Characterization of an anterior segment organ culture model for open globe injuries.

Open-globe injuries have poor visual outcomes and have increased in frequency. The current standard of care is inadequate, and a therapeutic is needed to stabilize the injury until an ophthalmic specialist is reached. Unfortunately, current models or test platforms for open-globe injuries are insufficient. Here, we develop and characterize an open-globe injury model using an anterior segment organ-culture platform that allows therapeutic assessment for up to 72 h post-injury. Anterior segments maintained in organ culture were kept at physiological intraocular pressure throughout, and puncture injuries were created using a novel pneumatic-powered system. This system can create high-speed, military-relevant injuries up to 4.5 mm in diameter through the cornea. From intraocular pressure readings, we confirmed a loss of pressure across the 72 h after open-globe injury. Proof-of-concept studies with a Dermabond tissue adhesive were performed to show how this model system could track therapeutic performance for 72 h. Overall, the organ-culture platform was found to be a suitable next step towards modeling open-globe injuries and assessing wound closure over the critical 72 h post-injury. With improved models such as this, novel biomaterial therapeutics development can be accelerated, improving care, and, thus, improving the prognosis for the patients.

Clinical characteristics and visual outcomes of work-related open globe injuries in Japanese patients.

PURPOSE: To investigate the clinical characteristics and visual outcomes of patients with work-related open globe injuries (OGIs) and compare them with patients with non-work-related OGIs. DESIGN: Retrospective, observational, multicentre, case-control study. METHODS: A total of 374 patients with work-related OGIs and 170 patients with non-work-related OGIs who presented to hospitals that belong to the Japan-Clinical Research of Study group from 2005 to 2015 were included in this study. Clinical data including age, sex, initial and final visual acuity, type of open globe injury, lens status, zone of injury, wound length, and presence of proliferative vitreoretinopathy, retinal detachment, expulsive haemorrhage, and endophthalmitis were recorded. MAIN OUTCOME MEASURES: Visual acuity. Results Work-related OGIs were associated with younger age, male sex, better initial and final visual acuity, more laceration, smaller wounds, presence of retinal detachment, and expulsive haemorrhage, compared with non-work-related OGIs. Multiple regression analysis revealed that final visual acuity is significantly associated with initial visual acuity, wound length, and the presence of proliferative vitreoretinopathy in work-related OGIs. CONCLUSIONS: Work-related OGIs showed better visual outcomes than other OGIs. Initial visual acuity, wound length, and the presence of proliferative vitreoretinopathy are predictors of visual outcomes in patients with work-related OGIs.

Conjunctival tattoo with inadvertent ocular globe penetration and vitreous involvement: Clinico-pathological correlation and scanning electron microscopy X-ray microanalysis.

PURPOSE: The aim is to report a case of conjunctival tattooing with inadvertent injection of tattoo ink into the vitreous cavity and its consequences, the scanning electron microscopy X-ray microanalysis of the ink components, and the microscopic findings of the affected conjunctiva and vitreous. METHODS: Descriptive case report. RESULTS: A 32-year-old man complained of ocular pain and blurred vision after undergoing a subconjuctival red ink tattoo in his left eye. Ophthalmologic examination revealed best corrected visual acuity of 20/80 and intraocular pressure of 26 mmHg. Pain was elicited with eye movements. The bulbar conjunctiva was colored intense red. In the anterior chamber, pigment granules and filaments were suspended on the aqueous humor, and lens capsule was also stained red. Ultrasonography showed high-density non-mobile echoes in the conjunctiva; anterior chamber and vitreous cavity revealed high-density mobile echoes corresponding to pigment particles. Conjunctival tattoo with inadvertent globe penetration was the clinical diagnosis. The patient received medical and surgical treatment. Histopathological examination of the conjunctiva showed red pigment globular deposits within the stroma, and neutrophils and sparse histiocytes with similar intracytoplasmic pigment granules were seen. No granulomatous foreign body reaction was noticed. Vitreous material contained pigment granules; no inflammatory cells were observed. Scanning electron microscopy X-ray microanalysis of the tattoo red ink revealed significant signals of iron, barium, and copper. CONCLUSION: Conjunctival tattoo is a new form of body decoration gaining worldwide popularity. This procedure is performed by untrained professionals causing severe ocular complications including blindness. Safety regarding tattoo ink needs further study as the composition varies among colors. Strict regulations on this matter should be considered.

Medical Event Management for Future Deep Space Exploration Missions to Mars.

