Characterization of an anterior segment organ culture model for open globe injuries.

Open-globe injuries have poor visual outcomes and have increased in frequency. The current standard of care is inadequate, and a therapeutic is needed to stabilize the injury until an ophthalmic specialist is reached. Unfortunately, current models or test platforms for open-globe injuries are insufficient. Here, we develop and characterize an open-globe injury model using an anterior segment organ-culture platform that allows therapeutic assessment for up to 72 h post-injury. Anterior segments maintained in organ culture were kept at physiological intraocular pressure throughout, and puncture injuries were created using a novel pneumatic-powered system. This system can create high-speed, military-relevant injuries up to 4.5 mm in diameter through the cornea. From intraocular pressure readings, we confirmed a loss of pressure across the 72 h after open-globe injury. Proof-of-concept studies with a Dermabond tissue adhesive were performed to show how this model system could track therapeutic performance for 72 h. Overall, the organ-culture platform was found to be a suitable next step towards modeling open-globe injuries and assessing wound closure over the critical 72 h post-injury. With improved models such as this, novel biomaterial therapeutics development can be accelerated, improving care, and, thus, improving the prognosis for the patients.

Penetrating eye injury by dart.

Darts are constantly gaining in popularity. However, their risk of injury is often underestimated. This report is about a juvenile who suffered from a severe eye injury including the opening of the eye bulb. The attending ophthalmologists ruled out the possibility that this kind of injury could be caused by a dart with a plastic point. However, by reconstructing the course of action and throwing darts at porcine eyes, the forensic medical advisory opinion was able to state that darts with damaged plastic points may cause the exact same form of injury. This casuistic illustrates the essential significance of forensic-traumatological knowledge and, especially in the case of rare injury patterns, case-related practical experiments.

Ocular porcupine quilling in dogs: Gross, clinical and histopathologic findings in 17 cases (1986-2018).

The objectives of this retrospective study were to evaluate the histopathologic changes associated with porcupine ocular quill injuries in dogs, to discuss the various methods of quill detection when quills are not grossly visible, and to discuss the pathogenesis of delayed ocular quill injuries in dogs. Seventeen globes sustaining ocular quilling injuries from 17 dogs (1986-2018) were identified in the COPLOW archives and the gross and histologic changes tabulated and compared. All cases were dogs, with one whole globe submitted from each patient. Sixteen of 17 cases had known or suspected porcupine encounters in the weeks or years preceding enucleation. Histopathologic findings included retinal detachment, hyphema, cataract, granulomatous to pyogranulomatous inflammation (uveitis, endophthalmitis, panophthalmitis), lens capsule rupture, suppurative phakitis, scleral perforation, stromal keratitis, breaks in Descemet's membrane, preiridal fibrovascular membrane, anterior and posterior synechia, Schnabel's cavernous atrophy, and periorbital fibrosis. Quill-associated ocular trauma can have a significant deleterious effect on vision and result in enucleation. The time from initial quilling to the manifestation of ocular signs may be prolonged (weeks to years). Any dog presenting for ocular signs with a history of a previous porcupine encounter should be carefully checked for quill migration into the globe as the source of ocular disease. Quills may not be visible grossly, and ancillary imaging techniques can be utilized with various rates of success.

Epidemiology and prognostic factors of open globe injuries in a Tunisian pediatric population.

INTRODUCTION: Childhood ocular trauma is a preventable cause of visual impairment and blindness worldwide. The purpose of our study was to determine demographic, etiologic, and clinical characteristics, visual outcome, and factors affecting visual prognosis in children with open globe injuries (OGI) and to analyze the predictive value of ocular trauma scoring systems for OGI in children. METHODS: We conducted a retrospective study enrolling 120 pediatric patients hospitalized for OGI from January 2010 to March 2017. Age, gender, date of trauma, time between trauma and presentation, place and circumstances of injury, etiology, visual acuity (VA), wound location and type of injury based on the Birmingham Eye Trauma Terminology, and the clinical signs were recorded. We recorded the number of surgical procedures performed, complications and visual outcomes. RESULTS: The mean age was 7.38 years. In all, 62.5% of the patients were male, and 37.5% were female. The gender ratio was observed to decrease with increasing age. The mean time interval between injury and consultation was 22.80±42.68hours. Injuries usually occurred at home (80%) followed by playgrounds and sports venues (8.3%), the street (6.7%) and school (5%). All of the OGI's were accidental, and the main context was play (70%). The most common traumas were penetrating injury (60.8%) and metal (30%) objects. Penetrating trauma accounted for 68.3% of cases, followed by rupture (27.5%) and intraocular foreign body (IOFB) (7.5%). Initial VA was<1/10 in 59.2% of cases, and the point of entry was the cornea in 65.8% of cases. Final VA was<1/10 in 39.69% of all cases. FVA was significantly correlated with BCVA prior to the surgery, mechanism of the trauma, wound location and size, and other associated lesions. The Ocular Trauma Score (OTS) and the Pediatric Ocular Trauma Score (POTS) were significantly correlated with final VA. CONCLUSION: OGI's in children occurs most frequently in school-age boys. Prognosis is determined by presenting visual acuity, trauma score, and wound severity and location.

