Enfermedades, lesiones y accidentes en trabajadores de la construcción en Uruguay, período 2014-2018 / Illnesses, injuries and accidents among construction workers in Uruguay, 2014-2018

El presente trabajo se realizó en el marco de las actividades de investigación y extensión del Departamento de Salud Ocupacional de la Facultad de Medicina Universidad de la República, por iniciativa de los trabajadores del sindicato único de la construcción y afines. El objetivo fue conocer el perfil de salud y enfermedad de los trabajadores del sector con el propósito de generar acciones que promuevan la salud laboral del colectivo involucrado. La investigación realizada es de carácter descriptivo a partir de fuentes secundarias. De los resultados se destacaron las enfermedades del aparato osteomioarticular, lesiones por traumatismos o envenenamiento y patologías del aparato respiratorio como principales causas de ausentismo de origen médico. La patología osteomioarticular fue la primera causa de incapacidad total y también es la primera causa de incapacidad para la tarea en el periodo estudiado. La tasa de incidencia acumulada de los accidentes en el año 2014 fue de 81,8 por 1.000 trabajadores cotizantes de la construcción, presentando una caída sostenida hasta el 2018 que alcanzó el valor de 60,2 por 1.000 trabajadores cotizantes. El tipo de accidente más frecuente observado en el periodo fueron las lesiones a esfuerzo excesivo. Con respecto a los accidentes mortales existe una caída marcada entre los años 2014 al 2016 con un ascenso progresivo en 2018. De la investigación surge como necesidad mejorar el reconocimiento de la patología profesional en el sector, profundizar las acciones en seguridad y salud con énfasis en aspectos ergonómicos de la carga física(AU)

This study was carried out under the framework of the research and outreach activities of the Department of Occupational Health of the School of Medicine of the University of the Republic, as an initiative of the workers of its single union of construction and related industries. The objective was to describe the health and disease profile of workers in the sector in order to generate actions to promote their occupational health. The study was descriptive and consisted of a secondary analysis of existing data. Musculoskeletal disorders, traumatic injuries, poisonings and respiratory illnesses were the main cause of sickness absence. Musculoskeletal disorders were the main cause of both work-related and total disability. The cumulative incidence rate of injuries in 2014 was 81.8 per 1000 dues-paying construction workers, and subsequently declined until 2018, to an incidence of 62.2 per 1000 dues-paying workers. Overexertion was the most common mechanism of injury. With respect to fatal accidents, there was a arked decline between 2014 and 2016, followed by a progressive increasein 2018. This study underscores the need to improve the recognition of occupational illness and injury in the construction and related industries sector, and to add depth to safety and health interventions, with an emphasis on ergonomic aspects of physical loads(AU)

Clinical outcomes and epidemiology of intraocular foreign body injuries in Cork University Hospital, Ireland: an 11-year review.

BACKGROUND/AIMS: To describe the epidemiology, outcomes, and prognostic factors of intraocular foreign body (IOFB) injuries at a tertiary ophthalmic referral centre in Cork University Hospital, Ireland. METHODS: A retrospective review of 23 eyes with IOFB that presented to Cork University Hospital (CUH) from January 2009 to December 2019 was performed. The mechanism and characteristics of IOFB injury were all noted. This data was collated and analysed to ascertain the epidemiology of IOFB injury in CUH and to describe the prognostic factors affecting visual outcome following IOFB injury. RESULTS: There was a 100% male prevalence. The mean age was 37.4 years. The majority of IOFBs were metal in nature and were acquired by hammering, often while working and frequently in the absence of personal protective equipment (PPE). The route of entry for the IOFB was via the cornea in 70% of cases. Fifty-two percent of cases were clinically detectable and 43% of cases were only identifiable on CT (computed tomography) imaging. Eighty-seven percent of cases underwent surgery on the same day as presentation. There was no incidence (0%) of endophthalmitis. Seventeen percent of cases developed post-operative retinal detachment (RD). The mean pre-operative VA was 0.79 LogMAR (6/38 Snellen equivalent-SE) compared to a mean VA of 0.58 LogMAR (6/24 SE) following surgery. CONCLUSIONS: This review provides important epidemiological data for IOFB injuries in Ireland. It also adds some useful information to the literature in relation to prognostic factors and lens status post IOFB injury.

