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.

Penetrating eye globe injury from trauma with a metallic nail: a case report.

We report a case of penetrating eye globe injury due to a metallic nail. This is the first case evaluated by our service that presented with an intact 2.5-centimeter nail penetrating the right eye with a significant intraocular component that the patient did not remove. We describe the initial presentation and the multi-step surgery that this complicated injury required. The early postoperative visual acuity remained unchanged when compared to the presenting. In addition, the patient had no retinal pathology or optic nerve damage after the procedure.

Brainstem injury by penetrating head trauma with a knife.

The authors describe a rare case about a traumatic lesion of brain and brain stem with a knife. In this case the patient had good clinical condition, diagnosed with TBI by infectious complications. We have highlighted the unusual diagnosis, proximity of vascular structures, the technique used in the treatment and the good outcome of the injury.

Vitreoretinal surgery of the posterior segment for explosive trauma in terrorist warfare.

BACKGROUND: To describe surgical management and establish anatomic and visual results of patients with explosive ocular trauma in terrorist attacks treated with extreme vitreoretinal surgery. METHODS: Retrospective study of clinical records (6-month follow-up) of patients with visual acuity (VA) of light perception or better with posterior segment injuries [vitreous hemorrhage, retinal detachment (RD), intra-ocular foreign bodies (IOFB), perforating trauma (PT)] from explosive weapons who underwent vitreoretinal surgery. We reviewed the demographic characteristics, type of weapon, time between injury and surgery, VA at arrival and 6 months after surgery, and type of trauma according to the International Trauma Classification. RESULTS: Fifty-seven out of 236 patients with ocular injuries from explosive weapons were included in the study; all of them were military men, average age 22 years (range 16-53 years). The average time between the blast and primary closing was 1 day, and 10 days between primary closing and vitreoretinal surgery. Open traumas by laceration accounted for 96% of cases and 4% were closed traumas; 76% of the eyes had IOFB, of which 18% involved PT; 5% had endophthalmitis. Contusion was the diagnosis for 100% of the closed traumas. Of the open traumas, 40% were localized at zone I, 44% at zone II, and 16% at zone III. Upon arrival, 98% of patients had VA 20/800-LP and 2% had >20/40. The patients with closed trauma had the injuries at zone III and presented VA 20/800-LP. All patients underwent posterior vitrectomy, scleral buckling, endotaponade and when required, lensectomy (82%), IOFB removal (72%), and/or retinectomy (25%). Postoperative VA improved in 43% of the patients, stabilized in 41% and evolved to NLP in 15% of the cases. Initial expressions of ocular trauma such as RD, PT and endophthalmitis suggest bad prognosis. CONCLUSIONS: We presented a series of patients with severe ocular trauma of the posterior segment from explosive weapons. These patients were treated according to our surgical protocol with extreme vitreoretinal surgery within the first 2 weeks after the blast; with our procedure we obtained stabilization or improvement of the VA for 84% of the cases.

Serious eye injuries caused by bottles containing carbonated drinks.

AIM: To analyse serious eye injuries caused by bottles containing pressurised drinks. METHODS: Retrospective review of the databases of US, Hungarian, and Mexican eye injury registries. RESULTS: In the combined database (12 889 injuries), 90 cases (0.7%) were caused by bottle tops or glass splinters. The incidence varied widely: 0.3% (United States), 3.1% (Hungary), and 0.9% (Mexico), as did the agent. Champagne bottle corks were responsible in 20% (United States), 71% (Hungary; p<0.0001), and 0% (Mexico). Most eyes improved, but 26% remained legally blind. CONCLUSIONS: The presence of warning labels on champagne bottles appears to reduce cork related eye injuries, as does using plastic bottles and caps.

Prognostic factors in open globe injuries.

