Ocular Paintball Injuries.

UNLABELLED: Background: One of the most alarming ocular injury trends in recent years has been the proliferation of paintball guns and the proportional increase in the number of ocular eye injuries caused by paintballs. OBJECTIVES: To describe five cases of paintball eye injuries that resulted in loss of functional vision in four of them. METHODS: We conducted a retrospective review of the clinical course in five patients with paintball eye injuries treated in the ophthalmology departments of two medical centers. RESULTS: Five young males were evaluated for paintball injuries caused by blunt trauma. There was one case of full-thickness laceration (globe rupture). Four patients required one to five surgical interventions: three of these involved the removal of traumatic cataract including two eyes with significant zonular dehiscence treated by lens capsule conservation using anchoring devices, one retinal surgery and two glaucoma filtration surgeries. However, final visual outcome was not favorable due to irreversible retinal damage. CONCLUSIONS: Paintball trauma often results in significant ocular injury and loss of functional vision despite successful surgical intervention. Most injuries occur in under-supervised settings and are easily preventable. Improved safety measures, strict regulation enforcement and appropriate public education could prevent such serious damage.

Hypothalamic-pituitary-adrenal axis function following intravitreal triamcinolone acetonide injection.

To evaluate the pituitary-adrenal axis function by means of the adrenocorticotropic hormone (ACTH) stimulation test following a single intravitreal injection of triamcinolone acetonide (IVTA). Prospective comparative clinical interventional study. Twenty-eight patients (28 eyes) received a single IVTA (4 mg in 0.1 ml) for macular edema. The basal cortisol level and the response to 1 µg adrenocorticotropic hormone stimulation were determined on the morning before IVTA injection and at 1 day and 1, 2, and 4 weeks after IVTA injection. Results were compared with those obtained from a control group of 50 healthy subjects. All patients in the study had normal basal cortisol and normal response to ACTH challenge before receiving IVTA. 1 day following IVTA, basal cortisol was suppressed in one patient in the study group. Fasting serum cortisol levels at 1, 2, and 4 weeks after IVTA injection were normal in all patients in the study group. 1 day following IVTA, the peak response to ACTH at 30 min was blunted in four patients (14.3 % of the study group, p = 0.05) and the cortisol response at 60 min was suppressed (p = 0.009). 1 week following IVTA, the response to ACTH challenge was blunted in only one patient. A single IVTA injection may be associated with impaired hypothalamic-pituitary-adrenal function in some patients during the first 24 h following IVTA.

Toward earlier detection of choroidal neovascularization secondary to age-related macular degeneration: multicenter evaluation of a preferential hyperacuity perimeter designed as a home device.

PURPOSE: The primary purpose of this study was to evaluate the ability of a home device preferential hyperacuity perimeter to discriminate between patients with choroidal neovascularization (CNV) and intermediate age-related macular degeneration (AMD), and the secondary purpose was to investigate the dependence of sensitivity on lesion characteristics. METHODS: All participants were tested with the home device in an unsupervised mode. The first part of this work was retrospective using tests performed by patients with intermediate AMD and newly diagnosed CNV. In the second part, the classifier was prospectively challenged with tests performed by patients with intermediate AMD and newly diagnosed CNV. The dependence of sensitivity on lesion characteristics was estimated with tests performed by patients with CNV of both parts. RESULTS: In 66 eyes with CNV and 65 eyes with intermediate AMD, both sensitivity and specificity were 0.85. In the retrospective part (34 CNV and 43 intermediate AMD), sensitivity and specificity were 0.85 +/- 0.12 (95% confidence interval) and 0.84 +/- 0.11 (95% confidence interval), respectively. In the prospective part (32 CNV and 22 intermediate AMD), sensitivity and specificity were 0.84 +/- 0.13 (95% confidence interval) and 0.86 +/- 0.14 (95% confidence interval), respectively. Chi-square analysis showed no dependence of sensitivity on type (P = 0.44), location (P = 0.243), or size (P = 0.73) of the CNV lesions. CONCLUSION: A home device preferential hyperacuity perimeter has good sensitivity and specificity in discriminating between patients with newly diagnosed CNV and intermediate AMD. Sensitivity is not dependent on lesion characteristics.

A Perforating Eye Injury Caused by a Staple Gun, Treated Successfully Without Vitrectomy.

A 30-year-old carpenter accidentally impaled his own left eye with a 5 cm staple ejected from a pneumatic gun. Entering the globe off-axis, the stainless steel staple caused a vitreous hemorrhage. On the day of injury, the staple was removed surgically. The vitreous hemorrhage cleared rapidly enough to permit laser treatment around the equatorial retinal perforation site. Visual acuity improved to 6/9 and remained stable over a one-year period of careful follow-up. No retinal detachment developed. No additional intervention was required. While vitrectomy with or without a circular buckling remains the standard for perforations into the posterior segment, selected cases may be managed conservatively.

Preoperative topical moxifloxacin 0.5% and povidone-iodine 5.0% versus povidone-iodine 5.0% alone to reduce bacterial colonization in the conjunctival sac.

