Ocular injuries and trauma

Transcription

ARVO 2015 Annual Meeting Abstracts
540 Ocular injuries and trauma
Thursday, May 07, 2015 12:00 PM–1:45 PM
Exhibit Hall Poster Session
Program #/Board # Range: 6034–6065/B0213–B0244
Organizing Section: Clinical/Epidemiologic Research
Contributing Section(s): Anatomy/Pathology, Cornea, Eye
Movements/Strabismus/Amblyopia/Neuro-Ophthalmology, Lens,
Retina
Program Number: 6034 Poster Board Number: B0213
Presentation Time: 12:00 PM–1:45 PM
Epidemiology of Ocular Trauma in Changsha, China
Sarah Chao Ying Xu1, Wanpeng Wang2, Jessica Chow1, Jessica
Maslin1, Nisha Chadha1, Ji Liu1, Baihua Chen2, Christopher C. Teng1.
1
Department of Ophthalmology and Visual Science, Yale School of
Medicine, New Haven, CT; 2Department of Ophthalmology, The
Second Xiangya Hospital of Central South University, Changsha,
China.
Purpose: To evaluate the epidemiology of ocular trauma cases
presenting to a tertiary hospital in Changsha, China over an 18
months period.
Methods: This retrospective study included 532 patients presenting
with eye trauma to The Second Xiangya Hospital of Central South
University between Dec 17, 2012 and June 29, 2014. Patient charts
were evaluated from the hospital’s electronic medical record system
for all hospitalized patients.
Results: Of the 532 patients presenting during this 18 month period,
434 (81.6%) were males and 98 (18.4%) females. Overall, open globe
injuries had the highest frequency (66.0%, n=351), compared to
closed globe injuries (33.1%, n=176), and thermal/chemical injuries
(0.9% n=5). 91 patients also had adnexal injuries (17.1%). Of the
open globe injuries, corneal penetration was the most common injury
(42.2% n=148) followed by intraocular foreign body (26.5% n=93).
The average age of all patients was 37.4 ± 20 years (range: 10 months
to 87 years). The frequency of ocular trauma peaked in children 10
years of age and younger (15.8%, n=84) and in adults between 40-50
years old (19.6%, n=104). The majority of ocular trauma in children
≤10 years of age was open globe injuries (81%, n=68), with corneal
penetration being the most frequent mechanism (58.8%, n=40).
Overall, the most frequent cause of ocular trauma was work-related
injuries (35.5% n=189) followed by injuries at home (23.3% n=124).
During the months of January and February, fire-cracker associated
ocular injuries were significantly higher than all other causes (23.8%,
n= 31, p<0.001). Ocular trauma occurred more frequently in rural
settings (72.6%, n= 386) than in urban settings (27.4%, n=146,
p<0.001).
Conclusions: The epidemiology of ocular traumas varied by age,
gender, urban/rural location and time. We found high rates firecracker associated ocular trauma during the months adjacent to the
Chinese New Year festival. Better understanding of the epidemiology
of ocular traumas may aid in improved health prevention efforts to
minimize eye injuries.
Commercial Relationships: Sarah Chao Ying Xu, None; Wanpeng
Wang, None; Jessica Chow, None; Jessica Maslin, None; Nisha
Chadha, None; Ji Liu, None; Baihua Chen, None; Christopher C.
Teng, None
Disparities in the Treatment of Open Globe Injuries
Katrina Chin Loy1, Augustine Obirieze2. 1Ophthalmology, Howard
University Hospital, Washington, DC; 2Surgery, Howard University
Hospital, Washington, DC.
Purpose: Ocular trauma is an important and potentially preventable
cause of vision loss worldwide. Traumatic open globe injury is an
ophthalmic emergency involving compromised integrity of the cornea
or sclera. In order to ensure the best ocular prognosis and potential
for vision preservation or restoration, the standard of care for open
globe injuries requires prompt evaluation with initiation of antibiotics
and primary surgical wound closure emergently, ideally within 24
hours or injury. Delay in treatment by even a few hours may result in
increased risk of poor outcomes. The goal of our study is to further
characterize demographics of trauma patients that present with open
globe injuries and elucidate potential disparities in receiving the
standard of care.
Methods: Between 2007 and 2010, 773 trauma centers across
the United States submitted information to the National Trauma
Databank (NTDB). From that dataset, patients included in the study
were those >18 years of age who presented with a diagnosis of open
globe injury at a Level I or II Trauma Center. Patients were excluded
if they were dead on arrival or died in the emergency room. Patients
without data reported for race or gender were also excluded. The
primary variable of interest studied was race/ethnicity with covariates including age, gender, mechanism of injury, hospital type,
insurance type. Primary outcome examined was time to operating
room. All results were analyzed with STATA/MP version 12.0.
Results: A total of 10,928 cases in the NTDB met the inclusion
criteria. Fifty-nine percent of the patients were White, 22% Black,
and 4% Hispanic. The majority of patients were between ages 25 and
44. Compared to Whites, who presented at a mean age of 49-yearsold, Blacks presented on average 8 years younger (p<0.0001) and
Hispanics 12 years younger (p<0.0001). Of those patients who
presented with open globe injuries, 8,199 patients underwent ocular
surgery. Eighty-four percent of surgeries were performed within 24
hours of presentation. The adjusted mean time to surgery was 15
hours for White patients, 20 hours for Black patients and 13 hours for
Hispanic patients (p<0.05).
Conclusions: Based on this database review, there do exist
statistically significant differences between Whites, Blacks and
Hispanics in terms of age of presentation for open globe injuries and
mean time to surgical evaluation and repair of such injuries.
Commercial Relationships: Katrina Chin Loy, None; Augustine
Obirieze, None
Ocular Trauma Scores in patients with combined open globe
injuries and facial fractures at a Level 1 Trauma Center in NYC
Kalla A. Gervasio, Brett M. Weinstock, Albert Y. Wu. Ophthalmology,
Icahn School of Medicine at Mount Sinai, New York, NY.
Purpose: There is a lack of consistent prognostic data on the visual
outcomes of patients with both open globe injuries and facial
fractures. The Ocular Trauma Score (OTS) is a system that supplies
patients with the likelihood of various visual acuity scores based on
initial visual acuity, presence of rupture, endophthalmitis, perforating
injury, retinal detachment, and RAPD. The purpose of this study is
to assess the predictive value and applicability of OTS in high acuity
patients with open globe injuries and facial fractures.
Methods: Between January 1, 2000 and June 30, 2012, we identified
25 patients with 28 open globe injuries and facial fractures from
the Elmhurst City Hospital Trauma Registry. A comprehensive
retrospective chart review was done and statistical analysis was
performed. The cutoff for p-value significance was less than 0.05.
Results: Average age was 52 (range 18-88) and patients were
predominantly male (84%). The majority of patients had an OTS
of 1 (84%), and of these patients, 76.2% and 14.3% had final visual
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
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acuities of no light perception (NLP) and light perception/hand
motion (LP/HM) respectively (p = 0.003). These corresponded
to 74% and 15% predicted by the original OTS guidelines (100%
sensitive and 100% specific). Independent of OTS score, initial
visual acuity and frontal bone fractures were predictive of NLP (p
= 0.006 and p = 0.047). Non-blindness was associated with nasal
bone fractures (p = 0.047). Final visual outcome had no significant
association with time to first surgical intervention (<24 hours or
>24 hours). OTS score of 1 was associated with zone 3 eye wound
location (p = 0.02), but was not associated with the presence of
retinal detachment or vitreous hemorrhage at presentation, despite
being one of the criteria included in calculating each score.
Conclusions: This study validates the use of Ocular Trauma Scores
in high acuity patients with combined facial fracture and open globe
injury. In the absence of data to calculate a full OTS, initial visual
acuity was the strongest predictor of final visual outcome. With
regard to fracture type, frontal bone fracture was predictive of NLP,
while nasal bone fracture was slightly protective in regard to final
visual acuity. Time until surgical intervention was not predictive of
visual outcomes in our cohort.
Commercial Relationships: Kalla A. Gervasio, None; Brett M.
Weinstock, None; Albert Y. Wu, None
Characteristics and outcomes of open globe injuries with clinical
optic neuropathy
Scott Barb, Avni Patel, Tomasz Stryjewski, Christopher Andreoli,
Matthew Gardiner, Simmons Lessell. Ophthalmology, Massachusetts
Eye and Ear Infirmary, Boston, MA.
Purpose: There is limited published data regarding optic neuropathy
in patients with open globe injury. We performed a retrospective chart
review of an open globe database to improve our understanding of the
characteristics and outcomes of those with clinical optic neuropathy.
We hypothesize that the typical mechanism of injury will limit the
number of cases of optic neuropathy but that analysis will provide an
interesting comparison of those with and without optic neuropathy.
Methods: We analyzed data from a large institutional database
(Massachusetts Eye and Ear Infirmary Trauma Database) over
thirteen years (1999-2012). Patients with open globe injury were
included for analysis. Clinical optic neuropathy was determined
based on the appearance of the optic nerve head and the presence
of an afferent pupillary defect (APD). Statistical analyses (a
combination of t-test, chi-square, and Fisher’s exact test) were
performed to determine if there were clinical and outcome differences
between those with and without clinical optic neuropathy.
