Epidemiology and clinical outcome of intraocular foreign bodies in Hong Kong: a 13-year review.

The purpose of this study was to describe the epidemiology, visual outcome and prognostic factors of intraocular foreign body (IOFB) injuries in a tertiary centre in Hong Kong. A retrospective review of 21 eyes in 21 patients with IOFB that presented to United Christian Hospital from January 2001 to July 2014 was performed. IOFB represented 16 % of all open-globe traumas. There was a high male predominance (90 %). The mean age was 42. Work-related injuries (86 %) were the main cause, where only 10.5 % had eye protection. Hammering was the commonest mechanism of injury (43 %). Most IOFBs were metallic (67 %). The IOFB was found in the anterior segment in 31 % and posterior segment in 69 %. 57 % presented with an initial visual acuity of ≥0.1, and up to 24 % of patients had an initial visual acuity of better than or equal to 0.5. Most cases (76 %) received prompt surgical intervention within 24 h, and there was a low (0 %) endophthalmitis rate. Forty-eight percent had an improvement in visual acuity, defined as final visual acuity more than or equal to 2 lines of improvement from initial visual acuity, and 48 % attained a final visual acuity of better than or equal to 0.5. One case underwent evisceration. A smaller IOFB size (<5 mm) was associated with a good final visual acuity of better than or equal to 0.5 (p = 0.048). It was also found that a posterior segment IOFB was more likely to give a final VA of less than 0.5 (p = 0.035). IOFB remains a significant complication of work-related injuries in Hong Kong. This is the first local study that explores the epidemiology of IOFB injuries in Hong Kong. The favourable visual outcome and low endophthalmitis rate may be related to early removal of IOFB. Despite legal ordinances for mandatory eye protection, the uptake of eye protection was low.

[Concretions and iatrogenic foreign bodies in the lacrimal system : Treatment recommendations]. / Konkremente und iatrogene Fremdkörper der ableitenden Tränenwege : Therapeutische Empfehlungen.

BACKGROUND: Deposits (dacryoliths or foreign bodies) inside the lacrimal system can cause chronic inflammation and recurrent lacrimal stenosis. Furthermore, dacryoliths can occur due to chronic inflammation. OBJECTIVE: Considering typical clinical courses, the different localizations and surgical options for removing deposits from the lacrimal system are demonstrated. MATERIALS AND METHODS: A retrospective analysis of 1451 lacrimal surgeries in 1131 patients was performed. Fourteen representative lacrimal surgeries of 11 patients were retrospectively analyzed in terms of current complaints, prior surgery, and the performed surgical intervention. In three cases, histologic findings of removed dacryoliths were assessed. The surgical approaches are described using precise photodocumentation. RESULTS: In 220 lacrimal surgeries (15.2 %), dacryoliths were detected. Iatrogenic foreign bodies were found in 0.8 % (n = 12). All chosen patients suffered painful chronic inflammation of the lacrimal system. Localization was either intrasaccular or intracanalicular. In 10 eyes, surgery was performed using a transcanalicular dacryoendoscope, either alone or in combination with another method. An external approach (transcutaneous/transconjunctival) was performed in 4 patients. Regarding the whole study population, dacryoliths were found in 16.9 % (n = 91) of dacryocystorhinostomies, in 14.6 % (n = 77) of dacryoendoscopies, and in 35.6 % (n = 52) of canaliculotomies. CONCLUSION: Foreign bodies and dacryoliths are important differential diagnoses in the treatment of chronic dacryocystitis. Different surgical approaches are possible and should be available for treatment. Patients' history often reports prior lacrimal surgery.

Ocular blast injuries related to explosive military ammunition.