BACKGROUND: Long-duration exploration missions (LDEMs), such as voyages to Mars, will present unique medical challenges for astronaut crews, including communication delays and the inability to return to Earth early. Medical events threaten crewmember lives and increase the risk of mission failure. Managing a range of potential medical events will require excellent technical and nontechnical skills (NTSs). We sought to identify medical events with potential for rescue, range them according to the potential impact on crew health and mission success during LDEMs, and develop a list of NTSs to train for management of in-flight medical events. MATERIALS AND METHODS: Twenty-eight subject matter experts with specializations in surgery, medicine, trauma, spaceflight operations, NTS training, simulation, human factors, and organizational psychology completed online surveys followed by a 2-d in-person workshop. They identified and rated medical events for survivability, mission impact, and impact of crewmember NTSs on outcomes in space. RESULTS: Sudden cardiac arrest, smoke inhalation, toxic exposure, seizure, and penetrating eye injury emerged as events with the highest potential mission impact, greatest potential for survival, and that required excellent NTS for successful management. Key NTS identified to target in training included information exchange, supporting behavior, communication delivery, and team leadership/followership. CONCLUSIONS: With a planned Mars mission on the horizon, training countermeasures need to be developed in the next 3-5 y. These results may inform policy, selection, medical system design, and training scenarios for astronauts to manage in-flight medical events on LDEMs. Findings may extend to surgical and medical care in any rural and remote location.

Traumatic Staphylococcus gallinarum endophthalmitis and detachment of a pallid retina.

A rare case of Staphylococcus gallinarum endophthalmitis with intraocular foreign body (IOFB) was managed successfully by vitrectomy, IOFB removal and intravitreal antibiotics with steroids. Intraoperatively, the inferior retina was noted to be pale, possibly secondary to arteriolar occlusion/inflammation. This pale retina detached while peeling the vitreous, but spontaneously reattached postoperatively within a week. The case report describes the natural course of an iatrogenic detachment of pallid retina and the outcome of an uncommon ocular infection.

Hydration of small leaking corneal perforations with cefuroxime.

PURPOSE: To describe a new technique for sealing small corneal perforations after penetrating trauma. METHODS: Corneal perforations in six eyes were sealed using a stromal cefuroxime hydration technique. This technique is identical to the current method used to seal leaking incisions upon completion of cataract surgery except for the use of cefuroxime instead of balanced salt solution. Additionally, cefuroxime was intentionally injected into the anterior chamber. A therapeutic contact lens was used after the hydration. Comparison was made in eight eyes with small traumatic corneal perforation that was sealed using therapeutic contact lenses without hydration. RESULTS: This novel technique was applied in six cases, with leakage stopping immediately following hydration in each of these eyes. In cases presenting with a shallow or flat anterior chamber, this maneuver produced immediate reformation of the chamber. Of note, the corneal scars after hydration were minimal with little effect on visual acuity. When compared to eyes with small corneal perforations which were sealed with therapeutic contact lenses without hydration, all cases that were hydrated with cefuroxime were sealed immediately, as opposed to cases treated without hydration. Furthermore, the eyes that underwent hydration with cefuroxime had a worse average visual acuity on admission, a better average visual acuity 1 month post-trauma, and a shorter average length of hospitalization. CONCLUSIONS: This new technique offers five major advantages: (1) Immediate sealing of the corneal perforation is achieved. (2) Definitive treatment can be achieved at the slit lamp. (3) Since neither stitches nor glue is applied, healing is achieved with minimal scarring and discomfort. (4) Little equipment is required. (5) Injection of cefuroxime into the anterior chamber provides prophylaxis against infection.

Hymenoptera insect stings: Ocular manifestations and management.

PURPOSE: To describe the ocular findings and management of Hymenoptera insect stings. METHODS: We treated and followed 8 patients with ocular Hymenoptera stings. All patients were admitted through emergencies and hospitalized at the Hedi Rays eye institute in Tunis. RESULTS: The site of the sting was the cornea in 5 cases, limbus in one case, conjunctiva in one case and upper lid in the last case. Retained stingers were objectified in 4 cases. Immediate surgical extraction carried out in all cases. We also followed one case of post-sting Adie's syndrome and one case of retrobulbar optic neuritis. The sting was conjunctival in one case and palpebral in the other case. Corticosteroids were ineffective in these two cases. CONCLUSION: Ocular Hymenoptera stings are rare environmental accidents. They may cause various severe ocular complications. Early management, adapted to the clinical manifestations, is the key to a good outcome.

