodies, treatment of double perforating wounds by silicone oil tamponade and gas, and emergency vitrectomy when necessary., Results: A varying degree of vision function improvement was achieved in 67 patients (69.7%). Most of the foreign bodies removed were metal and nonmagnetic. Only six foreign bodies were made of glass, and two 2 were of plastic material. In 29 patients (30.3%), the vision function remained unchanged or deteriorated after vitrectomy., Conclusion: Although satisfactory results were achieved, definitive evaluation of the procedures will be possible only after long-term follow-up.

Objectives: An increasing number of cases are being recognized in which a periocular anesthetic for cataract surgery has been inadvertently injected directly into the globe under high pressure until the globe ruptures or "explodes." The objectives of the current study were to (1) analyze this injury clinically and histopathologically through a series of seven case reports; (2) reproduce the injury experimentally in human eyebank eyes, live anesthetized rabbit eyes, and human cadaveric eyes; (3) investigate the biophysical basis of the injury; and (4) outline recommendations to help decrease the risk of ocular rupture with periocular injections. DESIGNS/PARTICIPANTS: Clinical, histopathologic, experimental animal, autopsy eye, and theoretical biophysical study., Methods: The clinical and histopathologic findings of the patients' eyes were documented. Human eyebank eyes, live anesthetized rabbit eyes, and human cadaveric eyes were exploded via direct intraocular saline injection. The laws of Bernoulli, LaPlace, Friedenwald, and Pascal were used to investigate theoretically the biophysics of the injury., Results: The findings of anterior and posterior scleral rupture, retinal detachment, vitreous hemorrhage, and lens extrusion were observed clinically and experimentally. In some clinical and experimental cases, the anterior segment appeared entirely normal despite a posterior rupture. The surgeon proceeded with and completed the cataract surgery in two of the seven clinical cases without knowledge of the rupture. The pressure required to produce such an injury is in the range of 2800 to 6400 mmHg, and this pressure is more easily attained with a 3-ml syringe than with a 12-ml syringe., Conclusions: Explosion of an eyeball during the injection of anesthesia for ocular surgery is a devastating injury that may go unrecognized. The probability of an ocular explosion can be minimized by (1) the use of a blunt needle and a 12-ml syringe, (2) aspirating the plunger and wiggling the syringe before injection, (3) discontinuing the injection if corneal edema or resistance to injection is noted, and (4) inspecting the globe for evidence of intraocular injection before ocular massage or placement of a Honan balloon. On recognition of an ocular explosion, immediate referral to and intervention by a vitreoretinal surgeon is optimal.

Background: In our institution the occurrence of endophthalmitis related to intraocular foreign bodies has been rare. In this review we analyse the outcome of eyes with retained intraocular foreign bodies presenting to two vitreoretinal surgeons over nearly 7 years., Methods: Review of the records of 26 patients who presented to two surgeons in a tertiary care vitreoretinal service in Toronto between January 1989 and November 1995. Information documented included mechanism of injury, time from injury to definitive surgery, entry site, presence of vitreous hemorrhage, type of surgery performed, initial and final visual acuity, and development of endophthalmitis., Results: All the injuries occurred in male patients, with a mean age of 36.1 (range 15 to 55) years. Most of the injuries occurred in the workplace, and in most cases (17 [65.4%]) the mechanism of injury was "metal on metal." The entry site was via a perforating wound of the cornea in 16 cases (61.5%). Almost all cases were repaired within 48 hours by means of pars plana vitrectomy. Concurrent lensectomy was required in 18 cases (69.2%) for lens damage at the time of the original injury. Vitreous hemorrhage was present in 22 cases (84.6%). One patient (3.8%) manifested clinically apparent endophthalmitis, which responded to intravitreal antibiotic therapy. Nineteen eyes (73.1%) had a final visual acuity of 6/24 or better. Eyes with coexisting or subsequent retinal detachment had significantly worse vision than those without retinal detachment (p < 0.001)., Interpretation: The incidence of endophthalmitis in our series is lower than that in other published series. Prompt definitive treatment was associated with a good prognosis in most cases.

