[Visual rehabilitation of patients with large post-traumatic defects of the anterior eye segment through iris-lens diaphragm implantation]. / Sistema zritel'noi reabilitatsii patsientov s obshirnymi defektami struktur perednego otrezka glaznogo iabloka na osnove implantatsii iridokhrustalikovoi diafragmy.

The diversity of methodological approaches and lack of pathogenetically reasonable tactics for patients with combined ocular injuries became the basis for the development and systematization of surgical rehabilitation stages of patients, in whom post-traumatic cataract is combined with post-traumatic aniridia and corneal scarring. AIM: to construct a visual rehabilitation approach to patients with post-traumatic defects of the anterior eye segment following optical-reconstructive surgery that involved implantation of an iris-lens diaphragm (ILD). MATERIAL AND METHODS: We have analyzed 80 reconstructive cases with ILD implantation in patients with post-traumatic aniridia and corneal damage. These patients constituted the first study group (Group 1). We have also investigated 58 eyes with residual ametropy and stable visual function 1 year after ILD implantation before and after conducting a laser keratorefractive surgery. These patients were assigned to the second study group (Group 2). RESULTS: Rehabilitation approach to patients after anterior segment injuries that has been proposed allows to achieve high clinical and functional results and reduce the risk of intra- and postoperative complications. CONCLUSION: The proposed approach to patients after optical-reconstructive surgery with iris-lens diaphragm implantation followed by keratorefractive surgery is an effective method of visual rehabilitation of anterior eye segment post-traumatic defects.

Digital capture, design, and manufacturing of a facial prosthesis: Clinical report on a pediatric patient.

A digitally captured, designed, and fabricated facial prosthesis is presented as an alternative to customary maxillofacial prosthodontics fabrication techniques, where a facial moulage and patient cooperation may be difficult.

Rigid gas-permeable contact lenses for visual rehabilitation of traumatized eyes in children.

PURPOSE: The aim of this study was to investigate the usefulness and tolerance of rigid gas-permeable (RGP) contact lenses in the visual rehabilitation of children postocular trauma. METHODS: In this retrospective case series, children below 15 years of age with ocular trauma were included. The best-corrected visual acuity with RGP contact lenses was compared with that of spectacle correction. The factors affecting visual improvement were analyzed, and problems caused by contact lens use were identified. RESULTS: Twelve eyes of 12 boys were included. The mean best-corrected visual acuity was 0.81 ± 0.29 (LogMar equivalent) with spectacles and 0.47 ± 0.27 (LogMar equivalent) with contact lenses (P < 0.001). Seven of the 12 eyes achieved a >2 line increase in visual acuity with contact lens correction as compared with that using spectacle correction. The mean astigmatism in eyes that achieved this improvement in vision was 5.45 ± 1.6 diopters, whereas the mean astigmatism in the eyes that did not improve was 2.6 ± 1.2 diopters, which was statistically significant (P = 0.009). No other factors (age, corneal scar location/density, grade/zone of injury, lens status, and occlusion) seemed to affect visual improvement with contact lenses. The mean follow-up duration was about 15 months during which 91% of the patients continued their contact lens usage. CONCLUSIONS: RGP contact lenses offer a useful refractive treatment alternative in traumatized eyes of children. Eyes with high degrees of astigmatism were found to benefit the most. RGP contact lenses were found to be well tolerated in this population.

Predictive factors of open globe injury in patients requiring vitrectomy.

BACKGROUND: To determine the outcomes and predictive factors of patients with open globe injury requiring pars plana vitrectomy (PPV). METHODS: The medical records of 114 patients age 10 years or older who had undergone PPV due to ocular trauma, with at least 6 months follow up, were retrospectively reviewed. RESULTS: The mean age of the patients was 42 (SD14) years, with males accounting for 89% of the cases. Penetrating eye injury was the most common injury mechanism (43%) with most injuries occurring secondary to work related incidents (54%). After surgical interventions, 78% of the patients had visual improvement of one or more Snellen lines, while no light perception occurred in 10%. Anatomical attachment was achieved in 87% of eyes at the final follow up. Logistic regression analysis showed that the presence of a relative afferent pupillary defect (RAPD) was a significant predictive factor of visual outcome, while initial retinal detachment was a significant predictor of anatomical outcome. CONCLUSIONS: Pupillary reaction is an important presenting ocular sign in estimating the post-vitrectomy poor visual outcome for open globe injury. Vision was restored and improved in more than half of the patients in this study; however, long-term sequelae should be monitored.