Clinical characteristics and visual outcomes of work-related open globe injuries in Japanese patients.

PURPOSE: To investigate the clinical characteristics and visual outcomes of patients with work-related open globe injuries (OGIs) and compare them with patients with non-work-related OGIs. DESIGN: Retrospective, observational, multicentre, case-control study. METHODS: A total of 374 patients with work-related OGIs and 170 patients with non-work-related OGIs who presented to hospitals that belong to the Japan-Clinical Research of Study group from 2005 to 2015 were included in this study. Clinical data including age, sex, initial and final visual acuity, type of open globe injury, lens status, zone of injury, wound length, and presence of proliferative vitreoretinopathy, retinal detachment, expulsive haemorrhage, and endophthalmitis were recorded. MAIN OUTCOME MEASURES: Visual acuity. Results Work-related OGIs were associated with younger age, male sex, better initial and final visual acuity, more laceration, smaller wounds, presence of retinal detachment, and expulsive haemorrhage, compared with non-work-related OGIs. Multiple regression analysis revealed that final visual acuity is significantly associated with initial visual acuity, wound length, and the presence of proliferative vitreoretinopathy in work-related OGIs. CONCLUSIONS: Work-related OGIs showed better visual outcomes than other OGIs. Initial visual acuity, wound length, and the presence of proliferative vitreoretinopathy are predictors of visual outcomes in patients with work-related OGIs.

Management of penetrating injury with retained intraocular lead foreign body from a writing instrument: surgical video with implications for paediatric public health and safety.

Penetrating ocular injuries from writing instruments that are thrown, especially by children, in the community can result in significant ocular morbidity. Often these cases present to the accident and emergency department. Accurate and prompt assessment is key in saving sight. We present a case of one such injury and how it was surgically managed.

Traumatic Staphylococcus gallinarum endophthalmitis and detachment of a pallid retina.

A rare case of Staphylococcus gallinarum endophthalmitis with intraocular foreign body (IOFB) was managed successfully by vitrectomy, IOFB removal and intravitreal antibiotics with steroids. Intraoperatively, the inferior retina was noted to be pale, possibly secondary to arteriolar occlusion/inflammation. This pale retina detached while peeling the vitreous, but spontaneously reattached postoperatively within a week. The case report describes the natural course of an iatrogenic detachment of pallid retina and the outcome of an uncommon ocular infection.

Eye injury from electrical weapon probes: Mechanisms and treatment.

PURPOSE: While generally reducing morbidity and mortality, TASER® electrical weapons have risks associated with their usage, including burn injuries and head and cervical trauma associated with uncontrolled falls. The primary non-fatal complications appear to be significant eye injury but no analysis of the mechanisms or suggested treatments has been published. METHODS: We used a biomechanical model to predict the risk of eye injury as a function of distance from the weapon muzzle to the eye. We compared our model results to recently published epidemiological findings. We also describe the typical presentation and suggest treatment options. RESULTS: The globe rupture model predicted that a globe rupture can be expected (50% risk) when the eye is within 6 m of the muzzle and decreases rapidly beyond that. This critical distance is 9 m for lens and retinal damage which is approximately the range of the most common probe cartridges. Beyond 9 m, hyphema is expected along with a perforation by the dart portion of the probe. Our prediction of globe rupture out to 6 m (out of a typical range of 9 m) is consistent with the published risk of enucleation or unilateral blindness being 69 ±â€¯18%, with an eye penetration. CONCLUSIONS: Significant eye injury is expected from a penetration by an electrical weapon probe at close range. The risk decreases rapidly at extended distances from the muzzle. Not all penetrating globe injuries from electrical weapon probes will result in blindness.

Hymenoptera insect stings: Ocular manifestations and management.

PURPOSE: To describe the ocular findings and management of Hymenoptera insect stings. METHODS: We treated and followed 8 patients with ocular Hymenoptera stings. All patients were admitted through emergencies and hospitalized at the Hedi Rays eye institute in Tunis. RESULTS: The site of the sting was the cornea in 5 cases, limbus in one case, conjunctiva in one case and upper lid in the last case. Retained stingers were objectified in 4 cases. Immediate surgical extraction carried out in all cases. We also followed one case of post-sting Adie's syndrome and one case of retrobulbar optic neuritis. The sting was conjunctival in one case and palpebral in the other case. Corticosteroids were ineffective in these two cases. CONCLUSION: Ocular Hymenoptera stings are rare environmental accidents. They may cause various severe ocular complications. Early management, adapted to the clinical manifestations, is the key to a good outcome.

[Transorbital penetrating injury without sequlae].

A 33-year-old man was admitted to hospital with a butter knife stuck in his head after having attempted to commit suicide by forcing the knife through his skull. Physical examination revealed a stable patient with only minimal associated haemorrhage. A CT scan revealed, that the penetrating knife had passed through the sphenoid bone, the posterior orbit and the ethmoid cells and ended in the contralateral nasal cavity. The knife was removed by its own trajectory. After surgery, the patient was neurologically intact with normal sight and well-functioning eye movements, and he made a full recovery.