Results: Of the 893 patients with open globe injury, 13 (1.46%)
patients were determined to have clinical optic neuropathy. There
was no difference between the age and sex of our two groups (p=
0.83, 0.626). The presence of APD was more common in those with
optic neuropathy (p=0.002). There was no difference in the incidence
of vitreous hemorrhage, intraocular foreign body, or orbital fracture
(p=0.068, 0.428, 0.555). The appearance of stretching of the optic
nerve on CT did not predict optic neuropathy (p=0.322). There was
no difference between the presenting and best visual acuity (p=0.12,
0.06). However, there was a difference in regards to the incidence of
retinal detachment development (p=0.013).
Conclusions: The incidence of optic nerve damage in the setting
of open globe injury is low as we hypothesized and thus evaluation
from a large patient cohort is necessary to determine the significance
of characteristics and outcomes in those with and without clinical
optic neuropathy. Of the evaluated clinical characteristics, only the
presence of an APD could predict the increased likelihood of clinical
optic neuropathy. It is surprising that there is no difference between
the presenting and best visual acuities in those with and without optic
neuropathy. However, it is likely that significant damage to other vital
structures such as the cornea and retina limit the visual potential.
Commercial Relationships: Scott Barb, None; Avni Patel, None;
Tomasz Stryjewski, None; Christopher Andreoli, None; Matthew
Gardiner, None; Simmons Lessell, None
The visual outcome and prognostic factors in open globe ocular
injuries
Azusa Fujikawa1, Hirofumi Kinoshita1, Makiko Matsumoto1, Eiko
Tsuiki1, Kiyoshi Suzuma2, Takashi Kitaoka1. 1Ophthalmology,
Nagasaki University, Nagasaki, Japan; 2Ophthalmology, Kyoto
University, Kyoto, Japan.
Purpose: To evaluate characteristics and prognostic factors in open
globe ocular injuries.
Methods: Retrospective study of 59 eyes of 59 patients presented
with open globe injuries between September 2008 and March 2014
at Nagasaki University Hospital was conducted. Demographic
factors including age, gender, and clinical data such as cause of
injury, presenting visual acuity (VA), location of injury, type of
injury, lens status, presence of intraocular foreign body, types of
required surgeries, and final VA were recorded. Prognostic factors
were analyzed by comparing the characteristics of two groups:
Light perception (LP) (range between LP-24/20) group and no light
perception (NLP) group. According to the classification of Ocular
Trauma Classification Group, wound location was classified into
three zones. Chi-square test was used to compare presented data.
Results: Fifty nine patients (46 LP group, 13 NLP group) were
included in this study. The mean age was 56.7± 21.8 years in
LP group and 62.3± 21.7 years in NLP group with no statistical
difference (P=0.67). According to cause of injury, work-related
trauma was the most common one (27 eyes) followed by falls
(19eyes). Work-related trauma was significantly common in
males (P=0.004), while falls was significantly common in females
(P=0.00001). Zone 3 injuries were significantly common in NLP
group (P=0.04). All cases of NLP group (100%) presented with
rupture globe. Posterior segment intraocular foreign bodies were
found in 12 eyes of all patients. Crystalline lens dislocation was
found in 11 eyes (5LP, 6NLP with P=0.0003). Poor VA at first visit
(P=0.00001), rupture globe (P=0.0026), history of penetrating
keratoplasty (P=0.02), and dislocation of crystalline lens (P=0.0003)
were considered as poor prognostic factors. Eyes first treated with
Pars Plana Vitrectomy (PPV) were significantly more likely to
achieve LP or better final vision (P=0.012).
Conclusions: Poor VA at first visit, rupture globe, zone 3 injuries,
history of penetrating keratoplasty, and dislocation of crystalline
lens were considered as poor prognostic factors. PPV had a good
prognostic value in open globe injuries associated with posterior
segment involvement.
Commercial Relationships: Azusa Fujikawa, None; Hirofumi
Kinoshita, None; Makiko Matsumoto, None; Eiko Tsuiki, None;
Kiyoshi Suzuma, None; Takashi Kitaoka, None
Visual outcome of open globe injuries in a rural, Appalachian
elderly population
Masih Ahmed1, Osama Sabbagh2, John Nguyen1. 1Ophthalmology,
West Virginia University, Morgantown, WV; 2West Virginia
University, Morgantown, WV.
Purpose: According to the 2010 United States census, 19.3% of
the population lived in rural areas with those over the age of 65
comprising more than 70% of the group. Previous studies of openglobe injuries (OGI) in urban dwelling elderly patients found poor
visual prognosis, and there is a dearth of information for those in
rural areas. Our aims are to characterize the nature of OGI and to
determine the long-term visual outcome in elderly patients seen at a
tertiary center in West Virginia. As ocular trauma is one of the most
common preventable public health problems, this knowledge can be
used to improve care in this vulnerable population.
Methods: Retrospective chart review of patients over the age of
65 seen in the West Virginia University Hospital for OGI between
January 2000 and December 2014 was performed. Data including
demographics, injury settings, type of injury, exam findings,
immediate intervention, and long-term outcome and complications
were collected. Descriptive statistical analysis was performed.
Results: 49 patients between 65 and 98 years old were identified.
37.2% were male, and 62.8% were female. 87.8% were trauma
related, and 12.2% were from surgical wound dehiscence. Of the
traumatic cases, the causes were fall (60.5%), yard work injury
(16.3%), ATV accident (9.3%), and motor vehicle accident (2.3%).
42.9% involved the right eye. 91.9% occurred at home, and 8.1%
happened in nursing facility settings. Over 60% had prior cataract
and/or corneal transplant surgery. Initial average visual acuity was
20/812, and 20.4% were NLP. Concurrent adnexal injuries included
eyelid lacerations (32.6%) and orbital fractures (16.3%). 100%
underwent primary OGI repair within 24 hours of admission. 97.8%
underwent primary ruptured globe repair, and 2.2% had primary
enucleation. Average follow-up time was 1.4 years. 13.9% underwent
subsequent enucleation. Other surgeries included vitrectomy (18.6%),
penetrating keratoplasty (9.3%), and retinal detachment repair
(6.9%). Final average visual acuity was 20/412, and 25.6% remained
NLP.
Conclusions: Elderly living in rural Appalachia with traumatic open
globe injury have a poor visual prognosis. While fall is the most
common cause, yard work and all-terrain-vehicle accidents are more
prominent in this population. Implementation of fall prevention
programs and proper facial protective equipment may help to
decrease these injuries and to maintain continued independence.
Commercial Relationships: Masih Ahmed, None; Osama
Sabbagh, None; John Nguyen, None
Effect of prior ophthalmic surgery and open globe injuries?
mohamud A. qadi1, Adrienne Scott1, Jiangxia Wang2, christina
prescott1. 1Department of Ophthalmology, Johns Hopkins University
School of Medicine Wilmer Eye Institute, Baltimore, MD;
2
Department of Biostatistics, School of Public Health, Johns Hopkins
University, Baltimore, MD.
Purpose: To review the epidemiology and detect the impact of prior
corneal, cataract, retinal, and refractive surgeries on visual recovery
in patients with open globe injuries.
Methods: We performed a retrospective case review of the Johns
Hopkins electronic medical records and found 39,000 ophthalmic
surgeries and 4,000 open-globe injuries from January 1, 1997 to
November 1, 2014. 400 patients who underwent ophthalmic surgeries
had subsequent open globe injuries. 79 patients out of these 400 had
prior ophthalmic surgeries for corneal transplant, cataract surgery,
retinal surgery, or refractive surgery in the same eye.
Gender, age, dates of prior ophthalmic surgeries, date of open-globe
injury, initial uncorrected visual acuity (UCVA), initial best-corrected
visual acuity (BCVA), type of open-globe injury, location of open-
globe injury, cause of open globe-injury, and type of open globe
repairs, were evaluated using logistic regression models for final
UCVA and final BCVA.
Results: A prognostic model for the impact of prior ophthalmic
surgeries on open globe injuries was constructed. Multiple logistic
models were performed for final visual acuity. The strongest
predictive factors for enucleation as a final visual outcome were prior
history of corneal transplant surgery, mainly penetrating keratoplasty
(PKP) and Descemet’s Stripping Endothelial Keratoplasty (DSEK).
The greatest predictors for final best corrective visual acuity
(BCVA) of 19/100 to 5/200 were prior history of cataract surgery
(phacoemulsification and extracapsular).
Conclusions: Patients who have prior corneal transplant surgery
may have worse visual outcomes after subsequent open globe injury
compared to other types of ophthalmic surgeries. This should be
useful in counseling patients and making clinical decisions regarding
open globe injury management in patients with prior ophthalmic
surgeries. This also demonstrates the importance of appropriate
counseling when considering ophthalmic surgical interventions in
patients at risk for ocular trauma, especially children.
Commercial Relationships: mohamud A. qadi, None; Adrienne
Scott, None; Jiangxia Wang, None; christina prescott, None
Open globe injuries requiring pars plana vitrectomy at an urban
hospital: retrospective review of 10-year experience
Tian Xia1, Alain M. Bauza1, 3, Nishant Soni2, Marco A. Zarbin1,
Paul D. Langer1, Neelakshi Bhagat1. 1Institute of Ophthalmology
and Visual Science, Rutgers New Jersey Medical School, Newark,
NJ; 2Ophthalmology and Visual Sciences, University of Maryland,
Baltimore, MD; 3Ophthalmology, Boston University, Boston, MA.
