Management and Outcomes of Traumatic Cataract During Open Globe Repair.

PURPOSE: To compare outcomes of primary lensectomy (PL) versus no lensectomy (NL) during repair of zone I (involving cornea and limbus) and II (up to 5mm posterior to the limbus) open globe injuries (OGIs) with lens involvement. DESIGN: Retrospective clinical cohort study. METHODS: 107 patients with OGIs involving both blunt and penetrating injury to the lens who presented to Wills Eye Hospital between April 1, 2017 and August 31, 2022 were included. Data from presenting visit was collected including demographic information, time from injury to surgery, visual acuity (VA), intraocular pressure (IOP), injury characteristics, and years since residency graduation of surgeon. VA, IOP, retinal detachment (RD) rate, and endophthalmitis incidence were compared between PL and NL groups at postoperative week 1 (POW1) and postoperative month 1 (POM1). VA, peak IOP, need for further surgeries, and types of additional surgery were compared between the two groups at the final visit. RESULTS: 19 (17.8%) patients underwent PL. Age, sex, and initial VA were similar between groups (all p≥0.05). The PL group had surgery later from the time of injury (6.1±14.6 days vs. 1.3±1.9 days; p=0.010), higher IOP at presentation (12.9±11.6 mmHg vs. 7.7±11.3 mmHg; p=0.046), shorter wounds (2.3±1.4mm vs. 4.7±3.2mm; p=0.003), more frequent lens capsule violation (89.5% vs. 50%; p=0.010), increased likelihood of intraocular foreign bodies (52.6% vs. 17.0%; p=0.004), and were more likely to be operated on by surgeons with ≥ 5 years of experience post-residency (68.4% vs. 28.4%; p<0.001). At POW1, the PL group had significantly better logMAR VA (1.2±0.9 vs. 2.0±1.0; p=0.002), and this continued at POM1 (1.0±0.8 vs. 1.6±1.1; p=0.031) and the final visit (0.4±0.7 vs. 1.0±1.1; p=0.010). The PL group had lower IOP at POW1 (12.4±3.0 mmHg vs. 17.3±8.2 mmHg; p=0.005) than the NL group. There was no difference in RD or endophthalmitis rates between the two groups at POW1 or POM1 (p>0.05 for all). The NL group was more likely to require additional surgery by final follow-up (77.3% vs. 47.4%; p<0.001). In the multivariable analysis, PL had better final VA and decreased need for further surgery (both p<0.05). CONCLUSIONS: In the appropriate circumstance, PL during lens-involving anterior OGI repair may lead to improved patient outcomes.

Epidemiology and prognosis factors in open globe injuries in the Federal District of Brazil.

OBJECTIVE: To identify the epidemiological profile and prognostic factors of open globe injuries that require emergency surgical treatment. DESIGN: Retrospective cohort study. SUBJECTS: Patients with OGI who underwent publicly funded emergency surgical treatment in the Federal District from 2014 to 2018. METHODS: Data were collected by reviewing electronic medical records through a questionnaire and tabulated. The statistical analysis was performed in SPSS Statistics 26.0.0.0 (p ≤ 0.05). RESULTS: A total of 359 records were included, corresponding to 336 eyes of 334 patients (294 males and 40 females). The average age was 32.7 years. The affected eye was the right eye in 165 cases, the left eye in 166 cases, and both eyes in 3 cases. The average time between injury and hospitalization was 75.7 h, and the time between injury and surgery averaged 173.7 h. The injury types were as follows: 197 penetrating; 109 rupture; 19 IOFB; 11 perforating. The injuries were in the following zones: 181 zone I; 82 zone II; 70 zone III. The OTS grades were as follows: 57 were classified as grade 1; 101 were grade 2; 142 were grade 3; 28 were grade 4; and 8 were 5. The most commonly performed surgeries were corneal suture, corneoscleral suture, and evisceration. The most common clinical features were traumatic cataract, herniated iris and hyphema. The following were risk factors for poor prognosis: zone III, time between trauma and surgery > 72 h, rupture injury, retinal detachment, disorganization of the eyeball, endophthalmitis, uveal prolapse, OTS classification 1 or 2, and low initial visual acuity. The following factors predicted a good prognosis: initial VA > 1/200, penetrating injury, OTS 4 and zone II. CONCLUSIONS: The high frequency of many of these factors may explain the high rate of severe visual loss found. Injury localization in zone II was identified as a previously unrecognized protective factor against severe visual loss.

Ocular trauma score as a visual prognostic factor of open globe injuries in a hospital of southern Brazil.

