Open Globe Injury (OGI) with a Presence of an Intraocular Foreign Body (IOFB)-Epidemiology, Management, and Risk Factors in Long Term Follow-Up.

The purpose of the study was to evaluate visual outcomes and consider management strategies in the eyes with an intraocular foreign body (IOFB). In a single-center, retrospective case-control study, 36 eyes of 36 patients who suffered from open globe injury (OGI) with IOFB were admitted to the Department of Vitreoretinal Surgery of Medical University of Lublin, Poland from January 2015 to December 2020. Most frequent primary procedure was the pars plana vitrectomy (PPV) with IOFB removal (n = 28). Retinal detachment (RD) developed in nine eyes soon after injury or as a further complication. Recurrent retinal detachment occurred in eight of these nine cases. Final VA 0.1 or better was observed in 21 eyes (58%). Fifteen patients had BCVA of less than 0.1. One eye was not included in the final VA assessment due to the short follow-up period. In 25 out of 28 patients who underwent any kind of pars plana vitrectomy (ppV) a BCVA of <0.4 was observed. The prognosis after an IOFB injury is uncertain due to multiple factors in a peri- and postoperative period. Factors predisposing to poor visual outcomes are: IOFB localization in the posterior segment, retinal detachment, vitreous hemorrhage and prolonged silicone oil tamponade.

Morphological Changes in Lamellar Macular Holes According to SD-OCT Examination over a Long Observation Period.

BACKGROUND: The aim of this study was to evaluate the quantitative morphological changes in lamellar macular holes (LMHs) based on SD-OCT examinations and to assess the correlations among minimal retinal thickness (MRT), reading vision (RV), and best corrected visual acuity (BCVA) over a 36-month follow-up period. METHODS: A group of 40 patients (44 eyes) with LMH was evaluated, with an average age of 69.87 (SD = 10.14). The quantitative parameters monitored in the follow-up period (at 0, 3, 6, 12, 18, 24, 30, and 36 months) were tested for normality of distribution by Shapiro-Wilk and Kolmogorov-Smirnov tests. RESULTS: The RV and BCVA values were stable, and no significant changes were found at any of the check-ups during the 36-month follow-up period (BCVA p = 0.435 and RV p = 0.0999). The analysis of individual quantitative LMH parameters during the 36-month follow-up period did not demonstrate statistically significant differences: MRT (p = 0.461), Max RT temporal (p = 0.051), Max RT nasal (p = 0.364), inner diameter (ID) (p = 0.089), and outer diameter (OD) (p = 0.985). CONCLUSIONS: The observations at 0, 6, 12, 18, 24, 30, and 36 months revealed moderate and significant correlations between RV and MRT. No significant correlation between BCVA and MRT was observed.

Pars plana vitrectomy with transscleral fixation of posterior chamber lens in the treatment of post-traumatic lens dislocation.

PURPOSE: To present our experience with post-traumatic lens dislocation management by vitrectomy followed with sutureless artificial lens fixation. METHODS: The retrospective study involved 15 patients (12 men and 3 women) aged from 36 to 78 (on average, 63 years old), from the Vitreoretinal Surgery Teaching Hospital, operated in the years 2013-2015. All cases concerned ocular traumas with dislocation of the natural or artificial lens to the anterior chamber, vitreous body chamber, or post-traumatic aphakia. After vitrectomy, patients had the implant fixated with a technique devised by Scharioth-sutureless fixation of posterior chamber implants in the groove area, with haptics placed in scleral tunnels parallel to the corneal limbus. Preoperative and postoperative condition of the eye was assessed. RESULTS: The average period of observation was 29 weeks. Average pre-surgery refraction was + 10.75, while post-surgery + 1.25. Average best-corrected visual acuity in Snellen charts before surgery was 0.3 and at the end of the observation period 0.5. The improvement in visual acuity after surgery in relation to visual acuity before surgery was statistically significant (P = 0.005). In the first 2 weeks after surgery, minor hypotonia was observed in three of the patients, while in two-moderate bleeding to the vitreous body and the anterior chamber, which subsided without surgical intervention. A slight decentration of the implant observed in two cases did not affect later refraction or BCVA. CONCLUSION: Basing on the abovementioned facts, we believe that this surgical approach facilitates the fixation of the dislocated lens and allows a successful treatment of secondary implantation or repositioning of a dislocated intraocular lens.