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.

Pattern of ocular injuries in Bangladesh and its surgical management at hospital setting: A retrospective study.

OBJECTIVE: To determine the pattern of ocular injuries and their surgical management.. Methods: The retrospective study was conducted at the Chittagong Eye Infirmary and Training Complex, Chittagong, Bangladesh, and comprised hospital data of patients with ocular injuries from October 1, 2016, to December 31, 2017. Information gathered related to type and cause of injuries, visual acuity, postoperative complications, follow-up visits, and outcome. SPSS version 22 was used for data analysis. Results: Of the total injuries, 370 (91%) were classified open globe and 36 (9%) as close globe. In terms of type of injury, 330 (81.4%) were penetrating, 30 (7.3%) ruptured globe, 29 (7.1%) lime burn and 17 (4.2%) injuries were traumatic hyphaema and chemical in nature. Open globe injuries were mostly found in subjects aged 18 years or below. Surgery was the main mode of management in 388 (95.5%) patients. Conclusion: Preventive measures along with high-quality management should receive priority for reducing monocular blindness.

The outcomes of bimanual posterior segment intraocular foreign body removal with vitrectomy and description of two different handshake techniques: A single surgeon case series.

PURPOSE: To evaluate the outcomes of bimanual intraocular foreign body (IOFB) removal with vitrectomy and describe the techniques of "active aspiration to forceps" and "forceps to forceps handshake" for IOFB removal. METHODS: Retrospective, interventional, single surgeon case series. The patients who had an IOFB and underwent vitrectomy with bimanual IOFB removal techniques and had a minimum follow-up period of 12 months were included. The main outcome measure was the functional and anatomical results of the bimanual surgical techniques. RESULTS: Twenty eyes were included. The mean follow-up time after surgery was 16.5±3.6 months (range 12-24 months). The baseline best corrected visual acuity (BCVA) was light perception in 8 eyes (40%), hand motions in one eye (5%), and≥1.0LogMAR in 11 eyes (55%). BCVA improved in 14 eyes (70%); was stable in 3 eyes (15%), and decreased in 3 eyes (15%). CONCLUSIONS: Both bimanual handshake techniques were safe and effective methods in the surgical treatment of IOFBs<5mm in size. The "active aspiration to forceps handshake" technique might be a gentle technique for the removal of IOFBs that are located on the surface of or trapped within the retina.

Intraocular foreign bodies after cataract surgery. / Cuerpos extraños intraoculares tras cirugía de catarata.

Intraocular foreign bodies after cataract surgery are relatively frequent, and there are many cases published in the literature on this topic. Different kinds of foreign bodies of various materials can be found, and some of them with the ability to produce side effects. Their extraction is recommended whenever possible, always individualising each case. It also recommended to carry out preventive measures in all surgeries for their prevention. In this work a review is presented on the topic, considered important due to the possible ocular complications that can occur.

Seasonal distribution of ocular conditions treated at the emergency room: a 1-year prospective study / Distribuição sazonal e causas de admissão em pronto atendimento oftalmológico - um estudo prospectivo de 1 ano

ABSTRACT Purpose: To determine the clinical characteristics and seasonal distribution of patients admitted to the ocular emergency department of a tertiary ophthalmology care center. Methods: The study cohort includes 27,120 patients who were admitted to ocular emergency room between November 2013 and November 2014. The age, sex, reason for admission, diagnosis, and complete ocular examination reports were recorded for each patient. X-ray and ultrasonographic examinations were performed if necessary. Results: The mean patient age was 32.83 ± 17.62 years (range, 0-95). The number of males was nearly two times the number of females, with 18,808 (69.4%) males and 8312 (30.6%) females. The diagnoses included viral conjunctivitis (7,859 patients; 29.0%), corneal foreign body (5,286 patients; 19.5%), bacterial conjunctivitis (3,892 patients; 14.4%), corneal abrasions (2,306 patients; 8.5%), and allergic conjunctivitis (1,433 patients; 5.3%) (Table 1). Other frequent diagnoses included subconjunctival hemorrhage, photo keratopathy, chemical eye injury, and penetrating and blunt eye injuries. Allergic conjunctivitis, ocular trauma, and corneal foreign body were more frequent in spring, whereas keratitis and chemical eye injury were more common in winter (chi-square test). The most common reasons for emergency room admission, in order of frequency, were viral conjunctivitis, corneal foreign body, bacterial conjunctivitis, and corneal abrasions. Conclusion: This study is the first long-term prospective study to evaluate the seasonal distribution and diagnosis of all adult and pediatric patients admitted to the emergency room for ocular conditions. The frequency of ophthalmological conditions seen in the emergency room may vary according to the season.