"The pen is mightier than the sword" - suicidal trans-orbital intracranial penetrating injury from a pencil.

A 40-year-old drug addict, who was being treated with methadone and occupational therapy, committed suicide by striking a wooden pencil into his right eye socket. While still conscious, he hit his head hard against a table, jamming the pencil even deeper into his head. The autopsy showed that the pencil missed the globe and lodged in the inner part of the right eye socket. It pierced the orbital part of the right ethmoid bone, the right ethmoid cells, and the right superior nasal concha, then passed through the body of the sphenoid bone and the clivus of the occipital bone before stopping in the brain tissue. The basilar artery was transected at the pontomedullary junction, where the tip of the pencil had lodged. Also, at the pontomedullary junction, an approximately 3 mm deep laceration of the brainstem was evident together with flecks of green paint. Histological examination revealed that laceration at the pontomedullary junction was even deeper than the macroscopic appearance had suggested, with several small lateral cracks, focal deep hemorrhage, and disruption of both gray and white matter of the brainstem. Fragments of cellulose originating from the wooden pencil could also be clearly distinguished. Toxicological analysis was performed using liquid chromatography with mass spectrometry, and it showed traces of methadone in the blood and humor vitreous samples. The cause of death was damage to the vital structures in the brainstem, resulting from a penetrating injury to the head by a pencil. Herein, we present a self-inflicted trans-orbital penetrating injury by a non-missile, low-velocity object - a pencil, with a rather unusual, immediately incapacitating outcome.

Self-inflicted injection of tattoo ink in the anterior chamber: a failed attempt to change the color of the eyes.

We report the case of a 29-year-old man, a tattoo artist by profession, with a history of schizophrenia, who was admitted to our hospital after injecting tattoo pigments in the anterior chamber of both eyes using a dermograph. The patient was diagnosed with penetrating ocular injury with secondary glaucoma, endotheliitis, and uveitis. Anterior chamber washout was performed immediately. At 4 months' follow-up the patient had a visual acuity of 20/25 in each eye and 360° peripheral anterior synechiae; there still were traces of tattoo pigment at the trabecular meshwork and endothelial corneal layer.

The mechanics of corneal deformation and rupture for penetrating injury in the human eye.

Penetrating eye injuries are surgical emergencies with guarded visual prognosis. The purpose of the current study was to determine the force required to rupture the cornea with a penetrating object, and to study how this force is affected by the object geometry. Thirty-six human cadaveric eyes from donors of various ages were characterized for diameter, axial length, and pre-test intraocular pressure. In order to investigate the effects of specimen storage time on the tissue response, half of the specimens were tested within two weeks of donor expiration, and half of the specimens were stored at -4°C for 12-18 months. Indenters of three different diameters (1.0, 1.5, and 2.0mm) were lowered into the apex of the cornea until rupture. Resistance to displacement (stiffness), displacement at failure, and the force at failure were determined. Multi-variable regression analysis was used to determine associations of the input variables (indenter size, test speed, and tissue postmortem time) on the mechanics of the tissue response. Twenty-nine of the 36 specimens failed at the indenter location in the cornea, four failed at the limbus, and three failed in the sclera near sites of muscle attachment. The average force at failure caused by the 1.0mm, 1.5mm, and 2.0mm indenters increased from 30.5±5.5N to 40.5±8.3N to 58.2±14.5N, respectively (p<0.002). The force at failure was associated with the donor age (p<0.001), and globe diameter (p<0.041), but was not associated with pre-test intraocular pressure, tissue postmortem time, axial length, or speed of the indenter. This study has quantified the force-displacement and failure response of a large series of human cadaveric eyes subjected to penetrating indentation loads on the cornea. The results provide useful data for characterizing the relationship between corneal rupture and the geometry of a penetrating object.

Penetrating Ocular Trauma from a Bean Bag Gun: A Case Report and Review of Less-Lethal Force and Their Consequences.

Although bean bag guns are considered a "less-lethal" form of law enforcement, these blunt projectiles have risk. The purpose of this study was to perform a literature review of morbidity and mortality associated with less-lethal munitions and present a case report of a bean bag injury leading to a traumatic globe evisceration and skull base fracture. Patients presenting with bean bag gun associated injuries warrant a high clinical suspicion for injury to deeper structures.

[EFFICACY OF COMBINED MICROSURGICAL TECHNIQUE IN SEVERE TRAUMATIC INJURY OF EYEBALL].

Analysis of clinical and functional results of microsurgical restoration of eyeball in remote terms after primary surgical processing for traumatic injury of eyes, using combined one-stage operative intervention on anterior and posterior segments, was presented. Satisfactory result was achieved in 56.4% injured persons, in 43.6% - functional outcome after the operation, concerning perspectives of further restoration of optic functions, have appeared unsatisfactory.