The Israeli Ocular Injuries Study. A nationwide collaborative study.

A nationwide study of patients hospitalized for ocular injuries was conducted in Israel during the years 1981 through 1983, with the participation of 17 ophthalmic departments. The study comprised 2276 patients (2416 eyes), 47% of whom were children. The male-female ratio was 4.3:1. Bilateral injuries occurred in 140 patients, with children sustaining the most severe injuries. Ocular injuries occurred most frequently at home, and children at play were most vulnerable. Most patients retained good vision, 3.7% lost vision totally, and 2% of the eyes had to be enucleated.

Eye injuries in children in Israel. A nationwide collaborative study.

A nationwide prospective collaborative study on ocular trauma was performed in Israel during a period of 3 years (1981 through 1983). Almost half of the traumas (1127 [47%] of 2416 eyes) were sustained by children younger than age 17 years, and mainly between the ages of 6 and 12 years. Most of the injuries happened at home (38.1%) or in the street (26.8%) and during play and sport (65.1%). The male-to-female ratio among the children was 4:1. Blunt injuries accounted for 59.2%; 30.5% were perforating injuries and the rest were chemical and radiation injuries. The visual acuity at the time of hospital discharge was better than 6/30 in the majority of the eyes but 122 patients (11%) had a visual acuity of less than 6/60, and no light perception was the result in 40 eyes (3%). The reasons for the severe outcome were as follows: 23 eyes (2%) owing to phthisis, 22 eyes (1.9%) were enucleated, and 16 eyes (1.4%) suffered from endophthalmitis.

Diagnostic and prognostic value of retinal hemorrhages in the neonate.

Ocular fundi of 410 newborns were examined for retinal hemorrhages within 24 hours after delivery. The purpose of this study was to investigate whether the course of pregnancy and management of delivery influence the incidence of neonatal retinal hemorrhage (RH) and whether this incidence could be reduced by electronic monitoring of delivery. To assess the prognostic value of neonatal RH for future development of the child, the physical, motor, and psychologic states of 252 infants were examined 6 to 18 months following delivery. The incidence of RH was 37.3% and was not influenced by maternal age, parity, gestational age, course of pregnancy, birth weight, or electronic monitoring of delivery. The mode of delivery did influence the incidence of RH. Gesell developmental schedule showed no correlation between ocular findings and later development of the child.

Late iris abscess after cataract extraction.

A 73-year-old woman underwent an uneventful intracapsular lens extraction. Two years later, an iris abscess, hypopyon, strong flare, corneal edema, and elevated intraocular pressure developed. Visual acuity diminished from 6/6 (20/20) with aphakic correction to hand movements. Gram-positive cocci sensitive to erythromycin and chloramphenicol were cultured from the anterior chamber. The hypopyon and the iris abscess reabsorbed because we administrated erythromycin at the beginning of the illness. Final visual acuity was 6/6 (20/20) and only a small hole remained in the iris at the site of the abscess. She was in good health four years later.

Long-term follow-up of photocoagulated retinal breaks.

126 cases of retinal breaks treated in our department by photocoagulation during a period of 10 years (1963-1973) were selected for a close annual follow-up. Eliminated from the study were cases of macular holes, breaks which developed in an eye after retinal detachment surgery, and cases in which a close follow-up was impossible for various reasons. The study includes symptomatic retinal breaks in myopic, non-myopic, and aphakic eyes as well as asymptomatic holes which were found in the undetached fellow eye. Four eyes treated by photocoagulation (3.2%) developed a retinal detachment. The causes of failures and complications, such as retinal detachment, vitreous haemorrhage, and macular pucker, are discussed.

Simultaneous trabeculectomy and cataract extraction.

A combined trabeculectomy and cataract extraction was performed on 46 eyes of 39 patients. The average follow-up period was of 27 months. The intraocular pressure remained controlled without the need of postoperative medication in 33 eyes (71.74%); 12 eyes (26.09%) needed further medical treatment; and in one eye the pressure remained uncontrolled and further surgery was necessary. After surgery the visual acuity improved considerably and the complications were few. The combined procedure has many advantages. The patient is cured by one surgical procedure, his visual acuity improves, his intraocular pressure is reduced to normal, and he is relieved from the need for medication postoperatively. By a single stay in hospital and by reducing the number of postoperative medical routine controls the expenses are reduced considerably. Owing to these advantages the combined procedure deserves to be considered in cases of glaucoma and cataract.

Simultaneous 4-muscle surgery in V-esotropia.

Simultaneous, bilateral and symmetrical surgery was performed on 60 patients with V-esotropia. The results following one surgical procedure were evaluated. The patients were subdivided into three equal groups. A bilateral recession of the medial recti was performed in all three groups. In the first two groups a weakening of both inferior obliques, either by recession or by myectomy at insertion, was performed. In the third group only horizontal muscle surgery was done. Satisfactory results were achieved in 48 out of 60 patients following one surgical procedure. Consecutive esotropia was present in eight and exotropia in four patients. In cases of V-esotropia with marked overaction of both inferior obliques, a simultaneous 4-muscle surgery is recommended in order to minimize the number of surgical procedures.

[Merkel cell carcinoma of the eyelid].

Merkel cell carcinoma is an infrequent but highly malignant cutaneous neoplasm. In a 73-year-old woman, a Merkel cell carcinoma of the right upper lid developed within 1 month, recurred within a month after its first removal, and metastasized to the parotid 2 months after secondary excision.

[Ocular injuries from seashore racketball].

A 3-year prospective study revealed 39 hospitalized cases of ocular injuries from seashore racketball sports. Most were children and young adults and most had internal injuries of the globe. Over a third had retinal edema, 2 eyes were blinded, and at least 4 are subject to serious future complications.

Visual recovery after recurrent rupture of the globe: case report.

A 42-year-old man was injured twice in his left eye. The first injury resulted in a lacerated skin wound on the forehead, eyebrows and lids, a broken orbital wall and rim, and a small rupture of the sclera at 12 o'clock. The second injury caused a rupture of his left globe. During the operation a large scleral rupture, 1 mm from the limbus, a prolapsed iris, vitreous, and the lens were found under the conjunctiva. The would had been cleaned, the prolapsed iris and vitreous were excised, and the scleral wound sutured. One year after the injury the visual acuity was 6/10 with an aphakic contact lens correction and binocular vision was established. Diagnostic features and indications for immediate repair are discussed.

Photocoagulation in retinal vein occlusion.

Photocoagulation was used to treat 40 eyes, 20 with central and 20 with branch vein occlusion. Panretinal photocoagulation was used over the fundus in central vein occlusion, and regional photocoagulation over the affected area in branch vein occlusion. No complications were observed during a follow-up period of 8 to 24 months. Recent as well as long-standing cases with macular edema were treated. Visual acuity improved in 85% of eyes with central vein occlusion and 80% of eyes with branch vein occlusion. Visual acuity results were more satisfactory with early treatment.