RESUMO Objetivo: Determinar as características clínicas e a distribuição sazonal dos pacientes admitidos no departamento de emergências oculares de um centro terciário de cuidados oftalmológicos. Métodos: Um total de 27.120 pacientes, admitidos no pronto atendimento ocular entre novembro de 2013 e novembro de 2014, foram incluídos neste estudo prospectivo. Idade, gênero, causa da admissão, diagnóstico e relatórios completos dos exames oculares dos pacientes foram registrados e exames de raios X e de ultrassonografia foram realizados quando necessários. Resultados: A idade média do paciente foi de 32,83 ± 17,62 anos (intervalo, 0-95). O número de homens era quase duas vezes maior que o número de mulheres, com 18.808 (69,4%) do sexo masculino e 8.312 (30,6%) do sexo feminino. Os diagnósticos incluíram conjuntivite viral (7.859 pacientes, 29,0%), corpo estranho corneano (5.286 pacientes, 19,5%), conjuntivite bacteriana (3.892 pacientes, 14,4%), abrasões corneanas (2.306 pacientes, 8,5%) e conjuntivite alérgica (1.433 pacientes, 5,3%) (Tabela 1). Outros diagnósticos freqüentes incluíram hemorragia subconjuntival, queratopatia fotográfica, lesões oculares químicas e lesões oculares penetrantes e contundentes. A conjuntivite alérgica, o trauma ocular e o corpo estranho da córnea foram mais frequentes na primavera, enquanto que a queratite e lesões oculares químicas foram mais comuns no inverno (teste qui-quadrado). Os motivos mais comuns para a admissão na sala de emergência, em ordem de frequência, foram conjuntivite viral, corpo estranho da córnea, conjuntivite bacteriana e abrasões da córnea. Conclusão: Este é o primeiro estudo prospectivo de longa duração avaliando as causas e a distribuição sazonal de todos os casos de admissão em um pronto atendimento oftalmológico para pacientes em idade adulta ou pediátrica. A frequência das causas de encaminhamento ao pronto atendimento pode variar em função da estação do ano.

Clinical characteristics and visual outcome, prognostic factor, visual acuity and globe survival in posterior segment intraocular foreign body at Tilganga Institute of Ophthalmology.

PURPOSE: To evaluate clinical characteristics, visual outcomes and globe survival after intraocular foreign body removal from posterior segment via pars plana approach. METHODS: A hospital based retrospective study. All the patients of penetrating eye injury with intraocular foreign body in posterior segment as detected by computed tomography were enrolled from 2012 to 2014. RESULTS: Thirty patients of 30 eyes were included. The mean age was 27.7 years. (2-52). Twenty-four (80%) were male. Out of 30 eyes 19 (63.3%) eyes had injury at Zone 1 and 11 (36.7%) eyes had injury at Zone 2. The mean time spent between primary repair following surgery and intra ocular foreign body removal, was 15.47 days. Retinal detachment and endophthalmitis prior to intraocular foreign body removal was present in 9/30 of eyes. We looked for correlation between post operative Phthisis bulbi with zone of injury and pre operative endophthalmitis and preoperative retinal detachment. However, p value for the above correlation was more than 0.552 and 0.815 respectively, which was statistically not significant. CONCLUSIONS: The eyes with posterior segment intraocular foreign bodies showing clinical features of preoperative endophthalmitis, retinal detachment and the zone of injury also did not have any direct significance with globe survival.

