Pediatric ocular trauma in Taiwan.

BACKGROUND: Ocular trauma is a significant problem in pediatric patients. The aim of this investigation was to evaluate the demographic, etiologic and prophylactic factors of pediatric ocular trauma in a tertiary center in northern Taiwan. METHODS: A retrospective review of medical charts of patients aged 15 years or younger who visited the emergency department of Chang Gung Memorial Hospital, Taoyuan for ocular trauma between July 2003 and June 2004 was undertaken. RESULTS: Of the 228 children in this study, ocular trauma occurred more frequently in boys than in girls (151:77 patients, p < 0.0001). Twenty-one patients (9.2%) presented with bilateral trauma. The most common ocular injury was closed globe injury (178 patients, 78.1%). The next most common ocular injuries were burns (35 patients, 15.4%), open globe injuries (8 patients, 3.5%) and orbital injuries (7 patients, 3.1%). Falling was the most common cause of ocular trauma in these children, followed by trauma caused by a fist or other part of the body. Sharp objects such as knives or scissors were the most common cause of open globe injuries. Visual impairment (visual acuity less than 20/50) occurred in three open globe injury patients. CONCLUSIONS: Ocular trauma in children is associated with visual loss. Many of the cases were preventable. Public education, general awareness and aggressive primary management may be indicated to optimize visual outcome.

Alternate-sided homonymous hemianopia as the solitary presentation of mitochondrial encephalomyopathy, lactic acidosis, stroke-like episodes syndrome.

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome has various presentations. We report on a case of MELAS in which alternate-sided homonymous hemianopia was the main symptom of recurrent neurological defects. A 19-year-old woman suffered from blurred vision, headaches, vomiting, and fever that subsided within days. The ophthalmic examination demonstrated right homonymous hemianopia. One month later a similar episode occurred again. Computed tomography (CT) and magnetic resonance imaging (MRI) of her brain revealed an infarct in the left temporo-occipital lobes. Exercise tests showed lactic acidosis, and a muscle biopsy confirmed the diagnosis of mitochondrial myopathy. Half a month later, a third episode occurred. Visual field examination demonstrated left homonymous hemianopia and partial recovery of the right visual field. The infarct in the brain, as revealed by CT and MRI, was compatible with the visual field changes. MELAS should be ruled out in young patients who present with homonymous hemianopia accompanied by recurrent headaches or other recurrent symptoms.

Amniotic membrane transplantation for corneal perforation related to vitamin A deficiency.

Corneal perforation is one of the most vision-threatening consequences of vitamin A deficiency. Amniotic membrane transplantation was performed in a 36-year-old man who presented with bilateral corneal ulcers. There was a small, sharply demarcated superficial ulcer with crevices of surrounding keratinized epithelium converging on the ulcer and minimal infiltration at the inferior periphery of the right cornea. A 3-mm perforation on a 9 x 7-mm area of stromal melting was noticed in the left cornea. The serum vitamin A level was 14.0 microg/dL (normal, 24.57 to 105.71 microg/dL) at presentation. A biopsy of the right corneal epithelium was performed to confirm the diagnosis. Multilayered amniotic membrane transplantation with debridement of the necrotic corneal stroma was performed on the left cornea. In addition to systemic vitamin A replacement, topical antibiotics and lubricants were also administered. The cornea ulcers healed in 10 days along with the restoration of the serum vitamin A level. The visual acuity improved from 20/250 to 20/20 in the right eye and from light perception to hand movement in the left eye at 3 months. Amniotic membrane transplantation could save eyes with corneal perforation related to vitamin A deficiency before reconstructive surgeries, such as penetrating keratoplasty, are necessary.

Amniotic membrane graft for the management of scleral melting and corneal perforation in recalcitrant infectious scleral and corneoscleral ulcers.

PURPOSE: To study the efficacy and safety of using cryopreserved human amniotic membrane (AM) graft as a patch graft to reduce stromal melting and promote reepithelialization in extensive infectious scleral and corneoscleral ulcers. METHODS: Four cases of infectious scleral ulcers with persistent scleral melting and no sign of reepithelialization and three cases of corneoscleral ulcers with corneal perforation were studied. All patients had previously undergone pterygium excision, and infections were caused by Pseudomonas (n = 4), fungi (n = 2), and atypical Mycobacterium (n = 1). The area of limbus involved ranged from 3 to 9 (mean, 4.7) o'clock positions. Repeated debridements were performed, the causative microorganisms were identified, and the appropriate topical and systemic antibiotics were given to all patients before AM grafting. Postoperatively, the speed of reepithelialization, changes in the severity of scleral melting and inflammation, recurrence of infection, and visual acuity were documented. RESULTS: Melting and inflammation at the lesion site decreased after AM grafting. Reepithelialization of the scleral lesions was complete at an average 15.7 +/- 8.7 days (range, 5-31) postoperatively. Focal melting of the AM graft occurred in two cases, and in one case, it was necessary to perform further corneoscleral graft. No recurrent infection was encountered, but sterile abscess occurred in three cases that were located away from the original lesion. Useful vision above 20/400 was maintained in all patients at the end of follow-up. CONCLUSION: The AM graft is effective in promoting conjunctival reepithelialization and reducing scleral melting and inflammation and can be considered as an alternative biomaterial to improve wound healing in scleral and corneoscleral ulcerations.