Ocular blast injuries in mass-casualty incidents: the marathon bombing in Boston, Massachusetts, and the fertilizer plant explosion in West, Texas.

PURPOSE: To report the ocular injuries sustained by survivors of the April 15, 2013, Boston Marathon bombing and the April 17, 2013, fertilizer plant explosion in West, Texas. DESIGN: Multicenter, cross-sectional, retrospective, comparative case series. PARTICIPANTS: Seventy-two eyes of 36 patients treated at 12 institutions were included in the study. METHODS: Ocular and systemic trauma data were collected from medical records. MAIN OUTCOME MEASURES: Types and severity of ocular and systemic trauma and associations with mechanisms of injury. RESULTS: In the Boston cohort, 164 of 264 casualties were transported to level 1 trauma centers, and 22 (13.4%) required ophthalmology consultations. In the West cohort, 218 of 263 total casualties were transported to participating centers, of which 14 (6.4%) required ophthalmology consultations. Boston had significantly shorter mean distances to treating facilities (1.6 miles vs. 53.6 miles; P = 0.004). Overall, rigid eye shields were more likely not to have been provided than to have been provided on the scene (P<0.001). Isolated upper body and facial wounds were more common in West largely because of shattered windows (75.0% vs. 13.6%; P = 0.001), resulting in more open-globe injuries (42.9% vs. 4.5%; P = 0.008). Patients in Boston sustained more lower extremity injuries because of the ground-level bomb. Overall, 27.8% of consultations were called from emergency rooms, whereas the rest occurred afterward. Challenges in logistics and communications were identified. CONCLUSIONS: Ocular injuries are common and potentially blinding in mass-casualty incidents. Systemic and ocular polytrauma is the rule in terrorism, whereas isolated ocular injuries are more common in other calamities. Key lessons learned included educating the public to stay away from windows during disasters, promoting use of rigid eye shields by first responders, the importance of reliable communications, deepening the ophthalmology call algorithm, the significance of visual incapacitation resulting from loss of spectacles, improving the rate of early detection of ocular injuries in emergency departments, and integrating ophthalmology services into trauma teams as well as maintaining a voice in hospital-wide and community-based disaster planning.

Graft Detachment Rate in DSEK/DSAEK After Same-Day Complete Air Removal.

PURPOSE: We retrospectively analyzed the rate of graft detachment from 310 Descemet stripping endothelial keratoplasty (DSEK)/Descemet stripping automated endothelial keratoplasty (DSAEK) cases performed by a single surgeon over a 10-year period using same-day complete air removal. Secondary outcome measures including primary graft failure, late endothelial graft failure, rejection events, and steroid-induced ocular hypertension were also analyzed. METHODS: A retrospective chart review was performed on all patients receiving DSEK/DSAEK for any cause by the same surgeon at 2 separate institutions from January 2005 to December 2014. The air bubble used to promote graft-host apposition was completely removed after 1 hour. Descriptive statistical analysis was used to report the rates of graft detachment, and χ analysis was used to assess for associations with secondary outcomes. RESULTS: Among 310 endothelial keratoplasties analyzed, there were 19 graft detachments (6.1%). The graft detachment rate was higher during the learning curve, but rapidly declined with experience, and was 1.3% for the last 79 cases over a 4-year period. No primary graft failures were reported. The rate of steroid-induced ocular hypertension was 20%. The rate of graft failure was 8%. The rate of graft rejection events was 10.7%. Two of the 6 patients (33%) who underwent trabeculectomy before endothelial keratoplasty suffered a detachment. CONCLUSIONS: A graft detachment rate as low as 1.3% can be achieved in DSEK/DSAEK with same-day complete air removal shortly after surgery. Factors believed to contribute to a low detachment rate include complete interface fluid removal and reconstitution of the normal anterior chamber milieu to assist corneal endothelial function.