The epidemiology of Open Globe Injuries presenting to a tertiary referral eye hospital in Australia.

BACKGROUND: Open globe injuries (OGIs) account for 44% of the cost of ocular trauma within Australia. It is estimated that 90% of ocular trauma is preventable. However, there have been few epidemiological studies within Australia that have identified groups at risk of OGIs specifically. The aim of our study was to review the epidemiology of OGIs presenting to a tertiary referral eye hospital in Australia. METHODS: The Birmingham Eye Trauma Terminology (BETT) system was used to classify injuries as globe ruptures, penetrating eye injuries (PEIs), intraocular foreign bodies (IOFBs) or perforating injuries. Demographic data, past ocular history, mechanism of trauma, ocular injuries, and best-corrected visual acuity (BCVA) before and after treatment were recorded. RESULTS: The 205 OGIs included 80 globe ruptures, 71 PEIs, 48 IOFBs and six perforating injuries. Falls predominated in older age groups compared to the other mechanisms of injury (p<0.0001). A fall was responsible for 33 globe ruptures and 82% of these had a history of previous intraocular surgery. Globe rupture and perforating injuries had poorer visual outcomes (p<0.05), consistent with previous studies. Alcohol was implicated in 20 cases of OGI, with 11 of these due to assault. PEIs and IOFBs commonly occurred while working with metal. BCVA was significantly worse following removal of an intraocular foreign body. We found presenting BCVA to be a good predictor of BCVA at the time of discharge. CONCLUSIONS: The causes of OGI varied in association with age, with older people mostly incurring their OGI through falls and younger adults through assault and working with metal. Globe ruptures occurring after a fall often had a history of intraocular surgery. The initial BCVA is useful for non-ophthalmologists who are unfamiliar with the ocular trauma score to help predict the BCVA following treatment.

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.

Intraorbital foreign bodies: Clinical features and outcomes of surgical removal.

BACKGROUND: The present study is an evaluation of clinical features and management outcomes of patients operated on for intraorbital foreign bodies (FBs). METHODS: Medical records of 24 patients who underwent surgery for intraorbital FBs within a 10-year period were reviewed. RESULTS: Twenty patients (83%) were male and 4 (17%) were female (mean age: 28 years; range: 4-69 years). Ten patients (42%) presented within 48 hours of injury, 7 (29%) within 3 days to 1 month, and 7 (29%) more than 1 month after injury. FBs were inorganic in 19 patients (79%), and organic in 5 (21%). Major ocular morbidities were orbital cellulitis (n=5), traumatic optic neuropathy (n=3), globe perforation (n=2), and rupture of rectus muscle (n=2). FBs could be completely removed in all cases. Mean follow-up time was 26 months (range: 1 month-10 years). CONCLUSION: Intraorbital FBs are usually inorganic and metallic, and occur more frequently in young males. Orbital cellulitis, considered typical for organic FBs, may also occur with metallic that perforate lacrimal sac or paranasal sinuses. With appropriate caution, intraorbital FBs can be removed safely with current orbitotomy techniques.

Epidemiology of Adult Open Globe Injury.

OBJECTIVE: The aim of this study was to evaluate the epidemiology and outcomes of adult open globe injuries (OGI) in the eastern part of Turkey. METHODS: The retrospective study included all the patients who were diagnosed with OGI (436 eyes in 425 patients) at our clinic between 1997 and 2015. The OGI patients aged over 16 years were included into the study. Open globe injuries were classified according to the Ocular Trauma Classification. Age, gender, medical history, time between trauma and hospital admission, and mechanism of injury were recorded for each patient. RESULTS: The incidence of OGI in adults was found to be 3.40/100,000, with 5.00/100,000 in males and 1.67/100,000 in females. Open globe injuries were mostly seen in the age group of 17 to 29 years and in October and November. The patients included 79.5% males and 20.5% females. Intraocular foreign body was detected in 99 (22.7%) eyes. A strong, linear, negative correlation was found between the Ocular Trauma Classification values and final visual LogMAR (rp = -0.602, P = 0.0001). The most common mechanism of injury was occupational accident (38.4%). CONCLUSION: Open globe injuries remain a serious public health problem, resulting in significant vision loss. Open globe injuries are mostly seen in the young, middle-aged, and male working population. Additional preventive measures should be taken for the individuals in these groups.

