REPAIR OF THE EXIT WOUND OF A PERFORATING GLOBE INJURY WITH THE AMNIOTIC MEMBRANE: A SURGICAL ADJUVANT FOR EARLY VITRECTOMY.

PURPOSE: To describe the use of the amniotic membrane for the repair of the exit wound of a perforating injury involving the retina and the choroid. METHODS: Case report. RESULTS: A 46-year-old man presented one day after a perforating ocular injury with an exit wound close to the inferior temporal retinal vascular arcade. The next day, the patient underwent a combined vitrectomy and phacoemulsification with intraocular lens implantation. During vitrectomy, a retinochoroidectomy was performed at the exit wound and the internal limiting membrane was peeled over the macula and up to the exit wound. Laser retinopexy was followed by plugging of a piece of the amniotic membrane to the exit wound. A second piece of the amniotic membrane was used to cover the bare retinochoroidectomy area. The surgery was concluded with a silicone exchange. Postoperatively, no sign of proliferative vitreoretinopathy was observed, and at 3 months, the silicone oil was removed. The follow-up was uneventful, and the eye achieved a final visual acuity of 20/30. CONCLUSION: The amniotic membrane may offer a simple and safe solution for the repair of the exit wounds of perforating injuries involving the retina and the choroid. The use of the amniotic membrane for this purpose may afford the opportunity for early vitrectomy in the management of perforating ocular injuries.

A case of perforating injury of eyeball and traumatic cataract caused by acupuncture.

Perforating globe injury is the leading cause of monocular blindness and vision loss. A 58-year-old male was injured by acupuncture needle during acupuncture treatment for his cerebral infarction. To the best of our knowledge, this is the first case report of perforating injury of the eyeball and traumatic cataract caused by acupuncture. The patient was hospitalized due to diagnosis of perforating ocular injury, traumatic cataract, and corneal and iris perforating injury. Moreover, he had to accept treatments of phacoemulsification, anterior vitrectomy along with intraocular lens implantation in the sulcus to improve his visual acuity. As acupuncture therapy has been widely performed for various diseases and achieved highly approval, the aim of this report is to remind acupuncturists operating accurately to avoid unnecessary injury during the treatment process, or the cure can also become the weapon.

Traumatic Branch Retinal Vein Occlusion With Retinal Neovascularization Following Inadvertent Retrobulbar Needle Perforation.

Retrobulbar injection of anesthesia is one of the most common procedures performed for ophthalmic surgery. Complications are rare but can be potentially serious, including retrobulbar hemorrhage, brainstem anesthesia, and inadvertent globe perforation. This is the preliminary report describing branch retinal vein occlusion (BRVO) secondary to accidental retrobulbar needle laceration with subsequent preretinal neovascularization.

Management of retinal detachment in block related globe perforation with pneumatic retinopexy.

Retinal detachment after ocular perforation related to local anesthesia is a common complication, which is usually associated with a poor prognosis despite complex vitreoretinal surgical procedures. We report a case of 62-year-old male with cataract surgery done 4 weeks back with nasal retinal detachment with a posterior break. Pneumatic retinopexy was performed and laser barrage of the breaks was done the next day when the retina got attached. A vision of 20/30 was achieved at the end of 2 months. To the best of our knowledge, this is a first case report in literature where pneumatic retinopexy was used to manage a retinal detachment caused by block-related perforation.

Experimental measure of retinal impact force resulting from intraocular foreign body dropped onto retina through media of differing viscosity.

BACKGROUND: To evaluate and compare the perfluorocarbon liquid, silicone oil, and viscoelastic against standard saline, in their ability to dampen the impact force of a foreign body, dropped within the eye. In an experimental surgical model in where cohesive and adhesive forces of the substances are not enough to float heavy-than-water foreign bodies. METHODS: A model of ophthalmic surgery was constructed. A BB pellet was dropped from 24 mm onto a force transducer through four different fluids: balanced salt solution, perfluoro-n-octane, viscoelastic, and silicone oil. The impact energy (force) for each case was measured and recorded by the force transducer. The mean force of impact for each fluid was compared using the Student t-test. RESULTS: Silicone oil resulted in the lowest force of impact. Both silicone oil and viscoelastic dampened the impact an order of magnitude more than perfluoro-n-octane and balanced salt solution. CONCLUSIONS: Silicone oil and viscoelastic cushioned the force from a dropped BB. They may be useful adjuncts to prevent iatrogenic retinal injury during vitrectomy for intraocular foreign body removal.