Lawn mower injuries as a cause of serious visual acuity impairment - Case reports.

[b]Abstract Objective.[/b] The aim of the study is to present four cases of lawn mowers injuries as a cause of serious visual acuity impairment. [b]Materials and Method[/b]. A retrospective study of four patients admitted in 2013-2015 to the Department of Vitreoretinal Surgery in Lublin with severe open or closed globe injury, one with an intraocular foreign body (IOFB). The presence of eye protective equipment was assessed, as well as visual acuity, eye tissue condition before and after treatment, and applied therapy. RESULTS: In all cases an improvement was achieved in local conditions. The intraocular foreign body was removed, wounds sutured and damaged tissues placed in position. All eyeballs were saved. In three cases, visual acuity was improved to a usable level. Three patients underwent pars plana vitrectomy, one with IOFB removal from the vitreous cavity. [b]Conclusions[/b]. Lawn mower induced eye injuries are a significant cause of serious visual acuity impairment or blindness. The presented study shows that lawn mower eye injuries are still a therapeutic, social and economic problem, yet are very preventable with proper eye protection and patients' education. Current prevention strategies are inadequate, and therefore should be updated.

Optic nerve avulsion after blunt ocular trauma - Case report.

INTRODUCTION: Avulsion of the optic nerve head is a rare and severe complication of ocular blunt trauma. The case reported is a 28-year old man presenting to the emergency department due to blunt trauma to his right eye globe with a tree branch. Lid haematoma and subconjunctival haemorrhage were present. Visual acuity soon after the injury was counting fingers (CF) and on admission to the Department of Ophthalmology he had no light perception (NLP). Fundus examination revealed prepapillary haemorrhage, which after few days dispersed into the vitreous cavity. Despite no light perception in the affected eye, the patient was qualified for vitrectomy. During surgery, an optic nerve avulsion with cicatricial gliosis was diagnosed. Six months after vitrectomy, the visual acuity was NLP in the right eye. DISCUSSION: The clinical signs, mechanism, treatment and natural history of this poorly known disease are described. CONCLUSION: Optic nerve avulsion must be considered in cases of trauma with forced rotation of the eye. Damage occurring at the disc may suggest mechanisms involving anterior luxation of the globe, retropulsion of the nerve, forced globe rotation, or a sudden explosive rise in intraocular pressure blowing the nerve off the sclera into its dural sheath. Damage and break of the nerve fibres are responsible for immediate visual impairments, and involving secondary haematomas and oedemas In spite of required safety precautions in agriculture work, eye injuries are still prevalent. Blunt ocular trauma remains a large part of this group, leading even to irreversible blindness.

[Sub-internal limiting membrane haemorrhage--causes, diagnosis and treatment]. / Krwotok pod blona graniczna wewnetrzna siatkówki--przyczyny, diagnostyka i leczenie.

PURPOSE: The purpose of this study was to present cases of patients with massive sub-internal limiting membrane haemorrhage, who were treated with vitrectomy. MATERIAL AND METHODS: We present 2 patients with sub-internal limiting membrane haemorrhages diagnosed clinically, seen in spectral optical coherence tomography and confirmed during vitrectomy with the internal limiting membrane peeling. Visual acuity and clinical manifestation in spectral optical coherence tomography were assessed before and after vitrectomy. RESULTS: The haemorrhage was successfully removed from under the internal limiting membrane in both cases. Visual acuity improved and normal anatomical relationships were restored within the fovea in both patients as well. CONCLUSIONS: Vitrectomy is a safe and effective method, offering fast improvement of visual acuity in patients with massive sub-internal limiting membrane haemorrhage.

[The analysis of morphological and functional macular changes after surgical treatment of idiopathic macular hole--the single centre experience]. / Analiza zmian morfologicznych i czynnosciowych plamki po leczeniu chirurgicznym idiopatycznego otworu plamki--wyniki wlasne.