PURPOSE: To compare the visual acuities predicted by the Ocular Trauma Score and each one of the Ocular Trauma Score variables with the final visual acuities of the victims of open globe injuries in a southern Brazil hospital. METHODS: A total of 120 eyes of 119 individuals with open globe injuries were analyzed in this cross-sectional retrospective study that was developed in a university hospital. The information on age, sex, affected eye, trauma mechanism, and other data (such as initial visual acuity, the presence of globe rupture, perforating injury, endophthalmitis, retinal detachment, and afferent pupillary defect) were used to calculate the Ocular Trauma score, and the final visual acuities of all patients were retrieved from the patients' medical records. RESULTS: We noted an agreement between the visual acuity predicted by the Ocular Trauma Score and the final visual acuity in our study. An isolated analysis of the variables demonstrated significance with regard to the initial visual acuity (p<0.001), retinal detachment (p=0.001), and afferent pupillary defect (p=0.004). No significant differences were detected between the final visual acuities and those determined by the Ocular Trauma Score system for the present study population. CONCLUSIONS: The Ocular Trauma Score can be applied for the determination of the visual prognoses of victims of open globe injuries. The most significant variables in this predictive analysis are initial visual acuity, retinal detachment, and afferent pupillary defect. Prospective studies with larger sample sizes are required to confirm our findings.

Clinical presentations and surgical outcomes of intraocular foreign body presenting to an ocular trauma unit.

OBJECTIVES: To describe, evaluate, and identify the characteristics, prognostic factors, and visual outcomes in patients with intraocular foreign body (IOFB) in a Latin American population. METHODS: A retrospective, observational case-series of patients with a diagnosis of IOFB. Variables analyzed included age, gender, initial and final best correct visual acuity (BCVA), ocular trauma score, intraocular pressure, mechanism of injury, material and number of IOFB, zone of injury, timing of primary repair and IOFB removal, complications, and follow up. RESULTS: Sixty-one patients with IOFB were identified of which 97% were male with a mean age of 37.9 years (SD 2.16). The most common IOFB location was intravitreal (43%). IOFBs were metallic in 78%, vegetal in 3%, and other materials in 11%. Primary repair and secondary IOFB removal were performed at a mean timepoint of 3 days and 5 days, respectively. Systemic and topical antibiotics were administered to all patients. The initial BCVA was 1.62 logMAR and the final was 0.6 logMAR, which was statistically significant (Pearson's chi-squared test, p value 0.01). No cases of endophthalmitis were seen. CONCLUSION: IOFB removal can be delayed when there are no signs of infection or evidence of retinal detachment, without an increased risk of endophthalmitis and a negative impact on visual outcomes. Use of topical and systemic antibiotics appear sufficient to prevent endophthalmitis in these cases.

Diagnóstico ultrassonográfico de corpo estranho ocular em cão / Ultrasonographic diagnosis of strange eye body in dog

Traumatismos causados com espinho de porco espinho são comuns em cães. Entretanto, estes espinhos não são inertes podendo carrear bactérias e outros micro-organismos. A indicação frente à essa situação é a remoção de todo o material sempre que possível. Ultrassonografia, tomografia computadorizada e ressonância magnética possuem valor significativo no diagnóstico e localização de corpos estranhos não visíveis no exame físico. O objetivo deste relato de caso é descrever a presença de um corpo estranho linear na região intraocular de um cão macho, três anos de idade, sem raça definida. O animal deu entrada no serviço clínico de um Hospital Veterinário com apatia e histórico de contato com porco espinho há trinta dias. Observou-se secreção ocular e olhos recobertos pela terceira pálpebra. Nesta ocasião, foram retirados espinhos de ouriço na cavidade oral e o animal foi liberado. Entretanto, o paciente retornou 40 dias com piora do quadro oftalmológico. Foi realizado exame ultrassonográfico transpalpebral que detectou uma estrutura linear hiperecoica medindo aproximadamente 1,47cm com sobra acústica evidente e conteúdo anormal de ecogenicidade mista na câmara vítrea. Encaminhado para enucleação transpalpebral que possibilitou confirmar o diagnóstico e identificar o objeto. Após a remoção cirúrgica o paciente apresentou melhora clínica significativa e recebeu alta médica em 14 dias.(AU)

Trauma caused by porcupine thorns is common in dogs. However, these spines are not inert and can carry bacteria and other microorganisms. The advice given this situation is the removal of all material whenever possible. Ultrasonography, computed tomography and magnetic resonance have significant value in the diagnosis and localization of foreign bodies not visible on physical examination. The purpose of this case report is to describe the presence of a linear foreign body in the intraocular region of a three year old, male dog, of mixed breed. The animal was admitted to the clinical service of a Veterinary Hospital with apathy and a history of contact with a porcupine within thirty days. Eye discharge and eyes covered by the third eyelid were observed. On this occasion, hedgehog spines were removed in the oral cavity and the animal was released. However, the patient returned 40 days later with worsening of the ophthalmic condition. A transpalpebral ultrasound examination was performed, which detected a hyperechoic linear structure measuring approximately 1.47cm with evident acoustic leftovers and abnormal mixed echogenicity content in the vitreous chamber. The dog was referred for transpalpebral enucleation, which made it possible to confirm the diagnosis and identify the object. After surgical removal, the patient showed significant clinical improvement and was discharged within 14 days.(AU)