Combination of photodynamic therapy with intravitreal bevacizumab for post-peribulbar anesthesia (penetrating trauma)-persistent choroidal neovascular membrane.

We report a case of a choroidal neovascular membrane (CNVM) following ocular penetration during peribulbar anesthesia in a 55-year-old male patient. A combination of photodynamic therapy with intravitreal bevacizumab led to resolution of the persistent CNVM.

Inadvertent ocular perforation during lid anesthesia for hordeolum removal.

PURPOSE: Ocular perforation during lid anesthesia is rarely reported. We describe here a case of inadvertent corneal perforation and traumatic cataract that occurred during lid anesthesia in a procedure for hordeolum removal. METHODS: A 33-year-old woman presented with a sudden visual loss of her left eye. She had undergone hordeolum removal the day before at a local clinic. On ophthalmologic examination, the cornea was perforated and the lens cortex was extruded into the anterior chamber. After cataract removal and IOL implantation, antibiotics were injected into the vitreous. RESULTS: Her final visual acuity of the left eye was 20/20. Postoperative specular microscopic examination revealed a normal-range endothelial cell count, coefficient of variation, and hexagonality despite the intracameral lidocaine injection. CONCLUSIONS: Anesthetic injection of an infected lid should be done with great caution. Although there are possibilities of corneal endothelial toxicity and endophthalmitis in case of intracameral lidocaine injection through the infected lid, yet proper management may save the patient's vision without complications.

Inadvertent Ocular Perforation during Lid Anesthesia for Hordeolum Removal

PURPOSE: Ocular perforation during lid anesthesia is rarely reported. We describe here a case of inadvertent corneal perforation and traumatic cataract that occurred during lid anesthesia in a procedure for hordeolum removal. METHODS: A 33-year-old woman presented with a sudden visual loss of her left eye. She had undergone hordeolum removal the day before at a local clinic. On ophthalmologic examination, the cornea was perforated and the lens cortex was extruded into the anterior chamber. After cataract removal and IOL implantation, antibiotics were injected into the vitreous. RESULTS: Her final visual acuity of the left eye was 20/20. Postoperative specular microscopic examination revealed a normal-range endothelial cell count, coefficient of variation, and hexagonality despite the intracameral lidocaine injection. CONCLUSIONS: Anesthetic injection of an infected lid should be done with great caution. Although there are possibilities of corneal endothelial toxicity and endophthalmitis in case of intracameral lidocaine injection through the infected lid, yet proper management may save the patient's vision without complications.

Ocular complications of needle perforations during retrobulbar and peribulbar injections.

As a whole, the complication rate of retrobulbar and peribulbar injections is low, especially if done correctly (see appendix I). Side effects, however, can be extremely serious, and alternative methods such as topical or sub-Tenon's anesthesia should be considered (see appendix II), particularly when evaluating monocular patients with high-risk characteristics.

Corneal abrasions associated with pepper spray exposure.

Pepper spray containing oleoresin capsicum is used by law enforcement and the public as a form of nonlethal deterrent. Stimulated by the identification of a case of a corneal abrasion associated with pepper spray exposure, a descriptive retrospective review of a physician-maintained log of patients presenting to a jail ward emergency area over a 3-year period was performed. The objective was to give some quantification to the frequency with which an emergency physician could expect to see corneal abrasions associated with pepper spray exposure. Of 100 cases of pepper spray exposure identified, seven patients had sustained corneal abrasions. We conclude that corneal abrasions are not rare events when patients are exposed to pepper spray and that fluorescein staining and slit lamp or Wood's lamp examination should be performed on all exposed patients in whom corneal abrasions cannot be excluded on clinical grounds.