Purpose: To describe the characteristics of open globe injuries
(OGIs) requiring pars plana vitrectomy (PPV) for posterior segment
trauma including epidemiology, presentation, management, outcomes
and complications.
Methods: Retrospective chart review of PPV after OGI presenting to
Institute of Ophthalmology and Visual Science, Rutgers New Jersey
Medical School, Newark, NJ between 2003 and 2012 was conducted.
Data was collected on demographics, clinical presentation, and
surgical procedures. Main outcome measures are visual acuity (VA),
retinal attachment based on fundascopic exam, and additional retinal
surgeries. Chi-square analysis and student t-tests were performed
with significance of p <0.05.
Results: One-hundred-twenty eyes (mean age, 39 years; 84%
male, 16% female) underwent PPV after OGI. They were divided
into three groups: 64 (53%) early RD (within 30 days), 30 (25%)
delayed RD (after 30 days) and 26 (22%) no RD patients. Injuries
were categorized to penetrating (35%, n=43), rupture (50%, n=60),
and penetrating injuries with retained intraocular foreign body
(IOFB) (14%, n=17). Injuries in Zone I, II and III were seen in 35%
(n=40), 34% (n=38) and 31% (n=35), respectively. Ocular trauma
scores were statistically significantly different between these groups
(p<0.01). Mean presenting and mean final logMAR VA were 2.20±
0.63 and 1.87 ±0.60 respectively (p <0.01) with a mean follow up
of 1168 days. Eighty-eight eyes (73%) underwent one PPV, 23 two
(19%) PPV, eight three (7%) PPV, and one four (1%) PPV. Final
overall anatomic success after surgeries was 98% for early RD, and
95% for delayed RD. Other posterior segment procedures with PPV
included scleral buckles (n=13), retinectomy/retinotomy (n=13), and
enucleation (n=7).
Conclusions: Overall functional and anatomic success for eyes with
posterior segment trauma that undergo PPV, are poor and comparable
to other studies. Delayed presenting RD may have poorer final visual
and anatomic success compared to the eyes presenting with early RD.
Further studies are needed to analyze these differences.
Commercial Relationships: Tian Xia, None; Alain M. Bauza,
None; Nishant Soni, None; Marco A. Zarbin, None; Paul D.
Langer, None; Neelakshi Bhagat, None
PROGNOSTIC INDICATORS OF FINAL VISUAL ACUITY
AFTER OPEN GLOBE INJURY
Gareth M. Lema, Henry Lin, Pradeepa Yoganathan. Ophtalmology,
University at Buffalo, Buffalo, NY.
Purpose: To identify prognostic indicators of postoperative visual
acuity and retinal detachment among patients with open globe
injuries, as well as to compare our findings to an established
algorithm for predicting long-term visual outcomes from ocular
trauma.
Methods: Retrospective chart review consisting of 54 eyes from
54 adult patients (38 male, 16 female) diagnosed with open globe
injury between September, 2011 and March, 2014. Inclusion
criteria included full assessment of Ocular Trauma Score criteria
(preoperative visual acuity, mechanism of injury, reverse afferent
pupillary defect, retinal detachment, and endophthalmitis), as well
as data on demographics and other injury characteristics (i.e. zone
of injury, lid/adnexal injury, hyphema, vitreous hemorrhage, loss of
uveal tissue and traumatic cataract). Multivariate linear regression
was used to assess the relationship between potential predictors and
postoperative visual acuity (FVA), after adjustment for age, sex, race
and preoperative visual acuity (IVA). Logistic regression was used to
evaluate the relationship between potential predictors and occurrence
of retinal detachment (RD).
Results: Mean participant age was 45.6 years, and mean follow-up
time was 1.2 years. Blunt trauma accounted for 57.4% (31/54) of
injuries. Globe perforation occurred in 14.8% (8/54) of cases, and
an intraocular foreign body was present in 20.4% (11/54) of cases.
The prevalence of RD was 42.6% (23/54). Mean time to RD was
9.3 days. Relative afferent pupillary defect was observed in 33.3%
(18/54) of patients. Only one patient developed endophthalmitis.
The base model including IVA accounted for 62.0% of the R2 in
FVA. Adding information about RD significantly improved R2 to
70.6%. In comparison, the ocular trauma score accounted for 65.7%
of R2 in FVA. No other injury characteristic was associated with
FVA after adjustment for IVA. Among patients with 20/200 or worse
FVA, 100% (27/27) had IVA of 20/200 or worse, and 70.4% (19/27)
also had RD. The same base model including IVA accounted for
38.8% of the R2 in RD. Adding information on vitreous hemorrhage
significantly improved R2 to 60.6%. No other injury characteristic
was associated with RD after adjustment for IVA. Among
patientswith RD, 95.7% (22/23) also exhibited vitreous hemorrhage.
Conclusions: IVA and occurrence of RD were the most important
prognostic indicators of FVA. IVA and vitreous hemorrhage were
significant predictors of RD.
Commercial Relationships: Gareth M. Lema, None; Henry Lin,
None; Pradeepa Yoganathan, None
Support: Unrestricted Grant to the Department of Ophthalmology,
State University of New York- University at Buffalo, from Research
to Prevent Blindness
A 19-Year Experience of Regional Anesthesia for the Surgical
Repair of Open Globe Injuries
Andrew J. McClellan, Jacquelyn J. Daubert, Harry W. Flynn, Steven
Gayer. Ophthalmology, Bascom Palmer Eye Institute, Miami, FL.
Purpose: To examine the changes over time in the factors and
outcomes of open globe injuries repaired under regional anesthesia
(RA), local block with monitored anesthesia care, compared with
those repaired under general anesthesia (GA) in salvageable adult
eyes.
Methods: A retrospective case series of all adult repairable open
globe injuries receiving primary repair at the Bascom Palmer
Eye Institute between January 1st, 2004 and December 31st, 2013.
Cases were identified by a post-operative diagnosis of open globe
injury (ICD-9: 360.5, 360.6, 871, or 918.1). Exclusion criteria were
patients less than 18 years of age and those treated with primary
enucleation. This data was then compared to that collected from our
own institution 1995 to 2003 with identical inclusion and exclusion
criteria [AJO 2002;134:707-711][OSLI 2005;36:122-128].
Results: 714 eyes met inclusion criteria. There was a high rate of RA
use at 79%. This is significantly more frequent than the preceding
10 years; 64% from 1995 to 1999 [p<0.001] and 41% from 2000 to
2003 [p<0.001]. The majority of subjects were male (70%), but there
was an insignificant difference in gender between those repaired with
RA versus GA [p=0.4]. Age was found to be significantly different
between these groups [p<0.001] with the mean age of those repaired
under GA being 7 years younger than those repaired with RA (45
v. 53 yrs). This difference was not found during the prior two study
periods. No mechanism of injury was any more prevalent in either
study group (bunt, sharp, intraocular foreign body, perforating, or
mixed) [p=0.6]. Open globe injuries repaired under RA, versus
GA, had wounds that were more anterior in location (Zone 1: 60 v.
23%, Zone 2: 29 v. 33%, Zone 3: 11 v. 44%), and smaller in size
(8 v. 14 mm) [p<0.001]. These eyes also had better presenting and
final logMAR visual acuities (2.13 v. 2.6, and 2 v. 2.58) [p<0.001].
Wound characteristics between the RA and GA group parallel those
found between 1995 and 2003 with a trend towards larger and more
posterior injuries being repaired with RA in the current study period,
though it was not found to be statistically significant.
Conclusions: Regional anesthesia is a suitable alternative to the risks
of general anesthesia for the repair of open globe injuries in selected
patients.
Percentage of Regional Anesthesia Use Over 19 Years
enucleation; thus, primary enucleation would not be saving these
patients from numerous subsequent surgical procedures. We
recommend attempting primary closure of traumatic open globes
and counseling patients presenting with VA of NLP or unable to
assess VA, incomplete primary closure, or posterior laceration that
enucleation may be required in the future.
Commercial Relationships: Kathryn Ortmann, None; John
Anderson, None; Alice Chuang, None; Lauren Blieden, None
Support: National Eye Institute Vision Core Grant P30EY010608;
Challenge Grant from Research to Prevent Blindness; Hermann Eye
Fund
Anesthetic Use by Zone
Commercial Relationships: Andrew J. McClellan, None;
Jacquelyn J. Daubert, None; Harry W. Flynn, None; Steven
Gayer, None
Primary enucleation in the treatment of traumatic open globe
injuries
Kathryn Ortmann1, John Anderson1, 2, Alice Chuang1, Lauren
Blieden1, 2. 1Ruiz Department of Ophthalmology and Visual Science,
The University of Texas Medical School at Houston, Houston, TX;
2
Robert Cizik Eye Clinic, Houston, TX.
Purpose: We performed a retrospective chart review to estimate the
incidence of traumatic open globes resulting in enucleation, average
number of surgical procedures occurring after primary open globe
repair, and identify prognostic indicators leading to enucleation. We
suspected primary enucleation may save some eyes from multiple
surgeries before ultimately undergoing secondary enucleation.