Nonsurgical Management of Retained Needlefish Jaw.

While scuba diving, the left medial canthus of a 53-year-old man was pierced by a needlefish. He immediately lost vision in his left eye. An orbital computed tomographic scan showed the needlefish jaw in the left optic canal. The left medial orbit was explored surgically but no foreign object was removed. One month later, MRI confirmed the presence of the retained needlefish jaw. A conservative approach was taken and the patient remained stable over 3 months of follow-up.

First identification of Gordonia sputi in a post-traumatic endophthalmitis patient - a case report and literatures review.

BACKGROUND: We present a case of post-traumatic endophthalmitis with relatively good prognosis caused by Gordonia sputi, which, to our knowledge is the first case in the literature. CASE PRESENTATION: A 24 year old man, who underwent an intraocular foreign body extraction half a month before presentation in the left eye, was referred to us complaining of blurred vision and slight pain for 5 days. His first presentation showed moderate intracameral and intravitreous purulent inflammation with a best corrected vision of counting fingers. After gram staining of the intravitreous samples revealed a gram-positive bacilli infection, a combination of amikacin and vancomycin was initially injected intravitreously. The left eye kept stable for three days but deteriorated on the 4th day. On the 5th day after presentation conventional culture characterized the bacterium as an Actinomyces sp. while 16S ribosomal RNA gene sequencing confirmed it as Gordonia sputi. Thereby a complete pars plana vitrectomy combined with lensectomy and silicone oil tamponade was performed. During the surgery an intraocular irrigation with penicillin G was adopted, followed by administration of intravenous penicillin G twice one day for a week. A relatively normal fundus with slight intracameral inflammation was observed a week after the operation, and the best corrected vision recovered to 0.15. One year later his vision remained 0.1. CONCLUSION: Gordonia sputi should be taken into consideration in patients with post-traumatic endophthalmitis especially due to foreign body penetration. Compared to conventional laboratories, molecular methods are recommended for an accurate diagnosis. A comprehensive strategy of antimicrobial agents and vitrectomy may render a satisfactory result.

[EPIDEMIOLOGY, CLINICAL CHARACTERISTICS, PROGNOSTIC FACTORS, AND VISUAL OUTCOMES IN PATIENTS WITH OPEN OCULAR INJURIES AND INTRAOCULAR FOREIGN BODIES].

AIMS: To describe and identify clinical characteristics, prognostic factors and visual outcome in patients with intraocular foreign bodies (IOFB) in southern Israel. METHODS: We conducted a retrospective review of all cases of open globe injury with IOFB treated and followed-up for at least 6 months in the Ophthalmology Department at Soroka University Medical Center, Beer Sheva, Israel, from 1995-2011. The study population was subdivided into two groups: 1. Patients whose difference in visual acuity (VA) between presentation and end of follow-up was considered "successful" (n = 54); 2. Patients whose difference in VA between presentation and end of follow-up was considered "non-successful"(n = 14). Comparing these two groups, we analyzed the following: time from trauma to admission, time from admission to operation, location of IOB, wound zone, best corrected VA at admission. RESULTS: A total of 97.1% of the study group were males and the mean age was 28.7 ± 15.3 years. Metallic IOB were found in 73.5% of cases. The IOFB penetrated at Zone 1 in 61.8% cases, and were located at the posterior segment in 65.2 % of cases. The two subgroups differed in their best corrected VA (by LogMAR) at presentation (p value = 0.02): the patients who were defined as "successful" (n = 54) had.a higher mean VA (1.2 ± 1.3) than those (n = 14) who were defined as "non-successful" (1.1 ± 0.6). The duration of time from trauma to admission was not found to be of statistical significance (p value = 0.361, and neither did the time from admission to operation (P value = 1). CONCLUSION: We present an innovative definition of VA changes during the follow-up period in patients with open globe injuries involving IOFB. Our study showed that patients who presented with worse VA had a better chance of a "successful" outcome.

Post-traumatic endophthalmitis in 143 eyes of children and adolescents from India.