OBJECTIVES: To report the clinical features of ocular injuries associated with explosive military ammunition in insurgent attacks in Turkey. METHODS: The medical records of 48 casualties who were treated for ocular injuries sustained in insurgent attacks at the Combat Region Hospitals in Turkey were retrospectively reviewed. The reviewed data included initial visual acuity, type of explosive military ammunition (ie, improvised explosive device, mine, hand grenade and rocket-propelled grenade), type of globe injury (open-globe vs closed-globe injury), traumatised globe zones, the presence/absence of an intraocular foreign body, medical interventions, status during the explosion and injuries to other parts of the body. The visual acuity differences between different explosive materials and between 'on-foot' and 'inside-vehicle' casualties were investigated. RESULTS: A total of 83 injured eyes were analysed. The mean patient age was 24.5±6.6 years. The mean initial logarithm of the minimum angle of resolution visual acuity was 0.60±0.63. The injuries were due to improvised explosive devices in 28 cases (58.3%), land mines in 16 cases (33.3%), and hand grenades and rocket-propelled grenades in 2 cases each (4.2%). Forty-seven eyes (56.6%) had open-globe injuries. The most frequently involved zones were zone 1 (50.0%) in closed-globe injuries and all zones (31.9%) in open-globe injuries. Intraocular foreign bodies were present in 45/47 (95.7%) eyes with open-globe injuries. Twelve (14.4%) eyes with no light perception were enucleated, and two (2.4%) eviscerated. The difference in the visual acuities between the on-foot and inside-vehicle casualties and between the injuries that were caused by the different types of explosive ammunitions was also insignificant (p=0.271 and 0.394, respectively). CONCLUSIONS: The clinical results for eye injuries caused by explosive military ammunition sustained during insurgent attacks in Turkey are disappointing irrespective of the explosive material. The use of protective eyeglasses might improve the outcomes and should be encouraged.

In vivo confocal microscopy of corneal microscopic foreign bodies in horses.

OBJECTIVE: To describe in vivo corneal confocal microscopy of horses with microscopic corneal foreign bodies and to correlate findings with clinical, cytological, and histopathologic evaluations of clinical cases and foreign body morphologies observed in vitro with the confocal microscope. ANIMAL STUDIED: Five horses with microscopic corneal foreign bodies. PROCEDURES: Sedated and anesthetized horses were examined with a modified Heidelberg Retina Tomograph II and Rostock Cornea Module. Confocal microscopy images were compared with images from cytologic and histopathologic corneal samples. To establish microscopic morphologic features, confocal microscopy images of burdock pappus bristles and surgical glove powder were obtained by in vitro examination. RESULTS: Horses were examined by in vivo confocal microscopy to assist in identifying corneal opacities detected by slit-lamp biomicroscopy, to determine the etiology of clinically idiopathic keratitis, or to localize corneal opacities presumed to be foreign bodies for surgical planning. Corneal foreign bodies presumptively identified by confocal microscopy included burdock pappus bristles, other plant foreign materials, and surgical glove powder. The corneal foreign bodies appeared as moderately or hyper-reflective linear, circular, or oval structures by confocal microscopy and did not resemble any normal anatomic structures. The confocal microscopic identification of the foreign bodies was corroborated by cytologic and histopathologic findings in some horses. The in vivo confocal microscopic appearance of the foreign bodies was consistent with morphologies observed during examination of foreign bodies in vitro. CONCLUSIONS: In vivo corneal confocal microscopy provides a noninvasive method for the detection, characterization, and localization of microscopic foreign bodies in the equine cornea.

Fish-hook injury of the eye.

The objective of this case report is to report two cases of fish-hook injury to the eye and ocular adnexa with review of literature. Both patients with fish-hook injuries were professional fishermen. The first subject was hit in his right eye by a hook which became embedded in the right cornea. He cut off the line but made no attempt to remove the hook and presented to the emergency department with the hook hanging from his right eye. Under general anaesthesia, the hook was rotated out without causing any further damage to the cornea and intraocular structures. The second subject was reeling the hook back to shore when it hit him in the face and embedded itself in the upper eyelid. He was immediately taken to the emergency department and after careful examination the eye was found to be unharmed and the hook was removed through a small incision under local anaesthesia. Fish-hook injuries, though rare, can result in visual morbidity. The hook should be removed under careful examination using the correct technique. The shaft of the hook should be left long and no attempt should be made by the subject or any non-trained person to remove it as doing so can result in further damage.

Scleral and suprachoroidal foreign body in a dog--a case report.

