Macular injury resulting from a high-powered tank laser telemetry device.

A high-powered laser is an essential part of a modern military rangefinder; however, this paper presents three cases with macular injury resulting from a high-powered tank laser telemetry device. All injuries occurred when another user deliberately pointed the telemetry target unit at the patient's eyes. The devastating effect of this high-powered laser resulted in a permanent foveal scar in the second patient and a macular hole formation in the third patient. This report emphasises that education plays a primary role in preventing accidental laser injuries. Using general guidelines and safety regulations will prevent accidental macular injuries.

An overlap of Coats and Eales diseases or a Coats variant?

OBJECTIVE: To report an association between Coats and Eales diseases, an uncommon presentation. CASE: A 21-year-old male presented with gradual visual impairment of two years duration in his left eye. The slit-lamp examination of the affected eye revealed +2 vitreous cells. The other findings were peri-papillary fluid accumulation and extensive macular lipid exudate deposition. Small white vessels were coursing over the macula. The major veins were dilated and tortuous and massive sheathing of both arteries and veins was forming a common sheath. In the mid-periphery and periphery of the retina, discrete hard exudates, tiny superficial retinal hemorrhages and massive vascular sheathing were present. In the inferotemporal region, two intra-retinal macrocysts were located distal to the retinal vasculature. Fluorescein angiography (FA) of the left eye highlighted numerous aneurysmal dilatations throughout the posterior pole. Fluorescein angiography also showed para-foveal telangiectasia and tiny telangiectatic vessels on the optic disk that led to late staining of the macula and optic disk. Hyperfluorescent patches of deep choroiditis were present in the early phases. There was segmental but no diffuse staining of the retinal veins which showed massive sheathing on fundoscopy. In the periphery, segmental venous staining and choroidal leakage to a lesser extent were observed. In the infero-temporal quadrant, a clear-cut zone of non-perfusion and vascular abnormalities (micro-macro aneurysms, veno-venous shunts, venous beading) at the junction between the perfused and non-perfused zones were present. The findings were reminiscent of both Coats and Eales diseases. CONCLUSION: Though known as two distinct entities, both retinal pathologies may present in a single form.

Influence of capsular tension ring on posterior capsule opacification in myopic eyes.

PURPOSE: To determine the effect of a capsular tension ring (CTR) implantation in preventing posterior capsular opacification (PCO) after cataract surgery in patients with high myopia. MATERIALS AND METHODS: In this prospective single-surgeon standardized-surgical-procedure fellow-eye comparison trial, 34 patients with high myopia had phacoemulsification surgery. Although one eye received an acrylic intraocular lens (IOL) and CTR, other eye received only an IOL as control. PCO, within the capsulorhexis overlap, was documented by standardized digital retroillumination images at least 2 years post-operatively, and the percentage area of PCO was scored (scale 0%-100%) using the POCOman software system. The PCO score and the incidence of neodymium-doped yttrium aluminum garnet (Nd: YAG) capsulotomy of groups, and correlations between PCO score and presence of CTR, age, phaco time, refraction, and axial length (AL) were determined. RESULTS: The mean time interval from surgery to PCO measurement was 43.4 ± 11.2 months for the eyes with a CTR and 43.1 ± 11.6 months for the controls (P = 0.91). The PCO score of the eyes with a CTR was significantly lower than in the controls (5.9 ± 4.3 vs. 22.3 ± 12.2, respectively; P < 0.001). There were statistically insignificant correlations between PCO score and pre-operative refraction (r = 0.02; P = 0.90), AL (r = 0.03; P = 0.80), phaco time (r = 0.11; P = 0.53), and patient's age (r = 0.23; P = 0.55). No patient with a CTR had a Nd: YAG laser capsulotomy, but it was six in controls (P = 0.025). CONCLUSIONS: CTR implantation seems to be effective in reducing the PCO and Nd: YAG laser capsulotomy rates in high myopic eyes.

Ocular injuries from improvised explosive devices.

PURPOSE: To document the characteristics, treatments, and anatomical and functional outcomes of patients with ocular trauma from improvised explosive devices (IEDs). METHODS: Retrospective review of ocular injuries caused by IEDs, admitted to our tertiary referral centre. RESULTS: In total, sixty-one eyes of the 39 patients with an average age of 24 years (range, 20-42 years) were included in the study. In total, 49 (80%) eyes of the patients had open-globe and 12 (20%) had closed-globe injury. In eyes with open-globe injury, intraocular foreign body (IOFB) injury was the most frequently encountered type of injury, observed in 76% of eyes. Evisceration or enucleation was required as a primary surgical intervention in 17 (28%) of the eyes. Twenty-two (36%) eyes had no light perception at presentation. Patients were followed up for an average of 6 months (range, 4-34 months). At the last follow-up, 26 (43%) of 61 eyes had no light perception. Postoperative proliferative vitreoretinopathy (PVR) developed in 12 (50%) of the 24 eyes that underwent vitreoretinal surgery, and four of these eyes became phthisical. There were no cases of endophthalmitis. The presence of open-globe injury and presenting visual acuity worse than 5/200 were significantly associated with poor visual outcome (<5/200, P<0.05). In eyes with open-globe injury, the presence of an IOFB was not associated with poor visual outcome (P>0.05). CONCLUSION: Ocular injuries from IEDs are highly associated with severe ocular damage requiring extensive surgical repair or evisceration/enucleation. Postoperative PVR is a common cause of poor anatomical and visual outcome.

Anatomical and functional outcomes in contusion injuries of posterior segment.

PURPOSE: To evaluate the clinical features, and anatomical and visual outcomes in patients with closed-globe contusion injury involving the posterior segment. METHODS: Retrospective review of posterior segment contusion injuries admitted to our tertiary referral center. RESULTS: In all, 115 patients (115 eyes) with complete data were reviewed. Surgery had been performed in 79 (69%) patients. The mean follow-up period was 6 months (range, 2-34 months). Retinal detachment, in 31% of eyes, was the most frequently encountered posterior segment pathology. The presence of retinal detachment was associated with poor visual outcome (<20/100), (P<0.001). Coexisting (five patients, 4%) and postoperative proliferative vitreoretinopathy (PVR) (two patients, 2%) was the main cause of failure in these cases. A significant positive correlation was obtained between initial and final visual acuity levels in both the medical treatment group and the surgical treatment group (P<0.05). The presenting visual acuity of <20/400 was associated with poor visual outcome (P<0.05 for both groups). Poor visual outcome in 13 patients with successful repair of retinal detachment was due to the macular lesions and the optic atrophy. CONCLUSION: Retinal detachment was the most frequently encountered posterior segment pathology subsequent to closed-globe contusion injuries. In addition to macular scarring and optic nerve damage, development of PVR has prognostic significance in these eyes.