Diagnóstico ultrassonográfico de corpo estranho ocular em cão / Ultrasonographic diagnosis of strange eye body in dog

Traumatismos causados com espinho de porco espinho são comuns em cães. Entretanto, estes espinhos não são inertes podendo carrear bactérias e outros micro-organismos. A indicação frente à essa situação é a remoção de todo o material sempre que possível. Ultrassonografia, tomografia computadorizada e ressonância magnética possuem valor significativo no diagnóstico e localização de corpos estranhos não visíveis no exame físico. O objetivo deste relato de caso é descrever a presença de um corpo estranho linear na região intraocular de um cão macho, três anos de idade, sem raça definida. O animal deu entrada no serviço clínico de um Hospital Veterinário com apatia e histórico de contato com porco espinho há trinta dias. Observou-se secreção ocular e olhos recobertos pela terceira pálpebra. Nesta ocasião, foram retirados espinhos de ouriço na cavidade oral e o animal foi liberado. Entretanto, o paciente retornou 40 dias com piora do quadro oftalmológico. Foi realizado exame ultrassonográfico transpalpebral que detectou uma estrutura linear hiperecoica medindo aproximadamente 1,47cm com sobra acústica evidente e conteúdo anormal de ecogenicidade mista na câmara vítrea. Encaminhado para enucleação transpalpebral que possibilitou confirmar o diagnóstico e identificar o objeto. Após a remoção cirúrgica o paciente apresentou melhora clínica significativa e recebeu alta médica em 14 dias.

Trauma caused by porcupine thorns is common in dogs. However, these spines are not inert and can carry bacteria and other microorganisms. The advice given this situation is the removal of all material whenever possible. Ultrasonography, computed tomography and magnetic resonance have significant value in the diagnosis and localization of foreign bodies not visible on physical examination. The purpose of this case report is to describe the presence of a linear foreign body in the intraocular region of a three year old, male dog, of mixed breed. The animal was admitted to the clinical service of a Veterinary Hospital with apathy and a history of contact with a porcupine within thirty days. Eye discharge and eyes covered by the third eyelid were observed. On this occasion, hedgehog spines were removed in the oral cavity and the animal was released. However, the patient returned 40 days later with worsening of the ophthalmic condition. A transpalpebral ultrasound examination was performed, which detected a hyperechoic linear structure measuring approximately 1.47cm with evident acoustic leftovers and abnormal mixed echogenicity content in the vitreous chamber. The dog was referred for transpalpebral enucleation, which made it possible to confirm the diagnosis and identify the object. After surgical removal, the patient showed significant clinical improvement and was discharged within 14 days.

Caracterización epidemiológica del trauma ocular a globo abierto / Epidemiological characterization of open globe ocular trauma

RESUMEN Objetivo: Determinar las características clínico-epidemiológicas del trauma ocular a globo abierto. Métodos: Se realizó un estudio descriptivo, observacional y transversal en pacientes con trauma ocular a globo abierto y afectación del segmento posterior en pacientes hospitalizados en el Servicio de Vítreo-Retina del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" entre julio del año 2017 y julio de 2018. Resultados: El 68,18 por ciento de los pacientes fue menor de 50 años y el 88,64 por ciento fueron hombres. El trauma más común fue el penetrante (91,11 por ciento); el 68,89 por ciento de las lesiones ocurrió en zona 1, con predominio de las heridas menor o igual a 4 mm (75,56 por ciento). La circunstancia más común del trauma fue la laboral (50 por ciento). El mecanismo de producción predominante fue el martilleo sobre metal (71,11 por ciento); el 65,91 por ciento de los traumas ocurrieron en zona urbana; el 96,46 por ciento no usaba protección; el 57,77 por ciento tenía una agudeza visual inicial de cuenta dedo o mejor, y la presencia de cuerpo extraño intraocular ocupó el 77,78 por ciento. Conclusiones: En el trauma ocular a globo abierto predominan la edad por debajo de 50 años, el sexo masculino y los traumas penetrantes. La mayor parte se presenta de forma unilateral, durante las actividades laborales y sin protección ocular. Más de la mitad de los pacientes presentan agudeza visual inicial de cuenta dedos o mejor. Los signos oculares asociados más frecuentes son el cuerpo extraño intraocular y la catarata traumática(AU)