A 2-year-old male castrated Springer Spaniel with a 3-week history of waxing and waning right sided exophthalmos, periorbital swelling, chemosis, and fundic changes was examined. Ophthalmic examination of the right eye revealed slight chemosis and nictitating membrane protrusion. Indirect ophthalmoscopy showed an approximately 8 mm peripapillary hyporeflective tapetal lesion with subretinal edema consistent with a bulbar/retrobulbar disease process. Inflammatory or neoplastic diseases were the main differential diagnoses. Ancillary diagnostics (ocular ultrasound and computed tomography) showed a focal, poorly defined dense tissue involving the caudomedial aspect of the right globe, adjacent to the optic nerve head without apparent orbital involvement. Considering the duration, location, and severity of the clinical findings, enucleation of the right globe was performed. Histopathology revealed focal thickening of the posterior wall with severe pyogranulomatous inflammation, surrounding a foreign body most consistent with plant material embedded between the sclera and the choroid (suprachoroidal). This report describes a rare case of a scleral/suprachoroidal foreign body (plant material), and outlines the difficulty of establishing an etiological diagnosis using standard ocular imaging.

Minimum velocity necessary for nonconventional projectiles to penetrate the eye: an experimental study using pig eyes.

To satisfy the Criminal Code of Canada's definition of a firearm, a barreled weapon must be capable of causing serious bodily injury or death to a person. Canadian courts have accepted the forensically established criteria of "penetration or rupture of an eye" as serious bodily injury. The minimal velocity of nonconventional ammunition required to penetrate the eye including airsoft projectiles has yet to be established. To establish minimal threshold requirements for eye penetration, empirical tests were conducted using a variety of airsoft projectiles. Using the data obtained from these tests, and previous research using "air gun" projectiles, an "energy density" parameter was calculated for the minimum penetration threshold of an eye. Airsoft guns capable of achieving velocities in excess of 99 m/s (325 ft/s) using conventional 6-mm airsoft ammunition will satisfy the forensically established criteria of "serious bodily injury." The energy density parameter for typical 6-mm plastic airsoft projectiles is 4.3 to 4.8 J/cm². This calculation also encompasses 4.5-mm steel BBs.

Ahmed implant coated with poly(2-methacryloyloxyethyl phosphorylcholine) inhibits foreign body reactions in rabbit eyes.

PURPOSE: Wound healing after Ahmed glaucoma valve (AGV) implantation often entails fibrosis as a foreign body reaction to the silicone plate. Poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) forms an antifouling surface that inhibits fibrosis during wound healing. In this study, we aimed to compare the effects of the implantation of AGV coated with PMPC (wPMPC) versus AGV without PMPC (woPMPC) in rabbits. METHODS: Six New Zealand White rabbit does underwent AGV implantation in both eyes. For each rabbit, one eye was randomly selected for implantation of AGV wPMPC and a conventional AGV (woPMPC) was implanted in the contralateral eye. Gross conjunctival vascularity was compared between the two groups at the first, second, and fourth weeks after surgery. The eyes were enucleated in four weeks and subjected to staining with hematoxylin and eosin and Masson's trichrome stain. The fibrosis and inflammation status among the eye samples were compared by measuring the thickness of the fibrotic walls and counting the number of chronic inflammatory cells around the AGV. Counting of inflammatory cells and measuring fibrotic wall thickness were done in a blinded method to eliminate observer bias. Statistical analysis was performed using the Mann-Whitney U test. RESULTS: Gross and histological examinations revealed no toxic effects of PMPC. There were no apparent differences in overall conjunctival vascularity between the two groups at weeks 1, 2, and 4 after surgery. The average inflammatory cell counts were 14.3 ± 5.8 per slide and 27.3 ± 8.6 per slide in the wPMPC and woPMPC groups, respectively (p = 0.037). The average thicknesses of the fibrotic wall were 57.9 ± 11.3 µm and 81.5 ± 21.3 µm in the wPMPC and woPMPC groups, respectively (p = 0.025). CONCLUSION: Compared to the woPMPC group, the number of inflammatory cells and fibrosis were significantly decreased in the wPMPC group.

Iatrogenic conjunctival entrapment of cilium and scleral ulceration after subtenon steroid injection.