Methods: We reviewed charts of patients treated for traumatic open
globe injuries over 7 years (2008 – 2014) with at least 3 months of
follow-up at the Robert Cizik Eye Clinic. Exclusion criteria include
missing data points for presenting visual acuity (VA) or whether the
injury was completely closed. Collected data included date of injury,
VA at presentation, location of laceration, presence of complete
primary closure, presence of intraocular foreign body, date and type
of subsequent ocular surgery sessions including enucleation, and VA
at last recorded follow-up. Baseline clinical data were summarized by
mean or frequency. Logistic regression analysis was used to identify
risk factors for enucleation.
Results: 711 charts were reviewed and of 190 traumatic open globes
that met eligiblity criteria, 52 eyes (27.4%) underwent enucleation.
Of those, 25 eyes (48.2%) had primary and 27 eyes (51.9%) had
secondary enucleation. Excluding enucleations, 93 eyes (49.0%)
had 0 subsequent surgical sessions following primary repair, 86 eyes
(45.3%) had 1 to 3 sessions, and 11 eyes (5.8%) had more than 3
sessions. Of the 27 eyes that underwent secondary enucleation, 25
eyes (92.6%) had no additional surgical sessions between primary
repair and secondary enucleation, and 2 eyes (7.4%) had one
additional surgical session. The odds ratio for requiring enucleation
was 10.4 for a presenting VA of no light perception (NLP) (P<0.001),
14.1 for incomplete primary closure (P<0.001), 3.5 for unable to take
VA at the presentation (P=0.031), and 2.8 for a posterior laceration
(P=0.044).
Conclusions: The majority of patients who underwent secondary
enucleation had 1 or fewer surgeries between primary repair and
Use of intravenous vancomycin and cefepime in preventing
endophthalmitis after open globe injury
Jason M. Huang, Preston H. Blomquist. Ophthalmology, University
of Texas at Southwestern, Dallas, TX.
Purpose: Prior studies have investigated the use of intravenous
vancomycin and ceftazidime for preventing endophthalmitis after
post-traumatic open globe injuries. However, no studies have
examined the use of vancomycin and cefepime for this purpose.
We performed a retrospective cohort study to determine the rate
of endophthalmitis after open globe injury with administration of
vancomycin and cefepime.
Methods: Charts of all patients (173 in total) who presented to
Parkland Health and Hospital System for open globe injury between
June 1, 2009 and June 16, 2013 were reviewed. Data collection
included time from injury to initial presentation, mechanism of injury,
ophthalmological exam details, timing of globe repair, and length of
follow-up. All patients were treated with a standardized protocol of
vancomycin and cefepime for 48 hours. Open globe surgical repairs
were performed by University of Texas Southwestern Department of
Ophthalmology faculty members. The primary outcome measure was
rate of endophthalmitis, and the secondary outcome measure was risk
factors for developing endophthalmitis.
Results: Out of 173 patients who presented after open globe injury, 3
patients had signs of endophthalmitis on initial exam prior to starting
antibiotics, and 2 patients developed endophthalmitis after initiation
of Vancomycin and Cefepime (1.2%). Delayed time from injury to
presentation was a risk factor for post-traumatic endophthalmitis
(P=0.0001). Association between presence of intraocular foreign
body and post-traumatic endophthalmitis was approaching
significance (P=0.057).
Conclusions: Use of intravenous vancomycin and cefepime for
prophylaxis against endophthalmitis after open globe injury resulted
in an endophthalmitis rate of 1.2%.
Commercial Relationships: Jason M. Huang, None; Preston H.
Blomquist, None
Support: Research to Prevent Blindness, Inc., New York, NY, USA
Ruptured Globe injuries presenting with high IOP associated
with poor visual outcomes
Hampton Addis, Samantha Uhlfelder, Jordan Margo, Osamah
Saeedi. Ophthalmology, University of Maryland School of Medicine,
Baltimore, MD.
Purpose: Ocular trauma is the leading cause of monocular blindness
and a common cause of disability. Low intraocular pressure (IOP) is
considered a reliable clinical predictor of open globe injury. However,
open globe injury with high IOP has been reported. The goal of
this retrospective study was to determine the frequency, clinical
characteristics and visual outcomes of patients that present with high
IOP and open globe injuries. We hypothesize that there is a significant
subset of patients that have high IOP in the setting of globe ruptures
and that the visual outcomes in these patients are poor.
Methods: A retrospective chart review was performed on globe
ruptures presenting to the University of Maryland between 2005
and 2014. Demographics, physical examination, including IOP of
the affected and un-affected eye, and follow-up evaluations were
analyzed. A masked trauma radiologist re-reviewed available CT
scans based on pre-determined radiographic findings. IOP was
measured as a continuous variable and univariate and multivariate
analyses were performed to determine 1) IOP association with
clinical and radiographic variables and 2) predictors of poor visual
outcomes.
Results: Of 132 eyes presenting with globe rupture, 37 (28%) had
IOP recorded. Mean IOP for the affected and unaffected eye were 14
+/- 10.3 mmHg, (range 0-44mmHg) and 16.6 +/- 4.1 mmHg (range
8-16 mmHg), respectively. Six eyes (16.2%) had IOP greater than
21 on presentation. All had uveal prolapse on examination, vitreous
hemorrhage on CT scan and a final outcome of no light perception
vision. On univariate analysis, risk factors for high IOP included
posterior rupture on physical examination (p=0.046), posterior
hemorrhage (p=0.025) and intraconal retrobulbar hemorrhage
(p=0.035) on CT scan. Final visual acuity light perception or worse
vision was also associated with high IOP (P=0.006). On multivariate
analysis, high IOP was associated with posterior rupture (p=0.042),
and final visual acuity of LP or worse was associated with high IOP
(OR =1.49, p=0.049)
Conclusions: High intraocular pressure is a frequent finding in
patients with ruptured globe injuries and is a poor prognostic factor.
High IOP is more likely in patients with posterior rupture and
posterior intraocular hemorrhage or intraconal hemorrhage on CT
Scan.
Commercial Relationships: Hampton Addis, None; Samantha
Uhlfelder, None; Jordan Margo, None; Osamah Saeedi, None
Risk factors for poor prognosis in patients with penetrating globe
injury
Rita D. Page1, Sumeet Gupta1, Zeynel A. Karcioglu1, 2.
1
Ophthalmology, University of Virginia, Charlottesville, VA;
2
Pathology, University of Virginia, Charlottesville, VA.
Purpose: To identify the risk factors that are predictive of poor
prognosis in penetrating globe trauma.
Methods: This retrospective case series evaluated 103 eyes that had
been surgically treated for an open globe injury from 2007 to 2010
at the Eye Clinic of UVA. There were 64 eyes with at least 6 months
of follow-up. The patient population was mostly male (74.1%); age
range was 3-88 years. We collected demographics and details of
the initial examination, primary repair, office visits, and subsequent
surgeries. Four risk factors [pre-operative best-corrected visual acuity
(pre-op BCVA), ocular trauma score (OTS), zone of injury (ZOI),
and time lapsed between injury and primary repair (TL)] and three
outcomes [final best-corrected visual acuity (final BCVA), monthly
rate of additional surgeries (MRAS), and enucleation] were identified
for analysis. Data were analyzed via univariate and multivariate
Spearman rank correlations and univariate and multivariate logistic
regression.
Results: The patients underwent a total of 159 surgeries, with an
average of 2.5 surgeries per patient (range 1-7). 7 patients (10.3%)
ultimately underwent enucleation. Pre-op BCVA was positively
associated with MRAS, final BCVA, and enucleation. Calculated
OTS was negatively associated with the outcome variables. No
association was found between TL and ZOI with the outcome
variables. Further age and predictor variable adjusted analyses
showed pre-op BCVA to be independently positively associated with
MRAS (p=0.008) and with final BCVA (p<0.001), while calculated
OTS was independently negatively associated with final BCVA
(p<0.001), but not uniquely associated with the MRAS (p=0.530).
Conclusions: A poor pre-op BCVA is associated with poorer visual
acuity outcomes, more additional surgeries, and a higher rate of
enucleation. A lower ocular trauma score signifies a more significant
injury and is predictive of a worse visual acuity outcome. Zone of
injury and time lapsed between injury and repair were not predictive
of outcomes. For an open globe patient’s prognosis, pre-op BCVA
and OTS are the factors that are most predictive of outcomes.
Commercial Relationships: Rita D. Page, None; Sumeet Gupta,
None; Zeynel A. Karcioglu, None
Perforating wounds observed healthy corneas: a one year
observatory report
Nicolas Famery, Nicolau Romain, Jean-Louis Bourges, Antoine P.
Brezin. Ophthalmology, Groupe hospitalier Cochin Hotel-Dieu, Paris,
France.
Purpose: Ophthalmic emergencies are numerous pathologies. Some
of them impact visual prognosis immediately and need an emergency
surgery. Ocular perforating trauma is a part of those emergencies
in witch we can found perforating wounds on healthy corneas.
There management and there visual outcomes are not well known.
We observed this item on a one year period in the ophthalmologic
emergency department of Assitance Publique Hôpitaux de Paris
(APHP) in Paris (France).