PURPOSE: to evaluate morphological and functional macular changes after surgical treatment of idiopathic macular hole. MATERIAL AND METHODS: a retrospective study included 25 patients (30 eyes) who underwent surgery for idiopathic macular hole. Male patients constituted 27% and female patients 73% of the study group. Mean age was 67 years. All patients underwent pars plana vitrectomy with internal limiting membrane peeling and gas tamponade (C3F8 or SF6). We evaluated age, sex, best corrected visual acuity as well a optical coherence tomography scans prior to surgery and postoperatively. The mean follow-up was 6 months. RESULTS: the mean preoperative best corrected visual acuity was 0.15 in Snellen charts (≤ 0.1 - 13 eyes, > 0.1 - 17 eyes) and it increased to 0.5 postoperatively. Five eyes were preoperatively classified as stage 2 Gass scale, 13 eyes as stage 3 and 13 eyes as stage 4. Postoperatively, 25 eyes were assorted as "U" shaped and 5 as "V" shape closure. CONCLUSIONS: surgical treatment of macular hole with pars plana vitrectomy significantly improves macular function measured by the best corrected visual acuity. The "U" shaped closure of macular hole promotes better visual outcomes.

Ocular blunt trauma during wood chopping as the reason for serious visual impairments.

AIM: The aim of the study was to present results of blunt ocular trauma with lens luxation to the vitreous during wood chopping. METHODS: A retrospective study of 15 patients treated in the Department of Ophthalmology between 2000-2011 who suffered from serious eye injury during wood chopping. As a standard surgical procedure, pars plana vitrectomy with lens removal and intraocular lens (IOL) implantation was applied in all cases. The analysis includes the age, gender, visual acuity and intraocular pressure before and after surgical procedure, and at the end of follow-up. RESULTS: Mean follow-up was 12 months. The group of patients consisted of 73.3% males (M) and 26.7% females (F). Mean age: 64 years (M - 63 y.o., F - 66.25 y.o.). Mean best corrected visual acuity (BCVA) before treatment: 0.24 on the Snellen chart (< 0.1 - 6 patients, 0.1-0.3 - 5 patients, and > 0.3 - 4 patients). Mean BCVA after surgical treatment: 0.33 (< 0.1 - 4 patients, 0.1-0.3 - 5 patients and > 0.3 - 6 patients). Intraocular pressure (IOP) on the day of admission to hospital varied from 9-52 mmHg (mean - 20.6 mmHg). IOP after surgical procedure: 4-36 mmHg (mean - 20.7 mmHg). SUMMARY: Wood chopping is still present in many homes in rural regions. In some cases, it may lead to serious ocular injury and potential loss of vision.

Differential role of tumor necrosis factor (TNF)-alpha receptors in the development of choroidal neovascularization.

PURPOSE: Tumor necrosis factor alpha (TNF)-alpha contributes to inflammation-associated angiogenesis. This study investigates the role of TNF-alpha receptors 1a and 1b in the development of choroidal neovascularization (CNV). METHODS: CNV was induced in Tnfrsf1a(-/-) and Tnfrsf1b(-/-) mice with C57Bl6/J background and their wild-type (WT) (C57Bl/6J) controls by laser damage to the Bruch's membrane. TNF-alpha expression in RPE/choroid was determined by Western blot analysis. Pathologic angiogenesis was estimated qualitatively and quantitatively by fluorescein angiography and histology on choroidal flat mounts and paraffin cross-sections. Inflammatory cell invasion was investigated by clodronic acid depletion of circulating macrophages and immunochemistry, and the apoptotic activity was investigated by TUNEL assay and by caspase-3 and caspase-8 expression. Receptor 1b-specific Bmx/Etk kinase was detected by immunochemistry. RESULTS: TNF-alpha levels were elevated after laser treatment. Severe CNV lesions and increased macrophage invasion were observed in Tnfrsf1a(-/-) compared with WT and Tnfrsf1b(-/-) mice. Increased immunoreactivity for Bmx/Etk kinase corresponded to the severity of CNV formation. Reduced pathologic angiogenesis and macrophage invasion in Tnfrsf1b(-/-) mice (vs. WT and Tnfrsf1a(-/-)) was accompanied by enhanced endothelial cell apoptosis and by caspase-3 and caspase-8 activation. CONCLUSIONS: Receptor 1b promotes the recruitment of inflammatory cells to the site of injury and exacerbated pathologic angiogenesis probably by way of the Bmx/Etk-kinase-dependent pathway in the absence of receptor 1a. On the other hand, receptor 1a-dependent apoptosis in the absence of receptor 1b leads to reduced inflammatory response and CNV lesions after laser treatment. This demonstrates the potential for specific targeting of TNF-alpha receptors for future therapies of inflammation-associated choroidal neovascularization.