Purpose: This investigation retrospectively examined ocular injuries associated with air bag deployment to gain a better appreciation of potential risk factors in motor vehicle accidents. National statistics regarding the efficacy of air bags were reviewed., Methods: Review of the literature from 1991 to 1998 identified 44 articles describing 97 patients with air-bag-induced ocular injuries. Variables extracted from each case were age, sex, height, position in the car, eye wear, vehicle impact speed, visual acuity, and specific ocular injuries., Results: Corneal abrasions occurred in 49% of occupants, hyphemas in 43%, vitreous or retinal hemorrhages in 25%, and retinal tears or detachments in 15%. The globe was ruptured in 10 patients. Patients involved in higher-speed accidents (over 30 mph) sustained a greater percentage of vitreous or retinal hemorrhages and traumatic cataracts, while those at slower speeds were more prone to retinal tears or detachments. In a subset of 14 patients with serious ocular injuries, the impact speed of 11 patients was recorded at 30 mph or less. Slower speed may be a risk factor for some ocular injuries. Occupant height was not a significant factor. National statistics confirm that air bags reduce fatalities in motor vehicle accidents. However, children sitting in the front seat without a seat belt and infants in passenger-side rear-facing car seats are at risk for fatal injury., Conclusion: Air bags combined with seat belts are an effective means of reducing injury and death in adults during motor vehicle accidents. However, this study has documented a wide variety of ocular injuries associated with air bag deployment. It is hoped that researchers can develop modifications that continue to save lives while minimizing additional harm.

Purpose: To assess ocular injuries caused by cow horns; to investigate clinical findings, treatment, and visual outcome in a population of dairy farmers; and to propose possible preventive measures., Methods: A retrospective review was conducted to identify patients seen over a 45-month period with cow horn-inflicted eye injuries. Eleven patients were identified and their charts reviewed for demographics, mechanism of injury, initial and final visual acuity, surgeries performed, and anatomic outcome., Results: The mean age of the patients was 64 years. Seven patients had open-globe injuries with vitreous hemorrhage. In five cases, pars plana vitrectomy was performed. Final best-corrected visual acuity was < or = hand motion in five patients, between 20/160 and 20/80 in three patients, and better than 20/32 in three patients., Conclusion: The majority of the cow horn injuries studied caused severe permanent impairment of vision. Owing to the blunt nature of the horns, a significant amount of energy is imparted into the eye. To prevent these injuries, coagulation of the horns should be performed 2 weeks after a calf's birth or farmers should be advised to wear safety glasses.

Three patients with intraocular foreign bodies and traumatic cataracts underwent single stage pars plana lensectomy with anterior capsule preservation, vitrectomy, removal of the foreign body, and intraocular lens implantation. The preserved anterior capsule permitted support for the placement of an intraocular lens in the posterior chamber in the ciliary sulcus. The procedure enabled early visual rehabilitation. This procedure seems useful in the management of posterior segment intraocular foreign body associated with cataract.

A 17-year-old girl attended a rock concert where promotional compact discs were being thrown into the audience as prizes. She suffered an extensive corneoscleral laceration with vitreous hemorrhage and retinal detachment when a compact disc struck her in the eye. An alternative, safer method must be used for distributing compact discs as prizes.

Objective: This study aimed to review visual morbidity resulting from inadvertent globe penetration during administration of local anesthetic and to identify the most appropriate management., Design: The records of 20 consecutive patients referred to a specialist vitreoretinal unit over a 2-year period were reviewed., Participants: Twenty eyes of 20 consecutive patients were included., Intervention: Observations included type of local anesthetic administered (e.g., retrobulbar or peribulbar), level of training of person administering the block, type of needle used for the block, and findings at presentation to the vitreoretinal unit. The authors also observed results of B-scan ultrasound evaluation of the retina, interval between the recognition of the complication and referral, as well as nature and timing of subsequent surgical intervention., Main Outcome Measures: Final visual acuity and retinal status (attached versus detached) were measured., Results: The most common presentation was vitreous hemorrhage observed from the first postoperative day. Ten eyes were found to have an associated retinal detachment on initial assessment in the vitreoretinal unit. These eyes generally had a poor visual outcome despite vitrectomy with long-acting gas or silicone oil tamponade. Seven (70%) of the remaining eyes with attached retina at the time of presentation achieved good visual recovery after vitrectomy., Conclusions: The authors recommend prompt referral for consideration of early vitrectomy in eyes with dense vitreous hemorrhage after inadvertent globe penetration. This management may improve the overall visual prognosis by preventing subsequent retinal detachment.