Methods: It was a retrospective chart review with all cases of
perforating wounds observed on healthy corneas operated between
April 1st 2013 and March 31st 2014 in the ophthalmologic
emergency department of APHP in Paris (France).
Results: On the observed period, 27562 patients underwent an
ophthalmologic examination, 40 eyes had a perforating wound, 29
concerned healthy corneas, 1 file was not available for evaluation.
Median age was 33 years old (15 to 96). Sex-ratio was 3/1
(21mens/7womens). There was no predominant side of trauma
(14 right eyes/14 left eyes). Eight patients had an ophthalmologic
preliminary event. Median size of wound was 4.5mm (±3.8mm).
Wound was in the central 3mm of the cornea above 8 corneas (29%),
linear for 14 corneas (50%), with extraophthamologic involvement
for 27 patients (96%). Average initial visual acuity was 0.32
LogMAR, not countable for 16 patients (57%), in witch 3 no light
perception (NLP) (19%). Average follow-up was 138 days (±104.8d).
Average final visual acuity was 0.24 LogMAR, not countable for 6
patients (21,4%), in witch the half with NLP. Wounds were sutured
with an average of 5.4 stiches (1 to 12), needing of 1.6 surgery per
patient, average of 5 appointments in the department. Associated
trauma were iris trauma (n=17, 17%), traumatic cataract (n=6,
21%), vitreous issue (n=5, 18%), retinal detachment (n=2, 7%),
intravitreous hemorrhage (n=2, 7%), retinal or choroidal bleeding
(n=2, 7%), scleral wound (n=8, 29%), intraocular foreign body
(n=7, 25%), lid or orbit trauma (n=7, 25%). Endophthalmy was not
observed. One evisceration was performed during follow-up.
Conclusions: When the cornea is healthy before traumatism, a
perforating wound allow to obtain an average final acuity better
than 0.30 LogMAR but can also be responsible for the loss of
visual function in 1 case out of 5. This accident is one emergency
examination out of 950.
Commercial Relationships: Nicolas Famery, None; Nicolau
Romain, None; Jean-Louis Bourges, None; Antoine P. Brezin,
None
Clinicopathologic Characteristics and Outcomes of Lacerating
Injuries to the Eye and Ocular Adnexa at a Tertiary Referral
Center
Nathan W. Blessing1, Benjamin P. Erickson1, Alexa M. Franco2,
Audrey C. Ko1, Sarah Read1, Wendy W. Lee1. 1Ophthalmology,
Bascom Palmer Eye Institute, Miami, FL; 2Miller School of
Medicine, University of Miami, Miami, FL.
Purpose: Lacerating injuries to the eye and ocular adnexa are
encountered both in specialty practices and general emergency
departments. However, large cohorts of these patients are not
typically identified and treated at a single institution. We performed
a retrospective observational clinical study to characterize the
demographics, mechanisms of injury, clinicopathologic features, and
outcomes of such patients at a large tertiary referral center with the
aim of refining current management algorithms and improving patient
outcomes.
Methods: We retrospectively identified patients who presented
to the Bascom Palmer Eye Institute over a 12-month period with
open wounds of the eye with and without concomitant damage of
the ocular adnexa. Patients repaired primarily at an outside facility
or with inadequate documentation were excluded. Demographic
information, initial and final visual acuity (LogMAR units), clinical
examination findings, and length of follow-up were recorded.
Results: A total of 100 patients (n=93, 7 excluded) were identified
with a mean follow-up time of 325 ± 110 days. A majority of patients
were male (78%), under the age of 40 (68%, range 2 – 94), and
had right-sided injuries (60%). The most common mechanisms
were assault (28%) and workplace injuries (25%). The presence
of hyphema, uveal prolapse, vitreous hemorrhage, and Zone 2 or
3 injuries were associated with a decrease in final visual outcome
(p<0.05). There was no significant difference in final visual outcome
in patients with adnexal lacerations or orbital fractures (p>0.05).
Presentation with a traumatic cataract or Zone 1 globe injury
portended a better visual outcome (p<0.05).
Conclusions: This study provides insights into a population of
patients with orbital trauma at a large tertiary referral center. These
patients vary widely in their degree of anatomical damage but some
clinical findings may be prognostic with regards to visual outcome.
In particular, the degree of adnexal damage does not appear to
influence the final visual outcome in these patients. In some cases,
follow-up was limited due to the patient’s ability to return for local
management. Consistent with prior studies, workplace related injuries
represent a potential preventable cause of vision loss. No patient in
this cohort reported the use of protective eyewear at the time of injury
and this remains a key public health concern.
Commercial Relationships: Nathan W. Blessing, None; Benjamin
P. Erickson, None; Alexa M. Franco, None; Audrey C. Ko, None;
Sarah Read, None; Wendy W. Lee, None
Purpose: Using a retrospective chart review, the purpose of our
study was to determine rate of outpatient follow-up after repair over a
3.5-year period and examine patient demographic, injury, and repair
characteristics associated with follow-up compliance.
Methods: We reviewed cases repaired at Memorial Hermann
Hospital from Jan 2011 through Apr 2014. Injury and repair
characteristics including age, insurance status, home address,
injury mechanism, repair details, and mental status at time of repair
were analyzed. Follow-up was reported as frequency (%). Patient,
injury and repair characteristics were summarized by mean (±
SD) or frequency (%) by follow-up status and compared using the
two-sample t-test or Fisher exact test. Stepwise logistic regression
analysis was used to identify the association between follow-up status
and patient, injury, and repair characteristics.
Results: 218 patients were included. Pediatric patients had a higher
percentage of follow-up (71%) than older age groups (57%). Patients
with health insurance had a 66% follow-up rate compared to 45%
for self-pay patients (P=0.0234). Distance of the patient’s home
address from the hospital was not significant. (P=0.6309). Highest
follow-up rates were found with patients sustaining blunt trauma not
related to assault at 79%. The lowest rate was in patients involved
in motor vehicle collisions at 46% (P=0.0025). When analyzing by
mental status and presence/absence of drug/alcohol influence at time
of repair, we found that 65% of alert and oriented patients followedup compared to 39% of sedated or altered patients (P=0.0125).
Patients that were not under the influence of drugs or alcohol had
a rate of 68% compared to 36% of patients intoxicated at time of
repair (P=0.0002). Higher rates in patients with other ocular injuries
were found at 71% compared to patients with isolated lacerations at
43% (P=0.0001). Of patients repaired in the operating room, 76%
followed-up compared with 50% repaired at the bedside (P=0.0001).
The odds ratios and 95% confidence intervals are shown in the Table
1.
Conclusions: Patients were less likely to follow-up if uninsured,
intoxicated, or had altered mental status at the time of repair. They
were more likely to follow-up if under the age of 18, had concurrent
ocular injuries, or had repair performed in the operating room.
Overall poor rates of follow-up lead us to recommend absorbable
repair materials that do not require removal.
Commercial Relationships: Helen Merritt, None; Judianne
Kellaway, None; Alice Chuang, None; Lauren Blieden, None
Support: National Eye Institute Vision Core Grant P30EY010608;
Challenge Grant from Research to Prevent Blindness; Hermann Eye
Fund
Trends of Outpatient Follow-up after Traumatic Lid Laceration
Repair
Helen Merritt1, 2, Judianne Kellaway1, 2, Alice Chuang1, Lauren
Blieden1, 2. 1Ruiz Department of Ophthalmology and Visual Science,
The University of Texas Medical School at Houston, Houston, TX;
2
Robert Cizik Eye Clinic, Houston, TX.
Cumulative Effects of Repeated Low-Level Blast on the Optic
Nerve in a Rat Model
Brian Lund1, Jae Hyek Choi1, Joseph Novak2, Danilo Mendoza1,
Teresa A. Bukre1, Peter R. Edsall1, André Akers1, Jeffery M. Cleland1,
Anthony J. Johnson1, Heuy-Ching H. Wang1. 1Ocular Trauma, U.S.
Army Institute of Surgical Research, JBSA Fort Sam Houston, TX;
2
Pathology, U.S. Army Institue of Surgical Reseach, JBSA Fort Sam
Houston, TX.
Purpose: Visual dysfunction is a common symptom observed in
victims of blast-induced traumatic brain injury (TBI). While effects
on the brain of primary blast exposure have been extensively studied,
less is known about primary blast effects on the eye or visual system.
In particular, little is known about the cumulative effects of repeated
low-level blast exposure. The purpose of this study is to characterize
the effects of repeated low-level blast exposure on the optic nerve
using a rat model.
Methods: A compressed-air driven shock tube was used to expose
Long-Evans rats to blast waves of peak overpressure 68 ± 3 kPa
and positive peak duration 2.8 ± 0.1 msec. Rats were divided into
groups receiving either a single blast exposure (SBE), SBE after
1hr (SBE+1hr), repeated blast exposure (RBE), control groups
(CTR) or CTR with repeated sedations (CTRS). Optic nerves were
collected at indicated sampling time points then processed for
immunohistochemistry to detect activated caspase 3, ionized calciumbinding adapter molecule 1 (iba-1) and glial fibrillary acidic protein
(GFAP).