[Comparative estimation of rehabilitative abilities after organ preserving operations for severe eye damages].

Postoperative analysis of rehabilitative potentialities in 59 patients operated on occasion of severe eye trauma with the use of various methods of ophthalmosurgery has been presented. It has been demonstrated that the method of organ preserving complex vitreoretinal surgery provided evading enucleation and retaining the damaged eyeball in 96.4% of cases. In 82.1% of cases it has been succeeded in retaining some vision functions and raising considerably the indices of life quality. It has been determined that properly made silicone tamponade provides the support of the necessary ophthalmotone and prevention of progressive growing of posttraumatic eyeball subatrothy--the most frequent outcome of a severe eye trauma.

Contact lens rehabilitation following repaired corneal perforations.

BACKGROUND: Visual outcome following repair of post-traumatic corneal perforation may not be optimal due to presence of irregular keratometric astigmatism. We performed a study to evaluate and compare rigid gas permeable contact lens and spectacles in visual rehabilitation following perforating corneal injuries. METHOD: Eyes that had undergone repair for corneal perforating injuries with or without lens aspiration were fitted rigid gas permeable contact lenses. The fitting pattern and the improvement in visual acuity by contact lens over spectacle correction were noted. RESULTS: Forty eyes of 40 patients that had undergone surgical repair of posttraumatic corneal perforations were fitted rigid gas permeable contact lenses for visual rehabilitation. Twenty-four eyes (60%) required aphakic contact lenses. The best corrected visual acuity (BCVA) of > or = 6/18 in the snellen's acuity chart was seen in 10 (25%) eyes with spectacle correction and 37 (92.5%) eyes with the use of contact lens (p < 0.001). The best-corrected visual acuity with spectacles was 0.20 +/- 0.13 while the same with contact lens was 0.58 +/- 0.26. All the patients showed an improvement of > or = 2 lines over spectacles in the snellen's acuity chart with contact lens. CONCLUSION: Rigid gas permeable contact lenses are better means of rehabilitation in eyes that have an irregular cornea due to scars caused by perforating corneal injuries.

[Contact lens fitting as a possibility for visual rehabilitation in patients after open globe injuries]. / Kontaktlinsenversorgung als Möglichkeit der visuellen Rehabilitation bei Patienten nach offenen Augenverletzungen.

INTRODUCTION: Visual rehabilitation after open globe injury may be a challenging process because of ametropia following aphakia, corneal scarring with high or irregular corneal astigmatism or loss of contrast sensitivity due to traumatic aniridia. We report on contact lens fitting for visual rehabilitation in patients after open globe injury. PATIENTS: From 2000 to 2003, contact lenses were fitted unilaterally for the visual rehabilitation in 13 patients after open globe injury. In three patients we found unilateral aphakia, in 8 patients a high or irregular astigmatism after penetrating or autorotation keratoplasty and in two patients a traumatic aniridia, in one case combined with aphakia. RESULTS: 11 rigid contact lenses were fitted with different designs of the front and back surface as well as two iris-print lenses. In 11 patients (86 %) a good visual rehabilitation was achieved with an increase of visual acuity up to 9 lines while obtaining a good contact lens tolerance. One patient wearing an iris-print contact lens was unable to tolerate the contact lens due to its thickness and its weight. In another patient fitting of a contact lens was not possible because of the complicated corneal condition. We did not observed severe contact lens complications at any time. CONCLUSIONS: In addition to operative procedures for visual rehabilitation after open globe injuries, the use of contact lenses is another possible procedure for refractive correction. Different problems such as ametropia following aphakia, irregular or high astigmatism or aniridia can be solved with good visual results, good tolerance and less complications.

[Priority trends in the sphere of eye injuries]. / Prioritetnye napravleniia v probleme glaznogo travmatizma.