[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.

Posterior segment intraocular foreign bodies: the effect of weight and size, early versus late vitrectomy and outcomes.

BACKGROUND: The objective of this study was to identify the effects of weight and size characteristics of posterior segment intraocular foreign bodies (IOFBs) in open globe injuries. METHODS: Fifty-eight eyes of 58 patients with posterior segment IOFBs were enrolled in the study. All IOFBs were removed by pars plana vitrectomy. Factors including age, gender, best corrected visual acuity (BCVA), nature of IOFBs, weight and dimensions of IOFBs, initial ocular features, timing of IOFB removal, entry site of IOFBs, interventions and complications were evaluated. RESULTS: Mean age of the patients was 32.7±14.2 years, and mean follow up period was 18±13.3 months. Weight, length, width and thickness of IOFBs were found negatively correlated with initial and final BCVA levels (p<0.05). Weight of IOFBs was significantly greater in eyes with initial hyphema, vitreous hemorrhage, retinal hemorrhage, retinal detachment, and uveal prolapse (p<0.05). Width and thickness of IOFBs were significantly greater in eyes with hyphema, vitreous hemorrhage, retinal hemorrhage and uveal prolapse (p<0.05). Length of IOFBs was significantly longer in eyes with hyphema (p<0.05). Presence of initial or subsequent retinal detachment was associated with poor final BCVA (p<0.05). There was no association between the timing of IOFB removal and incidence of endophthalmitis. CONCLUSION: Greater weight and size of posterior segment IOFBs were associated with worse outcomes in open globe injuries. Protective eyewear has a crucial importance to avoid work-related injuries. In our study, early or late vitrectomy for an IOFB removal had no significant effect on anatomic and visual outcomes. Therefore, vitrectomy can be postponed until optimal conditions are obtained.

Metallic corneal foreign bodies: an occupational health hazard / Corpos estranhos metálicos na córnea: um problema de saúde ocupacional

Purpose: To analyze the risk factors, outcomes, demographic characteristics, and attitudes of workers with metallic corneal foreign body (FB) injury. Methods: One hundred consecutive patients who presented with a metallic corneal FB to the eye clinic at Diyarbakir Training and Research Hospital were evaluated. The patients completed a questionnaire and were examined to determine features of the injury. Results: All patients were male. The mean age was 32.46 ± 1.03 years. Fiftyfive percent of the patients were unregistered workers, 59% were working in the metal industry sector, and 65% injuries resulted from metal cutting. Protective goggles were available in the workplace of 64% patients. However, 57% patients were not wearing goggles when the accident occurred, and 43% were injured despite goggle use. Most patients (52%) attempted to remove FBs by themselves. FBs were located in the central zone of the cornea in 16% patients. Rust marks remained after FB removal in 26% patients. Corneal scars from previous FB injuries were present in 58% patients. Only 8% workplaces provided compensation for physician visits for occupation related illnesses. Conclusions: Workplaces with a high risk for eye injuries should increase their protective measures, and educational programs should be implemented for both workers and occupational physicians. The government should enforce laws regarding unregistered workers in a better manner. .