Results: Activated caspase 3 was detected in the optic nerves from
RBE and SBE rats, but not in SBE+1hr, CTR and CTRs rats. A
significantly higher number of activated caspase 3 positive cells were
found in the portions of the optic nerve closest to the eye and optic
chiasm in RBE rats than in SBE rats. Activated microglial cells were
detected by iba-1 in the optic nerve of all groups. A significantly
higher number of iba-1 positive cells were found in the optic nerves
of RBE rats. GFAP expression was observed in the optic nerve of all
groups. However, a higher level of GFAP was observed in the RBE
rats.
Conclusions: Low-level repeated blast exposure lead to an increase
in apoptosis in the optic nerve as indicated by increased caspase 3
positive cells. Sections of the optic nerve closest to the eye and brain
were more susceptible. RBE increased gliosis and activated microglia
at the optic nerve . This suggests that there is either a cumulative
effect or a delay in healing from repeated low-level blast exposure
that may lead to visual dysfunction.
Commercial Relationships: Brian Lund, None; Jae Hyek Choi,
None; Joseph Novak, None; Danilo Mendoza, None; Teresa A.
Bukre, None; Peter R. Edsall, None; André Akers, None; Jeffery
M. Cleland, None; Anthony J. Johnson, None; Heuy-Ching H.
Wang, None
Consumer-product related ocular and periocular trauma in
Western Australian children
Annette K. Hoskin2, 1, Anne-Marie E Yardley1, 2, Kate Hanman2, 3,
Geoffrey Lam1, 3, David A. Mackey2, 1. 1Centre for Ophthalmology
and Vision Science, University of Western Australia, Nedlands,
WA, Australia; 2Lions Eye Institute, Nedlands, WA, Australia;
3
Ophthalmology, Princess Margaret Hospital for Children, Subiaco,
WA, Australia.
Purpose: Ocular trauma is a leading cause of monocular blindness in
children and consumer products are often the cause. Currently there is
a paucity of detailed data on how these injuries occur. We performed
a retrospective hospital-based study to identify and characterize
consumer product-related eye and adnexal injuries in children
admitted to Princess Margaret Hospital for Children (PMH) in Perth,
Western Australia, from 2002 to 2013.
Methods: A hospital-based retrospective review of children <18
years of age admitted with ocular and periocular trauma from 20022013 was performed. Narrative data were used to assess each case
in which a consumer product caused the injury. Demographic data
collected, diagnosis, incident location, consumer product category
and vision outcomes were analyzed.
Results: There were 207 consumer product-related admissions
representing 42% of the serious ocular and adnexal injuries identified
in the 12-year period. Of these, 56% involved children <5 years
(mean age 4.54 years, range 1 month to 15 years old) and 67%
involved males. More than 60 different products were implicated;
with pieces of furniture the most common (50) followed by toys (36),
food products or their containers (22) and stationery items (17). Postinjury visual acuity of worse than 6/18 was recorded in 12% of cases.
Kitchen utensils and toys were implicated more often in the injuries
with poorer visual outcomes.
Conclusions: This study shows that most consumer product-related
children’s eye injuries in Perth occur at home in children <5 years
old and are predominantly caused by toys, furniture and household
products. We must continue to monitor ocular trauma and work
closely with legislative and consumer groups to ensure adequate
prevention strategies are identified and adopted.
Commercial Relationships: Annette K. Hoskin, None; AnneMarie E Yardley, None; Kate Hanman, None; Geoffrey Lam,
None; David A. Mackey, None
Review of suspected non-accidental head injury cases at Batson
Children’s Hospital
Ryan Drumright, Bo Huang, Lee Moore. Ophthalmology, University
of Mississippi, Brandon, MS.
Purpose: Retinal hemorrhage has been reported to occur in
association with various types of non-accidental head injury
(NAHI). These include subdural hemorrhage (SDH), subarachnoid
hemorrhage (SAH), epidural hemorrhage (EDH), and skull fracture.
The purposes of this study were to evaluate the association between
the presence of retinal hemorrhage and the presence of various types
of NAHI and to evaluate the association between the presence of
extra-cranial skeletal fracture and retinal hemorrhage. We tested the
hypotheses that there would be an association between the presence
of retinal hemorrhage and SDH and an association between the
presence of extra-cranial skeletal fracture and retinal hemorrhage in
patients suspected to be victims of NAHI.
Methods: This was a retrospective cross-sectional study of patients
less than 5 years of age who were evaluated for NAHI with any of
the following diagnoses: SDH, SAH, EDH, or skull fracture. A total
of 210 charts were reviewed. After exclusion of 137 patients who
did not undergo ophthalmologic examination for suspected NAHI,
73 patients were included in the data analysis. Chi-square testing
was used to evaluate the association between the presence of retinal
hemorrhage and each specific NAHI diagnosis (SDH, SAH, EDH,
and skull fracture) as well as the association between the presence of
extra-cranial skeletal fracture and retinal hemorrhage.
Results: Forty-one patients had SDH, 13 had SAH, 2 had EDH, and
43 had skull fracture. Twenty-two patients had more than one NAHI
diagnosis. Retinal hemorrhage was present in 28 patients (38.4%).
The presence of retinal hemorrhage was highly associated with the
presence of SDH (p < 0.001), but there was no significant association
found with the presence of SAH, EDH, or skull fracture. Extracranial skeletal fractures were present in 15 patients and showed
marginal association with the presence of retinal hemorrhage (p =
0.053).
Conclusions: Retinal hemorrhages are highly associated with SDH
in patients that are suspected to be victims of NAHI, but they are
not associated with SAH or skull fracture. These results support
a shaking mechanism for the development of these injuries. The
number of patients with EDH was too few to draw any conclusions
on its association with retinal hemorrhage. Extra-cranial skeletal
fractures are more common in NAHI patients with retinal hemorrhage
but did not now show a statistically significant association.
Commercial Relationships: Ryan Drumright, None; Bo Huang,
None; Lee Moore, None
The role of visual symptoms in predicting the presence and
severity of ocular injury in orbital fractures
Juliana Gildener-Leapman, Anne Barmettler. Ophthalmology,
Montefiore Hospital/Albert Einstein College of Medicine, Bronx,
NY.
Purpose: Previous studies have evaluated the frequency of ocular
injuries that occur with different types of orbital fractures, but there is
a paucity of data regarding the relationship between patient reported
visual symptoms and ocular injury in these traumas. This study was
designed to assess the reliability of visual symptoms in determining
the presence and severity of ocular injuries in the setting of orbital
fractures.
Methods: This is an IRB approved retrospective chart review of
patients with orbital fractures seen in five emergency departments
in Bronx, New York over the past year. The following data was
collected: patient demographics, visual symptoms, ophthalmologic
exam, radiographic findings, along with medical and surgical
interventions. Exclusion criteria included age under ten years,
altered mental status, or insufficient data. Visual complaints were
categorized into new-onset blurry vision, double vision, complete
visual obstruction from edematous eyelid, and no visual complaints.
The charts were then reviewed for ocular injuries and treatments in
patients from each visual subset.
Results: A total of 68 patients were evaluated for orbital fractures.
Ophthalmology was consulted for 42 of these cases, among which
were all 13 patients who reported visual symptoms. Patient subsets
included 7 patients with blurry vision, 4 with diplopia, 2 with
complete visual obstruction from eyelid edema, and 49 who denied
visual symptoms. Patients sometimes had more than one ocular
injury. Ocular injuries in those with visual symptoms were as follows:
1 corneal abrasion, 4 extraocular muscle restrictions, 2 iritis, 1 lens
dislocation, 1 retrobulbar hematoma, and 1 retinal break. Ocular
injuries in those without visual symptoms included: 1 iritis and 1
retrobulbar hematoma. No emergent ocular procedures were needed
for patients who denied visual symptoms.
Conclusions: Prior studies have not looked at the relationship
between patient reported visual symptoms and ocular injury. This
study suggests that visual symptoms can be a useful predictor for
the presence and severity of ocular injury in orbital fractures. This
information may aid in the process of triaging patients for emergent
ophthalmologic examination. As not all patients in this study
were evaluated by ophthalmology, this may have resulted in an
underdiagnosis of ocular injuries. Larger studies in the future could
elucidate this further.
Commercial Relationships: Juliana Gildener-Leapman, None;
Anne Barmettler, None
Ocular Examination Findings and Orbital Fracture Locations
Predictive of Ocular Injury in Patients with Orbital Fractures
Nicholas Behunin, Ingrid U. Scott, Zachary C. Landis, Ana Rubin
Panvini. Ophthalmology, Penn State Hershey, Hershey, PA.
Purpose: Inpatient ophthalmology consultation is often obtained to
rule out ocular injury in the setting of orbital fractures. We performed
a retrospective chart review to investigate ocular examination
findings predictive of ocular injury in patients with orbital fractures.
We also investigated the correlation between orbital fracture location
and ocular injury.
Methods: Medical records were reviewed of all patients who
underwent inpatient ophthalmology consultation to rule out ocular
injury in the setting of orbital fracture at Penn State Hershey
Medical Center from July 31, 2011 to January 7, 2014. Patients with
retinopathy of prematurity or non-accidental trauma were excluded.
Data collected include demographics, mechanism of injury, fracture
location, ocular examination findings, and ocular injury. Statistical
analysis was performed with logistic regression utilizing Firth’s
penalized likelihood approach.