PURPOSE: The purpose of this study was to describe clinical features, risk factors, causative organisms, treatment options, and outcomes of post-traumatic endophthalmitis in children and adolescents. METHODS: Retrospective interventional case series. Case records of 143 consecutive eyes presenting with post-traumatic endophthalmitis between 1997 and 2007 were reviewed. Univariate and multivariate analysis were done to analyze factors associated with adverse outcomes. RESULTS: Mean age at presentation was 9.2 years (median 8 years, range: 2 months to 18 years). Broomstick and hypodermic needle were most common causes for injuries. Common presenting features were cataract (n=51), hypopyon (n=45) and retinal detachment (n=29). Corneal abscess (n=21; OR: 5, CI: 1.4-18.7) and retinal detachment (n=29, OR: 5, CI: 1.6-11.3) were independent risk factors for poor outcome (P=0.04 and 0.012, respectively). Gram-positive bacteria were isolated in 54% (n=31) of culture-positive cases. Forty-nine (34%) patients had ambulatory vision at final visit. Patients who received treatment within 24 h were 3.6 and 9 times more likely to have better anatomical outcome than those treated at 2-7 days, or >7 days, respectively (P=0.0001). Patients undergoing early vitrectomy were 27 times more likely to have better outcome (P=0.0001). CONCLUSION: Post-traumatic endophthalmitis in children is more common in boys <10 years of age and most often caused by injury with organic matter. Corneal abscess and retinal detachment are associated with poor outcome. E. fecalis is the most common causative organism. Early vitrectomy results in better outcomes.

Transorbital Penetrating Intracranial Injury with an Umbrella Wire Causing Cavernous Internal Carotid Artery Injury and Thrombosis.

BACKGROUND: Transorbital penetrating intracranial injuries, though rare, can have serious consequences. Intracranial penetration can be present even if orbital trauma is trivial. CASE DESCRIPTION: We report an unusual case of transorbital penetrating intracranial injury with umbrella wire, sustained while opening an umbrella, leading to internal carotid artery injury and thrombosis. The patient sustained only ipsilateral third nerve palsy that completely recovered during followup. CONCLUSION: Trivial orbital injuries can be associated with significant intracranial injury in a neurologically intact patient. This case emphasizes the potentially injury-prone opening mechanism of conventional umbrellas. A high index of suspicion is important while evaluating such patients.

[Posttraumatic endophthalmitis : Complication following severe eye injury]. / Posttraumatische Endophthalmitis : Komplikation nach dem Kampf ums Auge.

BACKGROUND: Posttraumatic endophthalmitis is a rare but another extremely threatening complication for quality of vision, which has already been compromised by the trauma after perforating eye injuries. One of the substantial difficulties is the distinction between posttraumatic inflammation and development of a bacterial infection. METHODS: In a hospital-based study 149 consecutive cases of perforating ocular trauma with open injuries to the eye within a 5-year period were retrospectively investigated. The study included assessment of the relationship between the severity of the injury and the risk of posttraumatic endophthalmitis using the ocular trauma score (OTS), the diagnosis, the therapeutic management and the prognosis concerning visual outcome 1 year after the posttraumatic endophthalmitis. RESULTS: In this study posttraumatic endophthalmitis was observed in 8 out of 149 cases (5.4 %) after perforating ocular injuries. Severe injuries had a higher risk of this complication. In comparison to the clinical courses of non-postraumatic endophthalmitis, the visual outcome showed a tendency to be worse after an average of 18 ± 6 months (1.25 vs 1.0 logMAR). In all of the cases the posttraumatic endophthalmitis could be successfully treated with antibiotics and surgery and the already severely limited visual function due to the injury could at least be maintained in most cases. DISCUSSION: Due to the low case numbers statistical evidence of a clear benefit of treatment by a rapidly initiated and intensive individualized surgery following trauma and a pathogen-specific and operative therapy is not possible: nevertheless, such a comprehensive therapeutic approach to posttraumatic endophthalmitis is recommended.

Factores predictivos relacionados con la aparición y el pronóstico visual de la endoftalmitis traumática / Predictive factors related to the occurrence and visual prognosis of traumatic endophthalmitis