Objetivo: Analisar os fatores de risco, resultados, características demográficas dos trabalhadores e atitudes em relação à lesão por corpo estranho metálico na córnea. Métodos: Foram avaliados cem pacientes consecutivos que se apresentaram com corpo estranho metálico na córnea à clínica oftalmológica do Diyarbakir Training and Research Hospital. Um questionário foi respondido e as características da lesão foram anotadas. Resultados: Todos os pacientes eram do sexo masculino. A idade média foi de 32,46 ± 1,03 anos. Cinquenta e cinco por cento dos pacientes eram trabalhadores não registrados. Cinquenta e nove por cento dos pacientes estavam trabalhando no setor da indústria metal, 65% das lesões resultaram de corte de metal. A presença de óculos de proteção no local de trabalho foi de 64%. Cinquenta e sete por cento dos pacientes não estavam usando óculos de proteção no momento do acidente, e 43% sofreram a lesão, apesar do uso óculos de proteção. Cinquenta e dois por cento dos pacientes tentaram remover o corpo estranho por si só. Dezesseis por cento dos corpos estranhos foram na zona central da córnea. Um depósito de ferrugem permaneceu após a remoção do corpo estranho em 26% dos pacientes. Cinquenta e oito por cento dos pacientes tinham cicatrizes na córnea por causa de lesões por corpo estranho anteriores. Os locais de trabalho que proporcionaram remuneração por visita médica relacionada à ocupação foram de apenas 8%. Conclusões: Locais de trabalho de alto risco devem ser detectados e medidas de proteção devem ser aumentadas. Os programas educacionais devem ser implementados para os trabalhadores e médicos do trabalho. As leis sobre trabalhadores sem carteira assinada ...

[Impact of follow-up loss over visual deficiency in open-globe ocular trauma]. / Impacto de la pérdida de seguimiento sobre la deficiencia visual en trauma ocular con globo abierto.

INTRODUCTION: Open-globe ocular trauma causes visual deficiency; calculating the magnitude of the latter often misses the estimation in patients without follow-up. AIM: to identify the modification of the postoperative proportion of visual deficiency in open-globe ocular trauma, which would introduce considering the proportion estimated in patients without follow-up. METHODS: Non-interventional, retrospective, longitudinal, analytical study. Visual outcome in eyes with open-globe trauma, with and without follow-up, was calculated using the Ocular Trauma Score. The observed postoperative proportion of visual deficiency was identified in eyes with follow-up; in eyes without follow-up, the postoperative proportion of visual deficiency was estimated using an analysis of scenarios: best (Ocular Trauma Score), mean (that of eyes with follow-up) and worst (last observation/no visual improvement). The estimated proportion of visual deficiency was added to that observed in eyes with follow-up, and the resulting proportion was compared with that expected in the sample, using the Ocular Trauma Score (χ(2)). RESULTS: 104 eyes, 70 without follow-up and 34 without it. In eyes with follow-up the expected proportion of visual deficiency was 58.6%, and the observed one was 71.4% (p = 0.1); the estimated proportion of visual deficiency in eyes without follow-up was 76.5%. The resulting postoperative proportion of visual deficiency in the sample would be 73.1%, which would overcome that expected by the Ocular Trauma Score (59.6%, p = 0.04). CONCLUSIONS: In open-globe ocular trauma, the efficacy of surgery to reduce the proportion of visual deficiency would decrease with regard to the standard expected by the Ocular Trauma Score, if the deficiency estimated in eyes without follow-up were considered.

Work-related open-globe injuries: demographics and clinical characteristics.

PURPOSE: To describe the demographics and clinical characteristics of work-related open-globe injuries (OGIs) at a level I trauma center over a 10-year period. METHODS: Retrospective series. RESULTS: A total of 183 eyes with work-related OGIs were identified. The majority of injuries occurred in men (96.7%). The anatomic site of the wound was zone 1 in 107 eyes (72.3%). The most common cause was nail gun use (47.0%). The types of OGI included 32 ruptures (17.5%), 112 penetrating injuries (61.2%), 38 intraocular foreign bodies (IOFB) (20.8%), and 1 mixed rupture/IOFB injury (0.5%). Presenting visual acuity (VA) was worse than 20/200 in 112 eyes (65.9%) and no light perception (NLP) in 10 eyes (5.8%). Final VA worse than 20/200 occurred in 64 eyes (37.2%); 11 eyes underwent enucleation. In comparison to non-work-related OGIs (420 eyes), we found significant differences in types and zones of injury, initial and final mean VA, enucleation rate, incidence of cataracts, hyphema, retinal detachment, hemorrhagic choroidals, and afferent pupillary defect (APD). Using multivariate analysis, significant prognostic factors for a final VA of NLP were zone 3 injury, rupture injury, and initial VA of NLP. Risk factors for enucleation included zone 3 injury, APD, and endophthalmitis. CONCLUSIONS: Work-related injuries were noted to have a much higher incidence of IOFBs and cataracts compared to non-work-related OGIs. Zone 3 injuries, rupture injuries, and a presenting VA of NLP were found to be significant predictors for a final VA of NLP. Zone 3 injury, APD, and endophthalmitis were found to be significant predictors for enucleation.

