Remarkable visual recovery after severe open globe injury.

PURPOSE: To describe a case of remarkable visual recovery after severe open globe injury. OBSERVATIONS: We present a case of a 70-year-old man with an open globe injury with no light perception vision before and after primary repair of his ruptured globe and before secondary vitreoretinal surgery to repair a total retinal detachment with a 360° giant retinal tear and retinal incarceration in a posterior scleral wound who proceeded to recover vision to the 20/60 pinhole to 20/50 level. CONCLUSIONS AND IMPORTANCE: Poor presenting acuity is a known risk factor for poor visual outcome after open globe injury. We hypothesize this remarkable visual recovery could be attributable to the presence of a massive choroidal hemorrhage and limited intraocular hemorrhage elsewhere. In rare cases, vision can improve from the no light perception level after secondary vitreoretinal surgery.

Pigmented deposits on a Boston keratoprosthesis from topical ibopamine.

PURPOSE: To report a case of pigmented deposits on a type I Boston keratoprosthesis (KPro) associated with the use of topical ibopamine as a treatment for hypotony. METHODS: Case report and literature review. RESULTS: The dopamine-like agent ibopamine caused black deposits on the bandage lens and on the front plate of the Boston KPro that resulted in reduced visual acuity. Change to a daily disposable contact lens and regular cleaning of the KPro front plate with diluted baby shampoo eliminated this problem. CONCLUSION: This is the first report of this complication with topical ibopamine use and should be considered when ibopamine is used chronically for hypotony.

Characteristics and outcomes of work-related open globe injuries.

PURPOSE: To evaluate the characteristics and outcomes of patients treated for open globe injuries sustained at work and to compare these results to patients injured outside of work. DESIGN: Retrospective chart review of 812 consecutive patients with open globe injuries treated at the Massachusetts Eye and Ear Infirmary between 1999 and 2008. METHODS: A total of 146 patients with open globe injuries sustained at work were identified and their characteristics and outcomes were compared with the rest of the patients in the database. RESULTS: Of the patients injured at work, 98% were men, and the average age of the patients was 35.8 years (17-72 years). The most common mechanism of injury was penetrating trauma (56%); 38 patients examined had intraocular foreign bodies (IOFB). Nine work-related open globe injuries resulted in enucleation. There was a higher incidence of IOFBs (P = .0001) and penetrating injuries (P = .0005) in patients injured at work. Both the preoperative (P = .0001) and final best-corrected visual acuity (P = .0001) was better in the work-related group. The final visual acuity was better than 20/200 in 74.1% of cases of work-related open globe injuries. However, there was no difference observed in the rate of enucleations (P = .4). CONCLUSIONS: Work-related injuries can cause significant morbidity in a young population of patients. Based on average patient follow-up and final visual acuity, those injured at work do at least as well as, if not potentially better than, those with open globe injuries sustained outside of work. While the statistically higher rate of IOFB in the work population is not surprising, it does emphasize the importance of strict adherence to the use of eye protection in the workplace.

Incipient corneoscleral xanthogranuloma with S-100 positivity in a teenager.

PURPOSE: To present a case of a corneoscleral juvenile xanthogranuloma (JXG) with diagnostically challenging features. METHODS: A 15-year-old boy's small corneoscleral mass of recent onset was examined histologically and immunohistochemically. RESULTS: The biopsy had some superficially misleading histological and immunohistochemical features: S-100 positivity (however, observable in 30% of JXG lesions) and lack of Touton giant cells (often absent in early lesions). Most importantly, the histiocytes stained negatively for CD1a and strongly positively for both lysozyme and CD68 antigen. CONCLUSIONS: JXG is a benign histiocytic disorder that usually appears early in childhood but is also encountered in 13%-18% of cases in the second decade. The histiocytes usually stain positively for CD68 and negatively for S-100 and CD1a. Correctly distinguishing JXG from the more aggressive spectrum of Langerhans cell diseases (100% have CD1a positivity) is essential for patient treatment.