Objetivo: determinar los factores predictivos relacionados con la aparición y el pronóstico visual de la endoftalmitis traumática. Métodos: se realizó un estudio longitudinal de serie de casos durante dos años, en 191 pacientes con trauma ocular a globo abierto severo. Se realizó interrogatorio, examen físico oftalmológico completo, refracción dinámica y en caso necesario ultrasonido ocular, radiografía y/o tomografía axial computarizada. Resultados: la prevalencia de endoftalmitis traumática se presentó en el 12,04 por ciento de los pacientes. La media de la edad fue 40,87 ± 14,25 con rango de 16-70 años, con predominio del sexo masculino (95,65 por ciento) y ojo derecho (69,57 por ciento). El análisis univariado de factores de riesgo de endoftalmitis traumática mostró significación estadística para ambiente (p= 0,052), presencia de cuerpo extraño intraocular (p= 0,069), disrupción cristalineana (p< 0,0001), tamaño de la herida (p< 0,0001)y reparación primaria de la herida (p< 0,0001). En el 26 por ciento de los pacientes con heridas autosellantes se decidió suturar, y todos los que tenían heridas autosellantes y desarrollaron endoftalmitis se encontraban dentro de las no suturadas. En el análisis univariado de factores de riesgo para el pronóstico visual de endoftalmitis traumática resultaron estadísticamente significativos: desprendimiento de retina (p=0,059), tamaño de la herida (p= 0,058) y uso de antibiótico sistémico (p= 0,004). Conclusiones: en el enfrentamiento del paciente con trauma ocular a globo abierto es esencial la profilaxis de endoftalmitis traumática, con seguimiento estricto del paciente. Puede ser aconsejable antibiótico sistémico, y constituye pilar importante la individualización mediante identificación de factores de riesgo que justifica la administración de antibiótico intravitreo(AU)

Objective: to determine predictive factors related with the occurrence and the visual prognosis of traumatic endophthalmitis. Methods: longitudinal case series study of 191 patients with severe open globe trauma conducted in two years. The patients answered a questionnaire, underwent complete physical ophthalmological exam and dynamic refraction, and if necessary, ocular ultrasound, x-and/or computed tomography scanning were applied. Results: prevalence of traumatic endophthalmitis was 12,04 percent. Mean age was 40,87 ± 14,25 (range of 16-70 year years). Males (95,65 percent) and the right eye (69,57 percent) predominated. The risk factor analysis related with traumatic endophthalmitis showed statistical significance for environment (p= 0,052), presence of intraocular foreign body (p= 0,069), rupture of the lens (p< 0,0001), wound size (p< 0,0001) and primary wound repair (p< 0,0001). Twenty six percent of patients with spontaneous closing wounds were sutured. All the patients with spontaneous closing wounds, who developed endophthalmitis, were in the non-sutured group. Retinal detachment (p= 0,059), wound size (p= 0,058) and systemic antibiotic use (p= 0,004) were statistically significant factors for the visual prognosis. Conclusions: in the management of patients with ocular open globe trauma, it is essential to prevent traumatic endophthalmitis, with strict follow-up of the patient. It may be advisable to administer systemic antibiotic, and another important pillar will be the individualization of treatment through identifying the risk factors supporting the administration of an intravitreal antibiotic(AU)

Factores predictivos relacionados con la aparición y el pronóstico visual de la endoftalmitis traumática / Predictive factors related to the occurrence and visual prognosis of traumatic endophthalmitis

Objetivo: determinar los factores predictivos relacionados con la aparición y el pronóstico visual de la endoftalmitis traumática. Métodos: se realizó un estudio longitudinal de serie de casos durante dos años, en 191 pacientes con trauma ocular a globo abierto severo. Se realizó interrogatorio, examen físico oftalmológico completo, refracción dinámica y en caso necesario ultrasonido ocular, radiografía y/o tomografía axial computarizada.Resultados: la prevalencia de endoftalmitis traumática se presentó en el 12,04 percent de los pacientes. La media de la edad fue 40,87 ± 14,25 con rango de 16-70 años, con predominio del sexo masculino (95,65 por ciento) y ojo derecho (69,57 por ciento). El análisis univariado de factores de riesgo de endoftalmitis traumática mostró significación estadística para ambiente (p= 0,052), presencia de cuerpo extraño intraocular (p= 0,069), disrupción cristalineana (p< 0,0001), tamaño de la herida (p< 0,0001)y reparación primaria de la herida (p< 0,0001). En el 26 por ciento de los pacientes con heridas autosellantes se decidió suturar, y todos los que tenían heridas autosellantes y desarrollaron endoftalmitis se encontraban dentro de las no suturadas. En el análisis univariado de factores de riesgo para el pronóstico visual de endoftalmitis traumática resultaron estadísticamente significativos: desprendimiento de retina (p=0,059), tamaño de la herida (p= 0,058) y uso de antibiótico sistémico (p= 0,004). Conclusiones: en el enfrentamiento del paciente con trauma ocular a globo abierto es esencial la profilaxis de endoftalmitis traumática, con seguimiento estricto del paciente. Puede ser aconsejable antibiótico sistémico, y constituye pilar importante la individualización mediante identificación de factores de riesgo que justifica la administración de antibiótico intravitreo(AU)