ABSTRACT Objective: Determine the clinical-epidemiological characteristics of open globe ocular trauma. Methods: A cross-sectional observational descriptive study was conducted of open globe ocular trauma and posterior segment damage in patients admitted to the Vitreous-Retina Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from July 2017 to July 2018. Results: Of the patients studied, 68.18 percent were under 50 years of age and 88.64 percent were men. Penetrating trauma was the most common type (91.11 percent); 68.89 percent of the lesions were found in zone 1, with a predominance of injuries smaller than or equal to 4 mm (75.56 percent). Most traumas occurred while at work (50 percent). The prevailing occupational activity being performed at the moment of the trauma was hammering on metal (71.11 percent); 65.91 percent of the traumas occurred in urban areas; 96.46 percent of the patients were not wearing the required protection equipment; 57.77 percent had an initial visual acuity of count fingers or better; and participation of foreign bodies accounted for 77.78 percent. Conclusions: In open globe ocular trauma a predominance is found of age under 50 years, male sex and penetrating traumas. Most are unilateral and occur while working without the required ocular protection. In more than half of the patients initial visual acuity is finger counting or better. The most common associated ocular signs are intraocular foreign body and traumatic cataract(AU)

The role of various imaging techniques in identifying and locating intraocular foreign bodies related to open-globe injury: three case reports and literature review. / Papel de distintas técnicas de imagen para identificar y localizar cuerpos extraños intraoculares relacionados con trauma ocular abierto: reporte de tres casos y revisión de la literatura.

BACKGROUND: Determining the precise location of intraocular foreign bodies is crucial for the management of patients with open-globe injury. Computed tomography is the most common method for detecting intraocular foreign bodies in the posterior segment. In this article, we describe three cases of open-globe injury with different types of intraocular foreign bodies in the posterior segment that were accurately located using computed tomography scans and B-scan ultrasonography. CASE PRESENTATION: Each of the three cases of open-globe injury described in this report had different types of ocular trauma, clinical symptoms, and intraocular foreign bodies. Computed tomography scans showed the exact location of the intraocular foreign bodies in the posterior segment in two of the three cases. A B-scan ultrasound was used to determine the location of a non-metallic intraocular foreign body in the third case. All three patients had intraocular foreign bodies, and one of them had an additional orbital foreign body. Case 1 had a perforating eye injury with the additional intraorbital foreign body; Cases 2 and Case 3 had different types of intraocular foreign bodies and prognoses. Various treatment approaches were used, ranging from observation to surgery, depending on the location of the intraocular foreign bodies, and all cases were successfully managed. These three cases show that proper use of various types of imaging tests is indispensable in the context of an intraocular foreign body related to open-globe injury. CONCLUSION: Imaging techniques are crucial for the detection of an intraocular foreign body, and computed tomography is one of the simplest and most useful, especially in cases of open-globe injury.

ANTECEDENTES: La ubicación precisa de un cuerpo extraño intraocular es crucial para el manejo de pacientes con trauma ocular abierto. La tomografía computarizada se usa habitualmente para detectar su ubicación en el segmento posterior. Reportamos tres casos con diferentes cuerpos extraños intraoculares en el segmento posterior, que fueron localizados con precisión mediante la tomografía computarizada y ecografía modo B. PRESENTACIÓN DEL CASO: Presentamos tres casos con diferentes mecanismos de trauma, tipos de cuerpo extraño intraocular, síntomas clínicos y pronóstico visual. La tomografía computarizada determinó la ubicación exacta de todos los cuerpos extraños intraoculares en el segmento posterior. El ultrasonido modo B se realizó en un paciente con un cuerpo extraño intraocular no metálico. El primer caso tuvo una lesión ocular perforante con un cuerpo extraño intraorbitario; el caso dos y el caso tres presentaron diferentes tipos de cuerpos extraños intraoculares con pronóstico diferente. El manejo y el pronóstico fue distinto en todos los casos; todos se manejaron con éxito. La ubicación exacta de los cuerpos extraños intraoculares utilizando las diferentes modalidades de diagnóstico es importante en estos pacientes. Estos casos sirven como recordatorio de que el uso adecuado de las pruebas de imagen es indispensable en el contexto de un cuerpo extraño intraocular relacionado con trauma ocular abierto. CONCLUSIÓN: Las diferentes técnicas de imágenes son muy importantes para la detección de un cuerpo extraño intraocular. La tomografía computarizada es una de las modalidades de imagen más simple y efectiva para la localización de cuerpos extraños intraoculares relacionadas con trauma ocular abierto.

Extracción de cuerpo extraño penetrante corneal e intracamerular / Removal of a penetrating corneal and intracameral foreign body

RESUMEN Paciente de 56 años quien acudió a la consulta por disminución de la visión, dolor y enrojecimiento ocular izquierdo, con antecedentes patológicos personales de hipertensión arterial esencial y antecedentes patológicos oculares de trauma ocular con fragmento de madera al cortar leña hace 37 años. El cuerpo extraño penetró hasta la cámara anterior y permaneció intracorneal, ya que en aquel momento no pudo ser removido en su totalidad. Se describe la técnica quirúrgica empleada, sobre la cual la información revisada ha sido escasa referente a los procederes quirúrgicos de remoción de cuerpos extraños semejantes, por lo que la técnica descrita debe contribuir a enfrentar futuros casos similares(AU)

ABSTRACT A 56-year-old male patient attends consultation with left eye vision reduction, pain and redness. The patient has a history of essential hypertension and eye trauma caused by a wood splinter while chopping wood 37 years ago. The foreign body went in as far as the anterior chamber and remained intracorneal, since at that time it could not be totally removed. A description is provided of the surgical technique used. Scant information was found about surgical procedures to remove similar foreign bodies. Therefore, the technique herein described should be useful to treat analogous cases(AU)

Conjunctival tattoo with inadvertent ocular globe penetration and vitreous involvement: Clinico-pathological correlation and scanning electron microscopy X-ray microanalysis.