PURPOSES: To evaluate the main factors related to visual outcome after open globe injuries (excluding intraocular foreign bodies). METHODS: Retrospective study analyzing consecutive ocular lacerations, primarily repaired in this institution, between January 1993 and January 2000. Of the 364 cases, 283 (77.75%) lacerations were statistically analyzed, correlating the preoperative variables with the postoperative visual acuity (VA). Excluded from this study were all patients with less than 6 months of follow-up, previous ocular surgery, unreliable information on VA, intraocular foreign bodies and endophthalmitis. When a bilateral injury was detected, only 1 eye was randomly chosen. RESULTS: It was observed, after statistical analysis (multivariate analysis), that the most important factors related to postoperative poor VA (less than 20/100) were: the length of the laceration, the elapsed time between the injury and the surgery and the presence or absence of vitreous loss, cataract (lens damage), hyphema, laceration posterior to rectus muscle insertion and retinal detachment. CONCLUSION: With this study, it was possible to point out the most important factors related to visual prognosis in open globe injuries. The results found are similar to results previously reported.

[Foreign body in the orbital cone: case report]. / Corpo estranho no cone orbitário: relato de caso.

Orbital injuries may be associated with the presence of foreign bodies in which long retention leads to damages such as loss of vision or cerebral abscess. We present the case of a 21-year-old male patient that developed ptosis, limitation of movements and an inflammatory reaction in the right eye after being hit by a tree branch. A CT scan of the orbits revealed an increased density in the right orbital cone. After the neurosurgical approach for the removal of the foreign body, a wooden fragment measuring 2.0x0.3 cm, the patient had a good outcome without visual deficits, ptosis regression and resolution of the inflammatory process. The postoperative CT scan didn't identify any remaining foreign body fragment. This case calls attention to the fact that the wooden splinter presented on CT scan with high density (136 HU) two months after the trauma and was removed by a supraorbital craniotomy.

Etiologia e tratamento inicial das perfurações oculares / Mechanism and primary treatment for ocular perforation

Foram estudadas 42 perfurações do globo ocular. Apenas um paciente apresentou trauma binocular. Identificamos com facilidade os fatores etiológicos. Como atendimento primário, a maioria foi levada a tratamento cirúrgico o mais rápido possível.

The authors have studied 42 perforating ocular injuries. Only one patient presented bilateral trauma. As the primary care, the majority undergone surgical repair as soon as possible. Preventive maesures are discussed.

[Perforating eye injuries in children]. / Ferimento perfurante de globo ocular na infância.

The author studied 140 cases of perforating eye injury in children up to 15 years old admitted at the Clinic Hospital of the Medical College of the University of São Paulo (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo) from January 1989 to December 1993. These cases represent 24.71% of the total of the perforating eye injuries seen during this period, showing a ratio of 76.42% of males, a ratio of 2/1 in the group from 0 to 6 years old, 7/1 in the group from 7 to 11 years old and a ratio of 3/1 in the group from 12 to 15 years old. The most common perforating eye injuries were due to sharp objects (54.71%), contusion (20%), explosions (7.85%) and flying objects (5.71%). The relation between the severity of the injury and the prognosis is emphasized. Safety precautions should be effective in order to reduce frequence and morbidity of these perforating ocular injuries.

[Perforating eye injuries caused by motor vehicle accidents: cases assisted during the year 1994]. / Ferimentos perfurantes do globo ocular por acidentes automobilísticos: casos atendidos durante o ano de 1994.

A prospective study of 32 patients with perforating eye injuries caused by motor vehicle accidents, 24.32% of the 131 cases of perforating injuries admitted at the University of São Paulo Medical School Hospital from January to december, 1994 was performed. Most of the accidents occurred at night (68.75%), and in urban areas (65.63%). There were more male victims (65.63%), mostly under 25 years of age (53.13%). None of the victims were using seat belts and those in the front seats were more vulnerable. Safety precautions should be effectively in use in order to reduce frequency and morbidity of these injuries.

Lance-headed viper (Bothrops moojeni) bite wounding the eye.

A 5-year-old girl was bitten in her left eye by a lance-headed viper identified as Bothrops moojeni, measuring 115 cm of length. There was severe facial swelling and left exophthalmus, and enucleation of the eye was necessary. The patient apparently had mild systemic envenoming, but local inflammatory signs and histological evidence of necrosis suggest that both the mechanical trauma and the local action of the venom had a role in the genesis of the eye lesion. It is arguable if the loss of the eye could be prevented even if the antivenom was administered earlier.