Objective: to determine predictive factors related with the occurrence and the visual prognosis of traumatic endophthalmitis.Methods: longitudinal case series study of 191 patients with severe open globe trauma conducted in two years. The patients answered a questionnaire, underwent complete physical ophthalmological exam and dynamic refraction, and if necessary, ocular ultrasound, x-and/or computed tomography scanning were applied. Results: prevalence of traumatic endophthalmitis was 12,04 percent. Mean age was 40,87 ± 14,25 (range of 16-70 year years). Males (95,65 percent) and the right eye (69,57 percent) predominated. The risk factor analysis related with traumatic endophthalmitis showed statistical significance for environment (p= 0,052), presence of intraocular foreign body (p= 0,069), rupture of the lens (p< 0,0001), wound size (p< 0,0001) and primary wound repair (p< 0,0001). Twenty six percent of patients with spontaneous closing wounds were sutured. All the patients with spontaneous closing wounds, who developed endophthalmitis, were in the non-sutured group. Retinal detachment (p= 0,059), wound size (p= 0,058) and systemic antibiotic use (p= 0,004) were statistically significant factors for the visual prognosis. Conclusions: in the management of patients with ocular open globe trauma, it is essential to prevent traumatic endophthalmitis, with strict follow-up of the patient. It may be advisable to administer systemic antibiotic, and another important pillar will be the individualization of treatment through identifying the risk factors supporting the administration of an intravitreal antibiotic(AU)

Presentation and Management Outcomes of Corneal and Scleral Perforations in Geriatric Nursing Home Residents.

We compared the clinical presentation and treatment outcomes of corneal and scleral perforations in geriatric nursing home residents, geriatric community residents, and non-geriatric population. The medical records of patients who were treated for corneal and scleral perforations at the Prince of Wales Hospital, Hong Kong between January 1, 2004 and May 1, 2013, were reviewed retrospectively. Of 144 cases, 53 (37%) occurred in the geriatric population, of which 16 (11%) lived in nursing homes, and 37 (26%) were community residents. There were 91 (63%) patients in the non-geriatric group. The mean age of the patients in nursing home geriatric group was 86.5 years (87.5% females). The most common etiology of perforation was trauma. Rupture due to fall was more common in geriatric patients (P < 0.001) whereas laceration due to penetrating eye injury was more common in non-geriatric patients (P < 0.001). There were more cases of infection leading to spontaneous perforation in geriatric nursing home group compared to the other groups (P = 0.001). In the geriatric nursing home group, visual acuity at presentation (P < 0.001) and postoperative visual acuity (P = 0.012) was worse compared to the other groups. Our study showed that corneal and scleral perforations in the geriatric nursing home residents carry a poor visual prognosis. The causes and anatomical outcomes of such events in geriatric age group differ from those in the general population. In our study, geriatric patients residing in nursing homes had worse baseline as well as posttreatment visual acuity, compared to community residents.

Cerebrovascular complications of transorbital penetrating intracranial injuries.

BACKGROUND: Cerebrovascular trauma secondary to transorbital intracranial penetrating injury (TIPVI) is rare. Relatively benign initial presentation may mask the underlying life-threatening vascular injury in transorbital intracranial penetrations. The aim of this study was to evaluate clinical features and endovascular treatment of TIPVI. METHODS: Six patients with angiographic documentation of TIPVI in subacute/chronic phase were reviewed retrospectively. Five were treated endovascularly; however endovascular treatment was aborted in one and conservative management was pursued. RESULTS: Except for one case presenting with vision loss and mild stroke, no significant neurologic deficit was present. Vascular lesions included two cases of carotid-cavernous fistulas, three traumatic aneurysms of cavernous carotid, anterior and middle cerebral arteries and a unique case of coalescing cavernous aneurysms following a through-and-through injury in which the aneurysms united within the thrombosed cavernous sinus on follow up. Fistulas were treated with covered stents, aneurysms with parent artery occlusion or flow diverters. All patients had uneventful recoveries. CONCLUSION: TIPVI may present in a delayed fashion after a seemingly benign presentation. A high index of suspicion is critical to rule out TIPVI with vascular imaging. Transcatheter angiographic techniques allow for both diagnosis and treatment of TIPVI with favorable results.