PURPOSE: The aim is to report a case of conjunctival tattooing with inadvertent injection of tattoo ink into the vitreous cavity and its consequences, the scanning electron microscopy X-ray microanalysis of the ink components, and the microscopic findings of the affected conjunctiva and vitreous. METHODS: Descriptive case report. RESULTS: A 32-year-old man complained of ocular pain and blurred vision after undergoing a subconjuctival red ink tattoo in his left eye. Ophthalmologic examination revealed best corrected visual acuity of 20/80 and intraocular pressure of 26 mmHg. Pain was elicited with eye movements. The bulbar conjunctiva was colored intense red. In the anterior chamber, pigment granules and filaments were suspended on the aqueous humor, and lens capsule was also stained red. Ultrasonography showed high-density non-mobile echoes in the conjunctiva; anterior chamber and vitreous cavity revealed high-density mobile echoes corresponding to pigment particles. Conjunctival tattoo with inadvertent globe penetration was the clinical diagnosis. The patient received medical and surgical treatment. Histopathological examination of the conjunctiva showed red pigment globular deposits within the stroma, and neutrophils and sparse histiocytes with similar intracytoplasmic pigment granules were seen. No granulomatous foreign body reaction was noticed. Vitreous material contained pigment granules; no inflammatory cells were observed. Scanning electron microscopy X-ray microanalysis of the tattoo red ink revealed significant signals of iron, barium, and copper. CONCLUSION: Conjunctival tattoo is a new form of body decoration gaining worldwide popularity. This procedure is performed by untrained professionals causing severe ocular complications including blindness. Safety regarding tattoo ink needs further study as the composition varies among colors. Strict regulations on this matter should be considered.

Papel de distintas técnicas de imagen para identificar y localizar cuerpos extraños intraoculares relacionados con trauma ocular abierto: reporte de tres casos y revisión de la literatura / The role of various imaging techniques in identifying and locating intraocular foreign bodies related to open-globe injury: three case reports and literature review

ANTECEDENTES La ubicación precisa de un cuerpo extraño intraocular es crucial para el manejo de pacientes con trauma ocular abierto. La tomografía computarizada se usa habitualmente para detectar su ubicación en el segmento posterior. Reportamos tres casos con diferentes cuerpos extraños intraoculares en el segmento posterior, que fueron localizados con precisión mediante la tomografía computarizada y ecografía modo B. PRESENTACIÖN DEL CASO Presentamos tres casos con diferentes mecanismos de trauma, tipos de cuerpo extraño intraocular, síntomas clínicos y pronóstico visual. La tomografía computarizada determinó la ubicación exacta de todos los cuerpos extraños intraoculares en el segmento posterior. El ultrasonido modo B se realizó en un paciente con un cuerpo extraño intraocular no metálico. El primer caso tuvo una lesión ocular perforante con un cuerpo extraño intraorbitario; el caso dos y el caso tres presentaron diferentes tipos de cuerpos extraños intraoculares con pronóstico diferente. El manejo y el pronóstico fue distinto en todos los casos; todos se manejaron con éxito. La ubicación exacta de los cuerpos extraños intraoculares utilizando las diferentes modalidades de diagnóstico es importante en estos pacientes. Estos casos sirven como recordatorio de que el uso adecuado de las pruebas de imagen es indispensable en el contexto de un cuerpo extraño intraocular relacionado con trauma ocular abierto. CONCLUSIÓN Las diferentes técnicas de imágenes son muy importantes para la detección de un cuerpo extraño intraocular. La tomografía computarizada es una de las modalidades de imagen más simple y efectiva para la localización de cuerpos extraños intraoculares relacionadas con trauma ocular abierto.