Results: The study included 203 patients (149 [73.4%] male; 54
[26.6%] female). The most common mechanism of injury was fall
(78 total, 38.42%), followed by motor vehicle accident (44 total,
21.67%), and altercation/assault (22 total, 10.84%). Subconjunctival
hemorrhage, chemosis, conjunctival injection, abnormal vision,
abnormal pupils, and abnormal motility were each independently
correlated with the presence of ocular injury (all p < 0.05).
Interestingly, eyelid laceration and periorbital ecchymosis were not
significantly correlated with ocular injury. Of the fracture patterns
studied, only medial wall fracture was significantly associated with
ocular injury (odds ratio [OR] 2.699; 95% confidence interval [CI]
1.257, 5.814; p=0.01). The presence of multiple orbital fractures did
not significantly correlate with ocular injury. Orbital roof fracture was
associated with an increased risk of optic neuropathy (OR 19.8; CI
1.875, 2679.356; p = 0.01).
Conclusions: In this study of patients with orbital fracture,
subconjunctival hemorrhage, chemosis, conjunctival injection,
abnormal vision, abnormal pupils, and abnormal motility were each
independently correlated with ocular injury. Of the fracture patterns
studied, only medial wall fracture was associated with ocular injury.
The presence of multiple orbital fractures was not correlated with the
presence of ocular injury.
Commercial Relationships: Nicholas Behunin, None; Ingrid U.
Scott, None; Zachary C. Landis, None; Ana Rubin Panvini, None
The Natural History of Pre-macular Hemorrhage in Infants
Christopher R. Stelton, G B. Hubbard. Ophthalmology, Emory
University, Atlanta, GA.
Purpose: In infants, the management of a very specific pattern
of hemorrhage confined to the sub-internal limiting membrane
or sub-hyaloid spaces after traumatic shaking injury has not been
extensively studied and no consensus among pediatric vitreoretinal
surgeons exists as to the optimal timing for surgical intervention. This
situation may be difficult for the pediatric vitreoretinal surgeon and
the literature offers little guidance. We describe the typical presenting
features, management, and visual outcomes of infants after non-
accidental trauma with pre-macular hemorrhage. We performed a
retrospective, observational case review.
Methods: Eligible patients were identified by a computerized
search of the Emory Eye Center database. Children with a specific
pattern of blood confined to the sub-internal limiting membrane or
sub-hyaloid spaces obscuring the macula were included. Relevant
information was recorded, including age at time of bleed, visual
function, anatomic findings, and associated neurologic history. A total
of 22 patients and 36 eyes over a period greater than 12 years were
identified. Our main outcome measures were mean time to resolution
of blood and other ocular co-morbidities.
Results: 30/36 (83.3%) eyes underwent observation. 6/36 (16.7%)
eyes had surgical intervention. There was no worsening of visual
function documented as compared with presenting vision in the 12
patients who had visual acuity noted at initial consultation and at
follow up. 5/12 eyes (41.7%) had improvement in visual function.
When observed, the mean time to resolution of the blood was 2.96
months. Once the blood cleared, children suffered lasting ocular
co-morbidities (i.e. optic atrophy, separation of the internal limiting
membrane, macular pigmentary changes or scar, and strabismus).
Conclusions: Most cases of pre-macular hemorrhage do not require
surgical intervention. When pre-macular blood is present, it typically
clears by 3 months. Visual prognosis is often limited by ocular comorbidities. Pre-macular membranes are common. Some eyes may
benefit from pars plana vitrectomy (i.e. large hemorrhages or eyes
with significant membranes).
Commercial Relationships: Christopher R. Stelton, None; G B.
Hubbard, None
Persistence of Subretinal Fluid and the Risk of Enucleation in
Group D Retinoblastoma Eyes
Grace Shih1, Jesse berry1, 2, Stavros Moysidis1, A. L. Murphree2,
Rima Jubran2, Jonathan W. Kim1, 2. 1Ophthalmology, University of
Southern California, Los Angeles, CA; 2Ophthalmology, Children’s
Hospital of Los Angeles, Los Angeles, CA.
Purpose: To evaluate the association of persistent subretinal fluid
(SRF) and the need for enucleation in Group D eyes of bilateral
retinoblastoma treated with chemoreduction.
Methods: 53 Group D eyes were evaluated for the presence of
SRF at diagnosis. They were subsequently treated with primary
chemoreduction, using a 3 drug chemotherapy regimen. Globe
survival analysis was used to evaluate whether persistence of
subretinal fluid was associated with persistent tumor activity after
chemoreduction and a worse overall outcome (i.e. enucleation).
Logistic regression analysis was used to assess the association
between duration of SRF and risk for enucleation.
Results: 79.25% (n=42) of Group D eyes exhibited SRF at diagnosis.
Of these 42 eyes, 25 eyes showed subretinal fluid that persisted after
the first round of chemotherapy. 9 eyes demonstrated continued SRF
after 3 cycles of chemotherapy and 2 eyes continued with fluid at 6
months. Ten eyes ultimately required enucleation (10/53 or 18.9%).
Only one of the 10 enucleated eyes demonstrated persistent SRF at
the time of enucleation. 8 of 10 eyes contained histologic evidence of
viable tumor cells. There was no statistically significant association
between the persistence of SRF and risk for enucleation.
Conclusions: We hypothesized that the persistence of subretinal fluid
during chemotherapy was a risk factor for enucleation. However,
the duration of SRF was not found to be an independent predictor of
whether Group D eyes will ultimately require enucleation following
chemoreduction.
Commercial Relationships: Grace Shih, None; Jesse berry, None;
Stavros Moysidis, None; A. L. Murphree, None; Rima Jubran,
None; Jonathan W. Kim, None
Support: An Unrestricted grant from Research to Prevent Blindness,
New York, NY 10022
Rescue Intra-Arterial Chemotherapy Following Retinoblastoma
Recurrence After Initial Intra-Arterial Chemotherapy
Renelle Pointdujour Lim1, 2, Emil A. Say1, 2, Christopher Cao1, 2, Carol
L. Shields1, 2. 1Ocular Oncology, Wills Eye Hospital, Philadelphia, PA;
2
Thomas Jefferson University Hospital, Philadelphia, PA.
Purpose: To determine the efficacy of rescue intra-arterial
chemotherapy (IAC) for tumor recurrence after previous IAC for
retinoblastoma.
Methods: Retrospective interventional case series of 12 patients
treated with repeat (rescue) IAC for tumor, subretinal seed or vitreous
seed control after previous IAC for retinoblastoma.
Results: Median age at presentation was 16 months and 8 were
female. The initial International Classification of Retinoblastoma
was group B (n=1), group D (n=7), and group E (n=4). In all cases,
initial IAC was delivered at Thomas Jefferson University Hospital
or elsewhere using M3 (n=3) or M5 (n= 7), M5+T1 (n=2) median 3
cycles (range 1-4). Of the 12 patients, 17% (n=2) had the opposite
eye previously enucleated so the rescue IAC was planned for the only
remaining eye. Rescue IAC was delivered for recurrent solid tumor
(n=1) recurrent extensive subretinal seeds (n=7), recurrent extensive
vitreous seeds (n=1), or for combination recurrent subretinal and
vitreous seeds (n=3). The median interval between final cycle of
initial IAC to first cycle of rescue IAC was 4 months (range 2-10
months). IAC was successful through the ophthalmic artery (10/12,
83%) or through the middle meningeal artery (2/12, 17%) when
ophthalmic artery obstruction was present from initial IAC elsewhere.
Each case received median 3 IAC cycles of Melphalan alone (4/12,
33%) or combination Melphalan and Topotecan (8/12, 67%). At
median follow-up of 7 months (range 3-31 months), complete tumor
control was achieved in 10 eyes (83%) and globe salvage in 9 eyes
(75%). Three eyes underwent enucleation for persistent subretinal
seeds (n=2) or neovascular glaucoma without viable tumor on
histopathology (n=1). There was no case of cerebrovascular stroke,
systemic metastasis, or death.
Conclusions: Rescue IAC following tumor recurrence after initial
IAC provided 83% tumor control and 75% globe salvage in this
series.
Regression of subretinal seeds after rescue intraarterial
chemotherapy. (A) Retcam photograph upon presentation with total
retinal detachment secondary to a large exophytic retinoblastoma.
(B) Main tumor regression after 3 sessions of intraarterial Melphalan
5mg. (C). Recurrent subretinal seeds at the superior arcade and (D)
in the inferior peripheral retina. (E & F) Complete regression of
the subretinal seeds after rescue intraarterial chemotherapy using
Melphalan 5mg and Topotecan 1mg.
Commercial Relationships: Renelle Pointdujour Lim, None; Emil
A. Say, None; Christopher Cao, None; Carol L. Shields, None
Success rates of intravenous chemotherapy for intraocular
retinoblastoma: A meta-analysis
Anthony B. Daniels5, 2, Shriji Patel1, Tatsuki Koyama4, 2, Joann
Alvarez4, 2, Debra L. Friedman3, 2. 1Department of Ophthalmology,
Vanderbilt Eye Institute, Nashville, TN; 2Vanderbilt-Ingram Cancer
Center, Nashville, TN; 3Division of Pediatric Hematology/Oncology,
Department of Pediatrics, Vanderbilt University, Nashville, TN;
4
Department of Cancer Biostatistics, Vanderbilt University, Nashville,
TN; 5Departments of Ophthalmology and Cancer Biology, Vanderbilt
University, Nashville, TN.