PURPOSE: To assess the effectiveness of adding topical moxifloxacin 0.5% to topical povidone-iodine 5.0% for preoperative reduction of bacterial recovery from the conjunctiva. SETTING: Emek Medical Center, Afula, Israel. METHODS: The study population comprised adult patients scheduled for elective intraocular surgery. Two hours before surgery, patients were randomly assigned to topical therapy with moxifloxacin 0.5% drops (study group) or normal saline drops (control group). Povidone-iodine 5% solution was also instilled in the conjunctival sac in both groups for 3 minutes immediately before surgery. Conjunctival cultures were obtained before prophylactic therapy and just before surgery. The major outcome measures were the rate of bacterial colonization and bacterial type in conjunctival cultures obtained after instillation of povidone-iodine and immediately before surgery. RESULTS: Overall, 464 patients completed the study; there were 237 patients in the study group and 227 patients in the control group. Positive conjunctival cultures were obtained before prophylactic therapy in 91 patients (38%) in the study group and 94 patients (41%) in the control group and just before surgery in 10 patients (4%) and 6 patients (3%), respectively; neither difference was statistically significant. Coagulase-negative Staphylococcus was the most prevalent bacteria and was found equally in both groups. CONCLUSIONS: Treatment with povidone-iodine 5.0% alone was effective in preoperative reduction of conjunctival bacterial colonization. Adding topical moxifloxacin 0.5% to povidone-iodine 5.0% had no significant effect on further reduction in the bacterial colonization rate.

Retinal toxicity of intravitreal kenalog in albino rabbits.

PURPOSE: To evaluate possible toxicity of intravitreal Kenalog (commercial triamcinolone acetonide) to the retina of albino rabbits. METHODS: Forty-three albino rabbits were injected intravitreally with 0.1 mL of experimental solution to the right eye and 0.1 mL of saline to the left eye (control). Rabbits in Group A (n=28) were injected with 4 mg/0.1 mL of Kenalog suspension; rabbits in Group B (n=8) were injected with 0.1 mL of Kenalog vehicle; and rabbits in Group C (n=7) were injected with 4 mg/0.1 mL of triamcinolone acetonide. Rabbits were examined ophthalmoscopically and by electroretinogram (ERG) recordings before and at different time intervals after injection. At the end of follow-up, animals were killed and the retinas were prepared for light microscopy. RESULTS: Thirty-eight rabbits completed 4 weeks of follow-up. Follow-up for 8 and 17 weeks was completed by 29 and 3 rabbits, respectively. Intravitreal commercial Kenalog or its vehicle alone caused approximately 50% reduction in the ERG b-wave amplitude at the end of follow-up. Pure triamcinolone acetonide caused only mild (up to 14%) reduction of the ERG b-wave amplitude. Histologic examination of retinas exposed to Kenalog or its vehicle showed severe damage to all retinal layers in areas close to the site of Kenalog injection. CONCLUSIONS: Intravitreal injection of 4 mg Kenalog suspension is retinotoxic to albino rabbit eyes. The vehicle of Kenalog is probably the main cause of this toxicity.

Evaluation of intravitreal kenalog toxicity in humans.

OBJECTIVE: To evaluate possible functional toxicity of intravitreal Kenalog (commercial triamcinolone acetonide) in patients' retinas. DESIGN: Observational case series. PARTICIPANTS: Thirty-two phakic eyes of 16 patients who had nonproliferative diabetic retinopathy and bilateral macular edema refractory to laser therapy, which had no other eye disorder and no previous ophthalmic operation. INTERVENTION: Kenalog (4 mg/0.1 ml) was injected intravitreally to one eye, whereas the second eye served as the control. The experimental eye was chosen as the eye with worse visual acuity (VA). MAIN OUTCOME MEASURES: Deterioration of electroretinogram parameters of the study eye measured at 3 months of follow-up when compared with the electroretinogram responses of the fellow, control eye and when compared with electroretinogram responses obtained before injection. Visual acuity, intraocular pressure (IOP), and eventual complications were assessed. No improvement or deterioration of VA or any increase in IOP was regarded as a secondary outcome. RESULTS: Average maximal response amplitude ratios of the dark-adapted b-wave (treated/control eyes) of the electroretinogram were 0.93 before (P = 0.221) and 0.94 (P = 0.387) 3 months after Kenalog injection. Average ratios of the light-adapted b-wave amplitude (treated/control eyes) of the electroretinogram were 1.04 (P = 0.702) before and 0.86 (P = 0.138) 3 months after Kenalog injection. No significant differences (P>0.05) were found between the electroretinogram parameters obtained from all eyes before and 3 months after Kenalog injection. Average VAs in the treated eyes were 1.08, 0.8, and 1.0 logarithm of the minimum angle of resolution units before and 2 and 4 months after injection, respectively. Temporary elevation of IOP was found in 4 treated eyes of 4 patients (25%). CONCLUSIONS: No electroretinographic evidence of a retinotoxic effect of intravitreal Kenalog was found in our patients.

[The effects of hormone replacement therapy (HRT) on the human eye].

HRT (Hormone Replacement Therapy) is the administration of low estrogen preparation to post-menopausal women. This therapy is considered to be effective in protecting various human tissues from aging processes, which are also related to the decrease in endogenous estrogen level. Estrogen receptors were found in many human tissues and organs, including the eye. Therefore HRT may also have a beneficial effect on the eye and its adnexa. This review presents the ever growing data accumulated over the past years concerning the beneficial effects of HRT on various eye pathologies. It was found that HRT may relieve dry eye symptoms in post-menopausal women, may decrease the intraocular pressure and may delay cataract formation in treated women. In the retina, HRT may play a role in decreasing the incidence of Aging Macular Degeneration (AMD) in post-menopausal women.