PURPOSE: To report the presence of an asymptomatic cilium in the subconjunctival area and an adjacent sterile scleral ulcer, together as a complication of subtenon injection of steroids, and the resolution of the ulcer despite the in situ cilium. METHODS: Medical management of a 51-year-old man, who was a known case of ankylosing spondylitis, with a 3-mm scleral ulcer located in the inferior palpebral area with one adjacent fully embedded cilium at the probable site of subtenon injection given for suspected acute iridocyclitis. RESULTS: On altering the medication, the ulcer resolved completely. This occurred despite the in situ cilium, which did not act as a nidus for infection or inflammation. CONCLUSIONS: The presence of cilia did not adversely affect the outcome of treatment of the adjacent ulcer. Therefore, if there is no exposure of the entrapped cilium through the conjunctiva, as was in this case, conservative management of the ulcer and not trying to remove the cilium seems to be a good alternative as opposed to reports in literature, which warrant its removal in most cases.

Sympathetic ophthalmia following vitreoretinal surgery.

The objective is to discuss the characteristics of three patients who developed sympathetic ophthalmia following vitreoretinal surgery. The first case was a 29-year-old man who underwent placement of an encircling band, pars plana vitrectomy, foreign body removal, endolaser photocoagulation, transscleral cryotherapy, and silicone oil injection due to a retained foreign body 3 months after a corneoscleral rupture repair. He experienced visual loss in the fellow eye 2 months after the vitrectomy. An extensive exudative detachment was detected in the fellow eye. Sympathetic ophthalmia was diagnosed and systemic steroids together with azathioprine were initiated. The injured eye was enucleated as there was no useful vision. The other two cases were operated for rhegmatogenous retinal detachments. One underwent placement of an encircling band, pars plana vitrectomy, silicone oil injection, and endolaser photocoagulation with good anatomic outcome. However, 4 months later, the fellow eye experienced severe visual loss with disc swelling and hyperemia and exudative retinal detachment. Systemic steroid was sufficient to reverse the process and the visual acuity recovered. The other case underwent placement of an encircling band, subretinal fluid drainage, SF(6) injection and 360 degrees indirect laser photocoagulation. Two years later, he noted a sudden visual decrease in the fellow eye in which we detected a Harada-like extensive exudative detachment. Systemic steroid without immunosuppressive therapy rendered regression of the detachment and recovery of good visual acuity. Sympathetic ophthalmia may occur following vitreoretinal surgery either for trauma-related problems or rhegmatogenous retinal detachment. Since it may present with relatively mild anterior segment findings and mainly posterior segment involvement; any visual disturbance in the fellow eye of a patient with a history of perforating trauma or vitreoretinal surgery should be thoroughly evaluated for sympathetic ophthalmia.

Prognostic factors in severely traumatized eyes with posterior segment involvement.

BACKGROUND: To determine the prognostic indicators of functional outcome in eyes with severe posterior segment trauma managed with pars plana vitrectomy. METHODS: One hundred and six eyes of 101 patients were retrospectively reviewed to determine the accuracy of a number of factors in predicting functional outcome after surgery. These potential prognostic indicators included initial visual acuity (VA), retinal detachment (RD), type of trauma, presence of intraocular foreign body (IOFB), type of IOFB, posttraumatic endophthalmitis, hyphema, choroidal detachment, initial hypotonia, accompanying lens subluxation/dislocation, and severe vitreous hemorrhage. In our study, functional success was defined as VA > or =5/200. Fisher's exact and chi-square tests were used for statistical analysis. RESULTS: The mean follow-up time was 12.8+/-0.52 (8-18) months. Thirty-three eyes (31.13%) had functional success. Forty-four (68.7%) of 64 eyes with preoperative RD had anatomical success (total retinal reattachment). Predictors of poor visual outcome (VA < or =5/200) were found to be poor initial VA (p<0.0001), presence of RD (p<0.001), and presence of endophthalmitis (p<0.05). No statistically significant correlation was found between the other predictors surveyed and visual outcome (p>0.05). CONCLUSION: Vitreoretinal surgery can improve anatomical and functional success in eyes with severe posterior segment trauma. Poor initial VA, RD, and posttraumatic endophthalmitis are poor predictors of visual outcome.