Purpose: Analysis of traditional versus comprehensive management techniques for eyes with ferrous IOFBs in the posterior segment., Patients and Methods: Retrospective review of 30 eyes undergoing IOFB removal by EM and of 34 eyes managed by PPV techniques., Results: Vitreous hemorrhage occurred commonly (EM group: 40%, PPV group: 50%). Only in the EM group did the intervention cause iatrogenic vitreous hemorrhage (23%) and has postextraction endophthalmitis developed (10%). Vision improved in 23% of eyes, deteriorated in 53%; >0.5 vision was achieved in 20%. Five EM eyes (17%) were anatomically lost; PVR developed in 48% of the remaining eyes. In the PPV group, no eye was anatomically lost and PVR developed in 12%. Vision improved in 68% of eyes, deteriorated in 15%; >0.5 vision was achieved in 68%. A single retinal impact site occurred in 71%, < or =2 impact sites in 21% of eyes., Conclusions: Approximately one of two eyes with posterior segment IOFB develops vitreous hemorrhage, over two-thirds sustain at least one retinal lesion, and one-fifth of eyes suffer multiple retinal injuries. Both the anatomical (p = 0, 003) and the functional (p = 0, 005) prognoses are significantly better in eyes undergoing PPV compared to eyes with EM use. Timely PPV appears to markedly reduce the risk of endophthalmitis development. These results confirm the need to abandon the EM and perform PPV for eyes with posterior segment IOFBs.

Ultrasound biomicroscopy (UBM) was employed in the assessment of the anterior chamber in patients affected by penetrating and blunt traumas. UBM detected correctly the extent and the localization of penetrating injuries and the presence of foreign bodies, IOL dislocation, and angular structures or ciliary body damages.

Perforating and penetrating globe injuries secondary to peribulbar and retrobulbar anaesthesia are often complicated by vitreous haemorrhage and retinal detachment. We describe the effectiveness of primary silicone oil tamponade in the repair of three perforated globes secondary to local anaesthesia for ophthalmic surgery. Three patients with axial myopia had peribulbar and retrobulbar anaesthesia for extracapsular cataract extraction (two patients) and cryotherapy (one patient). All eyes sustained a vitreous haemorrhage obscuring the view to the fundus. Retinal detachments were detected by B-scan ultrasound. In all eyes, scleral buckling, pars plana vitrectomy and silicone oil tamponade were performed as a primary surgical procedure. All the patients had complete anatomic reposition. In two patients, after two years follow-up, visual acuity was between 6/12 to 6/36 with the retina attached and no proliferative vitreoretinopathy (PVR). The third patient had blind painful eye and enucleation was performed. Primary use of silicone oil tamponade, in the management of perforated globe with retinal detachment due to local anaesthesia injection, is recommended.

Purpose: To report ocular perforation that occurred during retrobulbar injection in 7 highly myopic eyes., Methods: Seven patients with a diagnosis of globe injury during retrobulbar injection for ocular anesthesia before cataract surgery were managed by vitreoretinal surgery. All injections were performed by ophthalmologists. The surgeon recognized the perforation in 4 cases at the time of injection. The preoperative vision was hand motion perception in 4 eyes and light perception in 3 eyes. All patients underwent vitreoretinal surgery because of the presence of vitreous hemorrhage and/or retinal detachment diagnosed by funduscopy or ultrasonography. At the time of surgery, all eyes had vitreous hemorrhage and 4 eyes had rhegmatogenous retinal detachment. The number of vitreoretinal procedures performed was: 1 procedure in 4 patients, 2 procedures in 2 patients, and 3 procedures in 1 patient. The period of follow-up ranged from 4 months to 4 years, averaging 20 months., Results: At the end of the follow-up period, the retina was attached in 6 patients. The postoperative vision was 20/400 in 3 eyes, finger counting in 3 eyes, and light perception in 1 eye., Conclusion: Special care should be taken in retrobulbar injection of highly myopic globes, which have an increased risk of perforation. The functional outcome of surgical repair of these eyes was poor.

Purpose: This retrospective study was undertaken to review the clinical signs and management of patients with perforating eye injuries associated with regional anaesthesia for ophthalmic surgery., Methods: Fifteen consecutive patients presenting with inadvertent perforation of the globe were evaluated. Eleven required vitreoretinal surgery. The indications were retinal detachment (six eyes), vitreous haemorrhage (four) and an epiretinal membrane (one eye)., Results: Those eyes with retinal detachments generally had a poor functional outcome in spite of the retinae being attached in five of the six eyes. The operative findings of those eyes with vitreous haemorrhage but attached retina demonstrated varying retinal tear configurations., Conclusions: Eyes with perforating injuries following intraorbital anaesthesia are at risk of developing a retinal detachment. In those eyes presenting with dense vitreous but attached retina, consideration of vitrectomy and laser photocoagulation is advised.