BACKGROUND: Determining the precise location of intraocular foreign bodies is crucial for the management of patients with open-globe injury. Computed tomography is the most common method for detecting intraocular foreign bodies in the posterior segment. In this article, we describe three cases of open-globe injury with different types of intraocular foreign bodies in the posterior segment that were accurately located using computed tomography scans and B-scan ultrasonography. CASE PRESENTATION: Each of the three cases of open-globe injury described in this report had different types of ocular trauma, clinical symptoms, and intraocular foreign bodies. Computed tomography scans showed the exact location of the intraocular foreign bodies in the posterior segment in two of the three cases. A B-scan ultrasound was used to determine the location of a non-metallic intraocular foreign body in the third case. All three patients had intraocular foreign bodies, and one of them had an additional orbital foreign body. Case 1 had a perforating eye injury with the additional intraorbital foreign body; Cases 2 and Case 3 had different types of intraocular foreign bodies and prognoses. Various treatment approaches were used, ranging from observation to surgery, depending on the location of the intraocular foreign bodies, and all cases were successfully managed. These three cases show that proper use of various types of imaging tests is indispensable in the context of an intraocular foreign body related to open-globe injury. CONCLUSION: Imaging techniques are crucial for the detection of an intraocular foreign body, and computed tomography is one of the simplest and most useful, especially in cases of open-globe injury.

Video Caso Clínico: Trauma Ocular con Herida Penetrante con Hernia de Iris / Clinical Case video: Ocular Trauma Penetrating Eye Enjury with Iris Proplase

INTRODUCCIÓN: En lo que a traumatismos se refiere, el ojo es el tercer órgano más afectado después de manos y pies [1]. El trauma ocular constituye una de las principales causas de pérdida de la visión unilateral y determina consecuencias graves en el ámbito psico-social del individuo; siendo la causa más común de ceguera unilateral en la edad pediátrica, principalmente en países en vías de desarrollo [2]. La epidemiología de las lesiones oculares depende de varios factores; como el estilo de vida, el estado socioeconómico y las actividades deportivas y recreativas [2]. Según la Organización Mun-dial de la Salud (OMS), la incidencia anual mundial de traumatismo ocular es de alrededor de 55 millones [1]. Alrededor del 38-52% de todos los casos de urgencias oftálmicas son traumas ocu-lares y el 0.9-1.8% de ellos deben ser ingresados debido a un traumatismo grave [2]. Las lesiones varían desde una pequeña abrasión epitelial de la córnea hasta penetración y ruptura del globo [3]. El desgarro de la córnea, el desgarro de la esclerótica y el daño de la lente son las morbilidades observadas con mayor frecuencia del traumatismo ocular, seguidas de laceración del párpado, prolapso uveal, anomalías de la cámara anterior, desprendimiento de retina y avulsión del nervio óptico [1]. Las lesiones oculares, incluso las de menor importancia, pueden generar importantes cargas económicas por la necesidad de cuidados especiales, la costosa hospitalización, tratamiento y rehabilitación visual [2]. Este artículo presenta un caso clínico de trauma ocular, con pronóstico desfavorable según OTS. Epidemiológicamente entre el 30-40% de las cegueras monoculares son producidas por traumas oculares [2]. Al existir un trauma ocular con herida penetrante, se debe intervenir de forma oportuna en las primeras 24 horas para prevenir complicaciones y mejorar el pronóstico [4].(au)

BACKGROUND: The eye is the third most common organ affected by trauma after hands and feet [1]. Eye trauma is one of the main causes of unilateral vision loss and imposes major social and psychological impact on patients; in fact it is the most common cause of unilateral blindness in pediatric age groups, especially in developing countries [2]. The epidemiology of eye injuries depends on several factors, such as lifestyle, socioeconomic sta-tus, and sports and recreational activities.[2] According to the World Health Organization (WHO), the global annual incidence of eye trauma is around 55 million [1]. About 38-52% of all cases in ophthal-mic emergency rooms are ocular traumas and 0.9-1.8% of them needs to be admitted due to severe trauma [2]. Corneal tear, scleral tear and lens damage are the most frequently observed morbidities of ocular trauma, followed by lid laceration, uveal prolapse, anterior chamber abnormality, retinal detachment and optic nerve avulsion. [1]. Eye injuries, even the minor ones, can result in significant economic burdens due to special care and family costs, the expensive hospital admission, treatment and visual rehabilitation. [2] We present a case report of ocular trauma, with poor prognosis according to OTS. Epidemiologically between 30-40% cases of monocular blindness are caused by eye trauma [2]. In cases of ocular trauma with penetrating injuries, patients should be treated in the first 24 hours to prevent complications and improve the prognosis [4].(au)