Comprehensive recent research of eye traumatism is described, aspects related with changes in the trauma structure are defined and advanced methods of diagnostics as well as of therapeutic and surgical treatment in eye trauma are elucidated in the paper. It is pointed out that the above study results are valuable for rehabilitation of victims during peacetime, in emergency situations and in calamities; the contribution of civil ophthalmologic institutions to rendering a specialized medical care to victims of military conflicts is equally important. The case study comprises extensive research findings that can be used in the below cases requiring a specialized medical care: penetrating eye injuries, contusion, burn injuries of the eye, splintered trauma etc.; the current micro-surgery standards must be adhered to and the latest technologies must be used. Finally, the important role of and valuable contributions to the above research made by the Calamity Medicine Center ("Zashchita") are underlined.

Siderosis: análisis de casos clínicos / Siderosis: analysis of clinical cases

La Siderosis es una complicación tardía y muy temida de la presencia de un cuerpo extraño férrico intraocular. Su diagnóstico ensombrece el pronóstico visual, debido a los cambios irreversibles sufridos por las estructuras comprometidas. Hoy en día es cada vez menos frecuente por el diagnóstico y manejo más oportuno. Reportamos una serie de tres casos atendidos en nuestro servicio. El tiempo en que se desarrollaron los cambios varió de ocho meses a tres años. Todas las estructuras oculares fueron comprometidas. El daño retinal a nivel de los fotorreceptores fue severo con aplanamiento de las ondas de electrorretinograma. La ecografía B fue el pilar fundamental para el diagnóstico en todos los casos. En un caso se tomó una muestra de tejido iridiano durante la vitrectomía y se envió a estudio de microscopia óptica y electrónica, evidenciándose el daño por el depósito de hierro en las estructuras celulares.

[Epidemiology of open globe injuries]. / Epidemiologie offener Augenverletzungen.

BACKGROUND: Severe open globe injuries are frequent emergencies in an ophthalmologic clinic and required immediate operation. The extent of these injuries is various depending on the mechanism of the injury and involvement of ocular tissue. In many cases a full visual rehabilitation can be achieved but in a lot of cases blindness results. To prevent such severe eye injuries it is important to judge the leading injury mechanisms. For this we collected our data about open globe injuries. PATIENTS AND METHODS: Retrospectively we collected the data from 103 consecutive patients in the year 1996 and 1997, presenting with an open globe eye injury followed by operation. The data contained personal patients data, information about mechanism of injury, visual acuity, operation and rehabilitation. Statistical analysis was performed using binomimal-test and t-test for paired and unpaired samples (p < 0.05). RESULTS: 85.4% were male. Most of the injuries happened at home (38%) and at the working place (31%). Assaultive injuries happened in 6.8%. 35% of all patients were craftmen (mechanics, electricians, or the locksmith were preferred). Pensioners were affected in 14.6% of all cases followed by small children (7.8%) and school children (7.8%). In 50% of all cases metal and glass were responsible for the trauma, explosions were noticed in 8.7%. An intraocular foreign body was found in 37.9%. In 62% of all cases no second operation was necessary. An enucleation during the follow-up was performed in 2 cases. CONCLUSION: At least a third of all severe eye injuries would have been preventable. Concerning the non-preventable injuries accidents at home and in children were predominating. The rate of the open globe injuries was 2.32 in 100.000 people, which is about the same like in US-American studies. Most of the injuries happened at home because of carelessness and would have been avoidable. The rate of injuries at the working place is significantly higher than in the USA but there were significantly more gun-shot-injuries or offensive accidents abroad. The rate of accidents at home and in traffic were the same. We think that public campaigns and prevention strategies can help to reduce the potential risk of severe eye injuries.

Civilian eye casualties in east Jerusalem and the occupied territories.

Rapid, unexpected and drastic change characterises the political status quo in the Middle East. The recent upheavals have again focused world attention on the protracted problems of the region. In this paper we review the causes and outcome of 567 Intifada eye injuries which occurred over the six-year period 1987-93, and which were all treated at the St John Ophthalmic Hospital, Jerusalem.