The epidemiology of serious eye injuries from the United States Eye Injury Registry.

BACKGROUND: Trauma remains a major problem throughout the world. The prognosis of severe eye injuries is commonly bleak. This paper focuses on the epidemiology of eye trauma, the role of ocular epidemiology, and identification and reduction of risk factors. METHODS: An analysis of the first 8,952 patients reported with severe eye injuries, defined as those eye injuries resulting in permanent and significant (measurable and observable on routine eye examination) structural and/or functional changes to the eye, from the United States Eye Injury Registry as of 31 July 1998. RESULTS: The age of patients entered was from the 1st year of life to 103 years. Fifty-eight percent of those injured were less than 30 years of age. The male to female ratio was 4.6:1, reaching 7.4:1 in the fourth decade of life. Almost half of the injuries involved the retina, and 77% of the injured eyes required one or more surgical procedures, including a large proportion which have undergone vitreoretinal surgical procedures. CONCLUSION: Injuries remain the most serious public health problem facing developed nations. Yet, a persistent inadequacy exists both in the standardized documentation of eye injuries and in their treatment. With appropriate surgical and medical intervention, a majority of the reported injured eyes recovered functional levels of visual acuity. It appears that glasses, including prescription glasses and even non-prescription sunglasses, can offer measurable protection which results in a lower incidence of severe eye injuries to those wearing glasses.

Employee reactions to ergonomic job design: the moderating effects of health locus of control and self-efficacy.

A field survey of 180 municipal government office employees (82% women, 21-75 years old) investigated the potential moderating effects of internal health locus of control (HLOC) and self-efficacy on employees' reactions to ergonomic job design. Internal HLOC moderated the associations between ergonomic job design and somatic complaints and turnover intentions, and, to a lesser extent, job satisfaction. Self-efficacy moderated the associations between job design and job satisfaction, somatic complaints, and, to a lesser extent, persistent pain. Employees with low self-efficacy or low internal HLOC were influenced more by their physical job conditions than those with high self-efficacy or high internal HLOC. Implications for the ergonomic design of offices are discussed.

Surgical wound defects associated with endophthalmitis.

Twenty-five consecutive cases of culture-proven postsurgical endophthalmitis were evaluated. Patients underwent wound revision and pars plana vitrectomy with intravitreal antibiotic and steroid infusion (gentamicin 8 micrograms/cc, clindamycin 9 micrograms/cc, dexamethasone 8 micrograms/cc) and injection (gentamicin 100 micrograms plus clindamycin 200 micrograms [and amphotericin 5 micrograms in one case] and dexamethasone 800 to 1000 micrograms). Twenty cases demonstrated wound defects (eg, wound gape/malapposition, abscess/tissue necrosis, suture dehiscence, leak, vitreous wick). Culture-proven isolates included both gram negative and positive bacteria and fungi. Visual acuity improved in 18 of the 20 (90%) gram positive cases. Ten of the 17 (59%) patients in the Staphylococcus epidermidis subgroup achieved a visual acuity of 20/50 or better. Surgical wound defects are frequently associated with culture-proven endophthalmitis. When vitrectomy is included as part of the treatment regimen, we recommend meticulous inspection and closure of any defective surgical wounds associated with endophalmitis.

Orbital apex syndrome after penetrating orbital trauma.

Orbital trauma may be associated with various visual and ocular motility disturbances. We describe a case of orbital apex syndrome after penetrating orbital trauma.

Low-intensity grids improve sensitivity of amsler grid testing in diabetic patients without background retinopathy.

We tested 22 eyes of 12 diabetic patients without retinopathy for visual loss using four types of Amsler grids. The Amsler grids, in order of decreasing intensity, were the standard white, bright red, fine red, and threshold (through cross-polarizing filters). The threshold grid detected the largest number of scotomas--16 versus 12, seven, and seven, respectively--and the largest total area of all scotomas--1594 degrees 2 of arc versus 1237, 994, and 927, respectively. In addition, metamorphopsia lessened as grid intensity decreased. These results demonstrate that the sensitivity of Amsler grid testing for visual loss in diabetics without retinopathy improves by decreasing the intensity of the grid used.

A 20-gauge intraocular electromagnetic tip for simplified intraocular foreign-body extraction.

A modified tip for the Bronson intraocular electromagnet has been developed. The tip was machined to a 20-gauge cylinder that can be inserted readily into the eye either through an entrance wound or through a pars plana incision. Placement of the tip of the magnet inside the eye allows the foreign body to impact the tip of the magnet rather than the wall of the eye.

An improved approach to aqueous paracentesis.

We describe a quick and effective technique for performing safe anterior chamber paracenteses. The technique consists simply of inserting a small gauge disposable hypodermic needle without an attached syringe into the anterior chamber. The intraocular pressure and capillary action of the needle readily cause the rapid drainage of aqueous humor. This technique eliminates the cumbersome manipulations and potential complications associated with using an attached syringe for aspiration.

Light-induced maculopathy and cystoid macular edema.

We present two patients with paramacular burns induced by the operative light microscope. In one case there was associated cystoid macular edema. Of the 34 total reported cases of paramacular burns, there have been only two cases of cystoid macular edema. Thus, although the total number of reported cases of light-induced maculopathy is small, this disorder does not appear to predispose to cystoid macular edema. Loss of visual acuity is mainly caused by the proximity of the burn to the fovea.

Threshold Amsler grid testing in maculopathies.