[Species identification of the fragment of wood found in the left eye socket bone during exhumation of general Wladyslaw Sikorski's corpse]. / Identyfikacja gatunkowa fragmentu drewna znalezionego w trakcie ekshumacji zwlok generala Wladyslawa Sikorskiego w kosci lewego oczodolu.

During the exhumation of general Wladyslaw Sikorski's corpse, a fragment of wood was found embedded in the left eye socket bone. The wood fragment was referred by the Institute of Forensic Research to the laboratory of Department of Forest and Wood Utilization, University of Agriculture in Krakow, where investigations were performed, aiming at determining the species of the wood. The fragment was cut into 20 microm thick microtome scraps of three anatomy sections: transverse, tangential and radial. The scraps were immersed in 99.8% ethyl alcohol for 24 hours and then for about 1 hour in xylene. Subsequently, they were placed between a microscope slide and a cover-glass in Canada balsam. The thus prepared scraps were then analyzed with the use of a Jenaval Carl Zeiss microscope. On the basis of microscope observations it was determined that the investigated fragment of wood belonged to Douglas-fir species (Pseudotsuga menziesii (Mirb.) Franco).

Correlation between pathogenic species and clinical findings, disease severity, and visual outcome in patients with fungal keratitis.

PURPOSE: To determine whether a correlation exists between pathogenic species and clinical findings, disease severity, and visual outcome in patients with keratitis and fungal growth in microbiological culture. METHODS: A retrospective study of patients with fungal growth in the microbiological culture of corneal scrapings. Patients were treated at an ophthalmologic reference center in Southeastern Brazil from January 1992 to October 2015. RESULTS: Medical records of 181 patients (131 males and 50 females) with a mean age of 47 ± 18 years were analyzed. The three most common etiologies were Fusarium sp. (38.7%), Aspergillus sp. (15%), and Candida sp. (13.2%). Among these, Fusarium sp. was the most frequent in patients aged £50 years (p=0.002) and in those with a recent history of a foreign body and/or ocular trauma (p=0.01). Candida sp. was the most frequent etiology in patients aged >50 years (p=0.002), in those with postoperative ocular surgery (p=0.002); in those with a previous ocular pathology (p=0.0007); and in immunodepressed patients (p=0.0004). CONCLUSION: Fusarium sp. was predominant in patients aged £50 years and those with a recent history of foreign body and/or ocular trauma, whereas Candida sp. was predominant in older adults, in those with a postoperative ocular surgery, in those with a previous ocular pathology, and in immunodepressed patients.

Efficacy and safety of biodegradable collagen-glycosaminoglycan polymer as a material for scleral buckling.

PURPOSE: To test the efficacy and safety of a biodegradable collagen-glycosaminoglycan (CG) polymer as the material for scleral buckling in rabbit eyes. METHODS: Segmental scleral buckling was performed by using a silicone sponge in one eye and a biodegradable CG polymer in the other eye of 20 rabbits. Wound and conjunctival reactions were evaluated by external photographs 1 day and then every week after surgery. Echography was used to evaluate the extent of the buckling effect. Electroretinograms were used to evaluate the retinal function after scleral buckling. Histology and immunohistochemistry were used to check the tissue reaction and distribution of myofibroblasts during wound healing. Scanning electronic microscopy of buckling materials was used to analyze structural changes after episcleral implantation. RESULTS: Biodegradable collagen initially achieved a buckling effect comparable to a silicone sponge; the buckling effect decreased after 1 month. Within 8 to 12 weeks, the collagen was gradually absorbed. After implantation, the collagen matrix degraded, and the pore size decreased as a result of compression and degradation. In contrast, no major structural changes were observed in silicone sponges, except some cell debris, fibrin, and blood cells were detected inside the porous structure of the sponge. The inflammatory responses were comparable between sponge and collagen in most areas of peribuckling histology. In areas of degraded collagen, a foreign body reaction was observable. Electroretinography revealed no detectable difference in retinal function between control and experimental eyes. CONCLUSIONS: Biodegradable collagen was used effectively and safely as a material for scleral buckling.