El trauma ocular en la infancia / Ocular trauma in childhood

RESUMEN Objetivo: Determinar los resultados de la aplicación del ocular trauma score como herramienta de pronóstico visual en traumatismos. Métodos: Se realizó un estudio descriptivo longitudinal retrospectivo en el Servicio de Oftalmología del Hospital Pediátrico Provincial Docente "Eduardo Agramonte Piña", desde enero del año 2011 a enero de 2016. El universo estuvo conformado por 438 pacientes quienes recibieron ingreso hospitalario, y la muestra quedó conformada por 357 ojos de 356 pacientes con el diagnóstico de trauma ocular. Se analizaron las siguientes variables: etiología al ingreso, edad, sexo, topografía y tipo de lesión, evento traumático, agente causal, agudeza visual inicial según tipo de lesión y el pronóstico visual según el ocular trauma score. Resultados: El 81,3 por ciento de los pacientes ingresados presentaron etiología traumática; 64,6 por ciento fueron varones, con predominio del grupo de edad entre 5 y 9 años. Hubo una preponderancia de los traumas cerrados. Los accidentes recreativos fueron los más predominantes; los palos y las piedras resultaron el agente causal más frecuente y la agudeza visual final fue superior a la inicial. Conclusiones: La etiología traumática constituye la primera causa de ingreso en el Servicio de Oftalmología, donde se observa predominio de los pacientes entre 5 y 9 años, fundamentalmente del sexo masculino. Los traumas del globo ocular cerrado predominan sobre los del globo ocular abierto. Estos últimos presentan mayor afectación de la agudeza visual. El accidente recreativo y doméstico es más frecuente, así como los palos y las piedras como agentes causales. La mejoría de la agudeza visual fue significativa en este estudio, lo que se correspondió con la predicción sugerida por el ocular trauma score(AU)

ABSTRACT Objective: To determine the results of the application of the ocular trauma score as a tool for visual prognosis in traumatisms. Methods: Descriptive, longitudinal and retrospective study was carried out. The universe consisted of 438 patients who received hospital admission and the sample consisted of 357 eyes of 356 patients with the diagnosis of ocular trauma at admission. Different variables were analyzed: etiology at admission, age, sex, topography and type of injury, traumatic event, causal agent, initial visual acuity according to type of injury and visual prognosis according to ocular trauma score. Results: 81,3 percent of the patients admitted had traumatic etiology, 64.6 percent were males with predominance of the group aged between 5 and 9 years. There was a preponderance of closed traumas. The sticks and stones were the most frequent causal agent and the final visual acuity was superior to the initial one. Conclusions: The traumatic etiology is the first cause of admission in the Ophthalmology Service, where predominance is observed between 5 to 9 years, mainly of the male sex. The traumas to closed ocular globe predominate over those of open ocular globe presenting these last greater affectation of the visual acuity. The recreational and domestic accident is more frequent, as well as the sticks and stones as causal agents. The improvement in visual acuity is significant, corresponding with the prediction suggested by ocular trauma score(AU)

Electrophysiological findings in delayed discovery of a metallic intraocular foreign body in a child: case report.

PURPOSE: To report a case of a child with strabismus and delayed discovery of a metallic intraocular foreign body with good recovery of visual acuity and stereopsis with 36-month follow-up. METHODS: A 4-year-old girl was evaluated due to exotropia of right eye initiated 9 months before with progressive worsening. Visual acuity was 1.00 logMAR (20/200) in the right eye and 0.00 logMAR (20/20) in the left eye. Anterior segment evidenced a small paracentral corneal leukoma, posterior synechia and mild lens opacity in the temporal quadrant only in the right eye. Fundus examination in the right eye identified the presence of an intraocular foreign body, with appearance of metallic components surrounded by retinal pigmented endothelial cells atrophy. Full-field electroretinography (ERG) showed reduced amplitudes and delayed implicit times for both rods and cones in the affected eye. All tests were normal in the fellow eye. RESULTS: Pars plana vitrectomy was promptly performed in the right eye, followed by phacoemulsification with intraocular lens implantation 4 months later due to worsening of the lens opacification. The full-field ERG was repeated after the surgical procedures. The ERG showed mild worsening of all responses in the right eye. After 36 months of follow-up, visual acuity was 0.20 logMAR (20/32) with improvement of the ocular misalignment and with 60 s of arc stereopsis with ERG responses unchanged. CONCLUSION: In this young girl perforating ocular trauma with metallic material was lately diagnosed with strabismus as a sign of alert. Prompt surgical intervention and proper management were essential to provide reasonable visual function including some degree of stereopsis, even though retinal dysfunction characterized by ERG was persistent.

Registro de trauma ocular Colombiano (ReTOC). Primer reporte / Colombian eye injury registry (ReTOC). First report

