Mechanism and outcomes of recreational and sports-related open globe injuries.

OBJECTIVES: To describe the mechanisms and visual outcomes of recreational and sports-related open globe injuries (OGIs). METHODS: A retrospective case series of eyes experiencing OGI secondary to recreational and sports-related activities at Memorial Hermann Hospital - Texas Medical Center (MHH-TMC) from January 1st, 2010 through March 31st, 2015 was conducted. Exclusionary criteria included no documented ophthalmologic examination upon presentation and repairs performed by services other than ophthalmology. A two-tailed t-test and Fisher's exact test were utilized to assess for statistical significance (p < 0.05). RESULTS: A total of 20 eyes from 20 patients experiencing OGIs secondary to recreational and sports-related activities were included. Thirteen eyes (65 %) presented with OGIs from penetrating objects while seven eyes (35 %) had injuries from blunt injuries. Males comprised most of the total study group (17 of 20 patients), and zone 3 injuries were the most common location of OGI. While eyes with OGIs from blunt trauma underwent evisceration/enucleation procedures more frequently than OGIs from penetrating mechanisms (71% vs 23 %) (p = 0.10), the final visual outcomes were similarly poor between groups. Only three eyes in this series experienced an improvement from baseline VA; all three eyes had lacked initial findings consistent with severe injury. CONCLUSIONS: Recreational and sports related OGIs most commonly occur in zone 3 and in young males, regardless of injury type. OGIs due to both penetrating and blunt trauma mechanisms implicate poor functional outcomes, but the absence of certain presenting injury features may indicate possibility of eventual visual recovery.

Case series: Traumatic ocular lacerations secondary to pressure washers.

Purpose: Numerous causes of ocular lacerations, including, open globe injuries have been extensively reported but to our knowledge this is first time that pressure washers have been reported to be the culprit. Thus, in this case series we describe the uniqueness of ocular findings secondary to high-power pressure washer injuries that are a result of their mechanistic function. Observations: Here we report a case series of 3 patients who presented in an emergency department with pain and decreased visual acuity following usage of high-pressure washer machines. All three patients presented with features of both blunt and sharp mechanisms of ocular injury. Most lacerations caused injury that encompassed more than one zone. Two of the patients experienced an open globe injury, and all patients had poor final visual outcomes. Extraocular involvement included fractures and lid lacerations. All patients were managed surgically with repair of the ocular defects. Visual outcome in the first patient was hand motion, while the second patient received a prosthesis following enucleation due to lack of recovery after four months. Lastly, we were unable able to obtain visual outcome for the third patient due to lack of follow up. Conclusion: Ocular injuries due to pressure washers have not been reported in literature, however, this case series serves to elucidate that pressure washers can cause ocular injuries with both blunt and laceration mechanical effects. Moreover, special care should be taken in preventing and managing these injuries due to their high ocular morbidity.

Non-traumatic open globe injuries: presenting characteristics and visual outcomes.

PURPOSE: To describe clinical characteristics and visual outcomes of non-traumatic open globe injuries. SETTING: A level 1 trauma centre in a large urban medical centre. DESIGN: Retrospective study. METHODS: Charts of non-traumatic open globe patients admitted to MHH-TMC from 1/2010 to 3/2015 were reviewed for demographics, cause, clinical characteristics, visual acuity (VA) and enucleation. RESULTS: Thirty eyes were included: 15 (50%) were males with a mean age of 47 (±28) years. All presented with zone 1 injury. Twenty-five (83%) had a perforated corneal ulcer. Presenting VA was count fingers (n = 3, 10%) to NLP (n = 6, 20%). Twenty-four (80%) involved infection, 5 (17%) congenital, 3 (10%) chemical burn and 2 (7%) neurotrophic. Conjunctival injection (n = 22, 77%), corneal opacification (n = 20, 71%) and relative afferent pupillary defect (n = 9, 44%) were common. After treatment, 23 (88%) were worse than 6/60 (20/200), 9 (35%) were NLP and 8 (27%) required enucleation. CONCLUSIONS: Often non-traumatic open globe injuries are zone 1 and due to perforated infectious ulcers. Compared to previously reported traumatic injuries, these have higher rates of enucleation (27% vs 8%) and poorer final VA (88% vs 68% worse than 6/60 20/200).

A slippery slope.

A 74-year-old woman experienced chronic painless progressive binocular horizontal diplopia for 2 years. Initial examination showed a visual acuity of 20/20 OU. External and slit lamp examination was unremarkable. Orthoptic evaluation showed an incomitant esotropia, a small vertical strabismus, and a large degree of excyclotorsion. Investigation revealed a diagnosis of diffuse large B-cell lymphoma.

Versatile approaches for the synthesis of fused-ring γ-lactones utilizing cyclopropane intermediates.

A highly effective acid-catalyzed cyclopropyl ester to γ-lactone skeletal rearrangement has been demonstrated and applied to the synthesis of a variety of bi- and tricyclic functionalized lactones, rigid and highly compact structures for use as biological probes.