Foreign body traumas of the eye managed in an emergency department of a single-institution.

BACKGROUND: Superficial corneal foreign bodies (SCFB) are common injuries seen in the ED. The aim of this study was to describe the eye injuries caused by FBs and to determine clinical strategies for the prevention and management of ocular trauma. METHODS: This was a retrospective chart review of the previous two years. Demographic data, timing of the injury, injury type (open- or closed-globe injuries), source of the FB, hospital admission and ophthalmology consultation, treatments, and the long-term complications were recorded for each patient. RESULTS: There were 476 patients, and 83% were male, with an average age of 34.16±14.02 years. 9.7% of the eyes had an open-globe injury, while the rest were closed-globe injuries with or without SCFB. The most common FBs were metal fragments (37.6%) and dust (31.1%). The majority of the patients (72.1%) sustained work-related injuries. 42.4% of the patients were consulted to ophthalmology, and the remaining were treated by the emergency physicians. Only 10% of the patients required hospitalization, and complications were seen in 2.3% of the patients. CONCLUSION: Ocular FB involved mainly young healthy males who had sustained work-related injuries. In view of the large number of eye injuries seen in Eds, ED colleagues should train themselves in order to appropriately recognize, treat and refer the SCFB injuries seen in the ED.

[Intraocular foreign bodies (IOFB) of the posterior segment: retrospective analysis and management of 57 cases]. / Corps étrangers intraoculaires (CEIO) du segment postérieur : analyse rétrospective et prise en charge à propos de 57 cas.

PURPOSE: To determine the influence of prognostic factors and the type of tamponade agent in surgical management of intraocular foreign bodies (IOFBs) for better visual outcome. PATIENTS AND METHODS: Fifty-seven consecutive cases were retrospectively reviewed at the XV-XX National Hospital (Paris) between 1 January 2004 and 31 December 2007. Univariate and multivariate analyses were performed to identify prognostic variables. Several parameters were measured: pre- and postoperatively: best corrected visual acuity (BCVA), material and size of the foreign body, entry site, time from trauma to surgical removal, IOFB location, initial retinal detachment, choice of vitreous tamponade agent (none, gas, silicone oil), postoperative visual outcome, and complications (siderosis, endophthalmitis, and vitreoproliferative retinal detachment). RESULTS: Metal IOFBs accounted for the majority with 80.7% (n=46). The inferior retinal segment was the most frequent location found: 47.4% (n=27). Initial and final mean BCVAs were, respectively, 1.47 (±0.99) and 1.03 (±0.96) (LogMar scale). The mean follow-up was 20.7 months (range, 12-60 months). Initial retinal detachment was found in 24.56% (n=14), with a statically worse prognosis. The BCVA was better in the group with gas tamponade (n=16) than in the group with silicone tamponade (n=21) and the group without a tamponade agent (n=20). Initial BCVA was the most important predictive factor for final BCVA. Time to surgery was a predictive factor of final visual outcome with a cut-off in the first week. The scleral or corneoscleral entry site had a better prognosis than the corneal site. Five cases of siderosis (8.7%) related to delayed management and two cases of endophthalmitis (3.5%) were found (despite use of prophylactic systemic antibiotics). No statistical difference was found regarding the IOFB location on the retina, its size, or the material. Finally, the retina remained detached in nine cases (15.78%). A final BCVA of 20/40 or more was obtained in 39.3 and 17.5% had light perception or worse. CONCLUSION: The prognosis of an IOFB injury is for the most part uncertain due to a complex combination of parameters. Nevertheless, good postoperative results can be achieved without a silicone tamponade agent. The main prognostic factors related to better visual outcome were initial BCVA, time to surgery (first week), initially attached retina, and the scleral entry site. The main complications were vitreoproliferative retinal detachment, endophthalmitis, and siderosis. The location, type, and size of IOFBs were not statistically significant predictive factors in this study.