Introducción: el trauma ocular constituye una causa importante de morbilidad visual en todo el mundo. Se estima que 55 millones de traumas oculares ocurren cada año a pesar de ser prevenibles en la mayoría de los casos. Objetivo: Caracterizar el perfi l clínico y epidemiológico de los pacientes con trauma ocular, en diferentes ciudades de Colombia, entre junio de 2013 y enero de 2018. Diseño del estudio: observacional descriptivo, estudio transversal. Método: es un estudio observacional, descriptivo, cuya población objetivo fueron pacientes con trauma ocular, atendidos en diferentes centros y hospitales en Colombia, por los servicios de retina entre junio de 2013 y enero de 2018. Se diseñó un formulario de preguntas por medio de Google forms y se analizaron diferentes variables, apoyándonos en el Birmingham Eye Trauma Terminology System. Los datos fueron llenados principalmente por retinólogos. Resultados: se recolectaron datos de 619 pacientes entre junio 2013 y enero 2018, el rango de edad fue entre 16-30 años, en su mayoría hombres. La ciudad en donde se registraron la mayoría de los pacientes fue Cali. El compromiso de la agudeza visual (AV) fue severo en la mayoría de los casos (MM-PL) y el mecanismo más común fue el accidente laboral. La lesión más registrada fue la contusión ocular. La mayoría de los pacientes no usaba protección al momento del trauma. Conclusión: el trauma ocular se presentó más comúnmente en hombres, jóvenes en accidentes de tipo laboral. Presentaron compromiso severo de la AV, predominando la visión de MM a PL. Es el primer reporte de un estudio de sus características en Colombia, dando recomendaciones específicas al ministerio de salud y estimulando al registro de más datos a nivel nacional para lograr prevenir las causas más importantes de trauma.

Background: eye trauma is an important cause of visual morbidity worldwide. An estimated 55 million eye traumas occur each year despite being preventable in most cases. 3% of these lead to blindness. Objective: to characterize the clinical and epidemiological profi le of patients with ocular trauma, in diff erent cities of Colombia, between June 2013 and January 2018. Study design: cross-sectional. Method: it is an observational, descriptive study, whose target population was patients with ocular trauma, attended in different centers and hospitals in Colombia, for retina services between June 2013 and January 2018. A question form was designed using Google forms and diff erent variables were analyzed, based on the Birmingham Eye Trauma Terminology System. The data was filled mainly by retinologists, who receive patients referred from the emergency department. Results: data were collected from 619 patients between June 2013 and January 2018, the most common age range was between 16-30 years, mostly men. The city where the majority of patients registered was in Cali. The commitment of visual acuity was severe in most cases (MM-PL). The most common mechanism of trauma was the occupational accident and the most common lesion was ocular contusion. Most patients did not use protection at the time of the trauma. Conclusion: ocular trauma occurs most commonly in men, young people and in work-related accidents. They presented severe compromise of visual acuity, predominantly the vision of MM to PL. It is the fi rst report of a study of its characteristics in Colombia, giving specifi c recommendations to the ministry of health and encouraging the registry of more data at a national level to prevent the most important causes of trauma.

Ruptura del globo ocular / Rupture of the eyeball

Los traumatismos oculares representan la principal causa de pérdida de la agudeza visual en individuos jóvenes y se sitúa entre las causas de ceguera en el mundo. Pueden tener un efecto devastador sobre el globo ocular; es el tipo de traumatismo más severo en esta zona, con un pobre pronóstico visual para el paciente. Constituye un accidente grave, que en muchas ocasiones conlleva a la enucleación. Se presentan tres pacientes con rotura del globo ocular, con la conducta terapéutica, seguimiento y resultados visuales en cada caso, para mostrar a la comunidad médica, la complejidad y particularidades de este traumatismo(AU)

Ocular traumatisms represent the principal cause of loss of vision in young people and they are among the causes of blindness in the world. Trauma can result in a wide spectrum of tissue lesions of the globe and it can has devastating effect on the eyeball, since it is the most severe type of trauma in this area, with a poor visual prognosis for the patient. It is a serious accident, which often leads to nucleation as result of a bruised intense trauma. This is the report of three patients with rupture of the ocular globe with the therapeutic behavior, follow-up and visual results in each case, to show the medical community, the complexity and particularities of this traumatism(AU)

Oftalmia simpática / Sympathetic ophthalmia

Resumo Relatar um caso de um paciente portador de Oftalmia Simpática (OS), com descolamento seroso da retina documentado através de tomografia de coerência óptica de domínio spectral (SD OCT), indocianina verde (ICG) e angiofluoreceinografia (AGF), que o diagnóstico foi realizado em uma consulta de rotina e iniciado tratamento clínico .

Abstract To report the case of a patient with sympathetic ophthalmia (OS), with serous detachment of retinal documented by spectral domain optical coherence tomography (OCT), indocyanine green (ICG) and angiofluorecephography (AGF). The diagnosis was made in a routine consultation and clinical treatment was initiated.

Chorioretinitis sclopetaria caused by an intraorbital metallic foreign body.

A 44-year-old man was referred for evaluation of pain and temporal floaters after receiving a rebounded bullet impact to his right eye. Typical funduscopic findings, together with the confirmed presence of an intraorbital metallic foreign body, led to the diagnosis of chorioretinitis sclopetaria. Conservative management was performed as no severe symptoms were observed. The favorable clinical outcome was confirmed in subsequent reviews. Chorioretinitis sclopetaria is characterized by a proliferative chorioretinal inflammation as a consequence of the expansive wave caused by the entrance of a bullet between the eyeball and the orbit.