The Amsler grid is a suprathreshold target and thus may fail to detect relative scotomas. If the grid is viewed through two cross-polarizing filters creating low luminance conditions (threshold Amsler grid testing) the test is far more sensitive. Ten patients with disorders of the macula with normal standard white Amsler grid testing were studied with three other Amsler grid tests. Of the 15 involved eyes, 12 had visual field defects present with threshold Amsler grid testing. Tangent screen examination showed defects in 10 of these 12 eyes. The two red grids used were not as sensitive as the threshold grid. Three eyes had metamorphopsia with the white grid which became the site of a visual field defect with threshold testing. Threshold Amsler grid testing is a rapid and sensitive technique for the evaluation of the central 10 degrees of visual field in patients with maculopathies.

Retinal toxicity secondary to intraocular gentamicin injection.

The authors present five cases of severe retinal ischemia associated with gentamicin injection. In three of the cases massive doses of gentamicin were erroneously injected into the eye; in two of the cases the authors presume that gentamicin toxicity occurred. The sequence of clinical findings was similar in all five cases. The prominent findings included early superficial and intraretinal hemorrhages, opaque and edematous retina, cotton-wool infarcts, arteriolar narrowing, and venous beading. Fluorescein angiography revealed severe retinal vascular nonperfusion. Chronic findings included rubeosis irides, neovascular glaucoma, retinal pigmentary degeneration, and optic atrophy. Of the documented cases of massive intraocular gentamicin injection, two patients had no light perception (NLP) vision and one had bare light perception. Of the two cases of presumed gentamicin toxicity, one had 20/400 vision and one had count fingers vision. Strict precautions are necessary to prevent the catastrophic events resulting from inadvertent gentamicin injection; such precautions should include precise labeling of all injectable solutions on the surgical field, waiting to draw up injectable antibiotics until the time they are needed, and drawing up injectable antibiotics under direct physician observation. All intravitreal injections should be performed slowly, in the anterior vitreous, with the needle bevel up.

A shorter scleral needle.

A scleral needle for retinal detachment surgery, which has a shorter length than has previously been available, has been developed. This shorter length makes the passage of the needle easier in the limited space available posterior to the equator of the eye.

Effect of hypothermic perfusion on corneal endothelial morphology.

The effect of moderate in-vivo hypothermic perfusion on corneal endothelial integrity was studied in the cat. Eleven cats underwent in-vivo anterior chamber perfusion for 30 minutes with either normothermic (23 degrees C) or hypothermic (5 degrees C) perfusate. Corneas were then evaluated clinically (biomicroscopy), functionally (vital staining), and morphologically (scanning electron microscopy) for changes attributable to hypothermic perfusion. All 3 modes of evaluation suggested no difference in corneal endothelial integrity under the 2 experimental perfusion conditions. At the clinical and scanning electron microscope levels hypothermic perfusion does not show any effects on the corneal endothelium. Regional hypothermia is of theoretical and potential utility in procedures involving prolonged intraocular perfusion.

Ocular hypothermia: anterior chamber perfusion.

The anterior chambers of 27 rabbit eyes were perfused at constant pressure with room temperature (25 degrees C) or cooled (11 degrees C) balanced salt solution at constant flow rates of 4.8 ml/min or 8.5 ml/min. Intraocular temperature changes in the anterior chamber, anterior vitreous, mid vitreous, and posterior vitreous and on the retina surface were monitored with an intraocular thermocouple probe. Perfusion of the anterior chamber of the pigmented rabbit eye with cooled fluid significantly reduced the temperature of the anterior chamber and anterior vitreous and even that of the retina. Both an increase in the rate of perfusion and a lowering of the perfusion temperature enhanced the cooling effect. The observed decrease in temperatures returned to approximately normal 4 minutes following the cessation of perfusion.

Results of 110 vitrectomies with a portable vitrectomy system.

We retrospectively evaluated the VITAC (vitreous-tissue aspiration cutter), a portable vitrectomy system with an end-cutting vitrectomy probe with a self-sharpening oscillating blade and a monoblock design, in 110 vitrectomy procedures, 34 performed at the University of California Davis Medical Center and 76 performed at the Eye and ENT Hospital in Shanghai, China. The indications for vitrectomy included penetrating injuries (22 eyes), intraocular foreign bodies (28 eyes), vitreous hemorrhages (18 eyes), cataracts (17 eyes), endophthalmitis (seven eyes), pupillary-block glaucoma (five eyes), bullous keratopathy (five eyes), aphakic penetrating keratoplasty (three eyes), pupillary membranes (two eyes), massive preretinal proliferation (one eye), and cystoid macular edema (one eye). Vitrectomy resulted in visual improvement in 19 of 34 eyes in the California series (56%) and in 60 of the 76 eyes in the Shanghai series (79%). This difference was attributable to the higher percentages of cases involving the posterior segment and vitreous hemorrhage in the California series. When results from both institutions were combined, surgery with the VITAC produced visual improvement in 79 of 110 cases (72%), comparable to the results obtained with other vitrectomy systems.

A 19-gauge illuminating infusion probe.

A 19-gauge illuminating infusion probe has been developed and used during the past four years. This instrument is potentially useful in many deep vitrectomy procedures in which intraocular illumination is also required.

Use of the temporary keratoprosthesis in the subacute management of massive ocular trauma.

The Landers-Foulks temporary operating keratoprosthesis was used in the treatment of a severe double perforating injury involving both the cornea and retina in a 12-year-old boy. The use of the keratoprosthesis permitted surgical intervention at the optimal time for successful treatment of the retina and vitreous, providing the patient with useful visual acuity. The temporary keratoprosthesis is an excellent device for the subacute management of massive ocular trauma involving both anterior and posterior segments.