Purpose: To analyze the reported success rates for intravenous
chemotherapy for the treatment of intraocular retinoblastoma (RB),
based on classification group and chemotherapy regimen.
Methods: PubMed was searched for English articles containing the
words “retinoblastoma” and “chemotherapy”, yielding 2329 papers.
In vitro/genetic studies (n=1119), animal studies (n=291), studies
unrelated to retinoblastoma treatment (n=473) or using a different
treatment modality (n=137) were excluded. Case reports/small series
(n=114) and editorials (n=108) were excluded. Thus, 87 studies met
our inclusion criteria. Success was defined as globe retention without
salvage external beam radiotherapy (EBRT). Studies with planned
EBRT were excluded. Studies in which eye classification (Reese-
Ellsworth [R-E] or International Classification of Retinoblastoma
[ICRB]) could not be determined were excluded, as were papers in
which it was not possible to identify which eyes avoided both EBRT
and enucleation. Duplicate papers reporting on previously published
cohorts of patients were excluded. This yielded 23 studies included in
this analysis. Weighted point estimates and 95% confidence intervals
for success rates by classification group were calculated. We also
assessed for different success rates based on chemotherapy regimen
and focal treatment and created a model based on these variables.
Results: Weighted estimates of globe salvage rate with
chemoreduction were 83% (95%CI: 67-92%) for R-E Group 1 eyes,
76% (95%CI: 66-84%) for Group 2 eyes, 67% (95%CI: 53-78%) for
Group 3 eyes, 49% (95%CI: 36-63%) for Group 4 eyes, and 38%
(95%CI: 28-49%) for Group 5 eyes (39% [95%CI: 24-57%] for
5A eyes and 46% [95%CI: 34-59%] for 5B eyes). Using the ICRB,
weighted globe salvage rates were 93% (95%CI: 79-98%) for Group
A eyes, 83% (95%CI: 71-91%) for Group B, 74% (95%CI: 50-89%)
for Group C, 40% (95%CI: 30-52%) for Group D, and 24% (95%CI:
9-52%) for Group E. No statistically-significant difference between
chemotherapy regimens was detected.
Conclusions: Reporting of outcomes in retinoblastoma is not
standardized. There is significant selection bias in many studies,
as worse eyes are more likely to be enucleated primarily without
an attempt at chemoreduction. Both R-E and ICRB predict
chemoreduction success. New techniques such as intra-arterial and
intravitreal chemotherapy should be compared to these historical
success rates of IV chemotherapy.
Commercial Relationships: Anthony B. Daniels, None; Shriji
Patel, None; Tatsuki Koyama, None; Joann Alvarez, None; Debra
L. Friedman, None
Customized Iris Prosthesis in eyes with post-traumatic aniridia
Anja Nessmann, Julia Wagner, Efdal Yoeruek, Karl U. Bartz-Schmidt,
Peter Szurman, Martin S. Spitzer. University Tuebingen Eye Center,
Tuebingen, Germany.
Purpose: Posttraumatic partial or total iris defects often cause
significant debilitating glare, photophobia, decreased vision and
cosmetic problems. Currently the best cosmetic results can be
obtained with a customized silicone iris prosthesis. However, little is
known about the functional results and the rate of complication if this
type of iris prosthesis is implanted into severely traumatized eyes.
Methods: A consecutive series of 36 patients that received a
customized silicone iris prosthesis after severe globe injury with total
or sub-total iris loss was analyzed retrospectively. In 18 patients,
the iris prosthesis insertion was combined with intraocular lens
implantation and in 4 patients with corneal transplantation. Mean
visual acuity prior to iris prosthesis implantation was 1.1 logMAR
units (0.3 – 2.6 logMAR units). Median follow-up was 17.5 months.
3 patients had preexisting glaucoma and 8 patients hypotony.
Results: Postoperative results showed a rather diverse picture. Visual
acuity 12 months after surgery was 1.4 LogMAR units (0.2 – 2.6
logMAR units). Patient`s satisfaction increased by reducing glare and
enhanced cosmetic appearance. Complications were an increase of
intraocular pressure (IOP) requiring new or more pressure lowering
therapy in 3 patients, persisting intraocular inflammation or macular
edema in 14 patients, and corneal endothelial decompensation (CED)
in 5 patients. Moreover, in 5 other cases penetrating keratoplasty
was necessary during or after iris prosthesis implantation as a
consequence of corneal scarring due to the initial trauma.
Conclusions: The customized silicone iris prosthesis is an
individualized treatment approach, which can be tailored to distinct
eye properties. Therefore, especially trauma eyes with highly
different posttraumatic conditions could benefit. In addition, the
customized silicon iris prosthesis is a favorable cosmetic solution for
the reconstruction of the iris in posttraumatic eyes. However, in some
patients the implantation of this device may cause an increase of
IOP, corneal endothelial decompensation or persisting inflammation.
Thus, the risks of benefits of implantation must be weighed carefully
in patients with high or low IOP as well as pre-existing corneal
endothelial damage.
Commercial Relationships: Anja Nessmann, None; Julia Wagner,
None; Efdal Yoeruek, None; Karl U. Bartz-Schmidt, None; Peter
Szurman, None; Martin S. Spitzer, None
A case series of automobile wing (side) mirror ocular injuries
Donovan N. Calder1, 2, Ivor crandon1, Jennifer calder3, 4, Nicole
Meeks-aiken1. 1Surgery, University of the West Indies, Kingston,
Jamaica; 2Ophthalmology, Mount Sinai, Toronto, ON, Canada;
3
Epidemiology and Community Health, New York Medical College,
Valhalla, NY; 4Epidemiology, Columbia University, New York, NY.
Purpose: Traffic-related injuries are estimated to become the
fifth leading cause of the global burden of diseases by 2020. A
2008 showed that although responsible for 3.3% of all emergency
department eye injury visits, traffic-related injuries were responsible
for 19.1% of these visits that required hospitalization. The motor
vehicle industry has been responsive to the safety needs of drivers
and passengers, however studies related to wing mirror related ocular
injuries are few. This is the largest case series to date that assesses the
severity of wing mirror related ocular injuries.
Methods: From January 1996 to December 2005 patients were
recruited from two ophthalmology clinics and a trauma registry.
Demographic, driving history, vehicle-specific, and clinical data
were collected. An ocular injury was any disruption in the integrity
of the eye or surrounding orbital structures. Eyebrow or eye lid
lacerations or corneal abrasions were considered minor injuries,
all other injuries were considered to be major and were classified
according to the Birmingham Eye Trauma Terminology System
(BETTS). Visual acuity (VA) at presentation and outcome was based
on Recommendations of the WHO Consultation on “Development
of Standards for Characterization of Vision Loss and Visual
Functioning” for monocular vision. All patients underwent slit
lamp examination and were treated with as appropriate. Data were
analyzed using SAS 9.4
Results: 39 patients had 41 eye injuries (Table 1). Seven of 39
(17.9%) patients had minor injuries. The remaining 32/39 (82.0%)
patients had at least one major eye injury which was classified using
BETTS (Figure). In persons experiencing minor vs. major injuries
there was a statistically significant difference in the mean ages at
which driver’s licence was obtained (p=0.0184) and the accident
occurred (p=0.0177), and years of driving experience (0.0314). The
VA at presentation was associated with that at outcome (p=<0.0001).
Only 38% of persons who were categorized as blind at presentation
had improved VA at outcome.
Conclusions: While wing mirror-related ocular injuries are rare, we
show that many cause permanent blindness. Great strides have been
made in improving automobile safety, however few standards exist
for wing mirrors and even these need review. We propose a larger
study to assess the risk factors for wing mirror-related ocular injuries
and to develop an international automotive standard.
Commercial Relationships: Donovan N. Calder, None; Ivor
crandon, None; Jennifer calder, None; Nicole Meeks-aiken, None
Outcomes and Prognostic Factors in Patients with Traumatic
Corneal Foreign Body Injuries: a review of 387 cases
Amy M. Cherof, Jeffrey B. Kennedy, Ronald Wise. Ophthalmology,
University of Colorado, Denver, CO.
Purpose: To evaluate outcomes and identify prognostic factors in
patients with traumatic corneal foreign body injuries.
Methods: A retrospective chart review was performed of all
patients with traumatic corneal foreign body injuries treated by
one corneal specialist at the University of Colorado Department
of Ophthalmology, from January 8, 2008 through November 6,
2013. The primary outcome of the study was visual acuity, with a
poor outcome defined as loss of one or more lines of Snellen visual
acuity or a final best corrected visual acuity worse than 20/40 at final
follow up. Patient demographics, injury characteristics and treatment
methods were recorded and analyzed in order to assess the potential
relationship to visual outcome.
Results: A total of 534 consecutive cases were reviewed, of which
387 were included in the study. Overall, 9.8% of patients had a poor
outcome. Improvement in Snellen acuity by 1 or more lines was seen
in 66.9% of patients. Time to presentation, foreign body location,
foreign body material, removal method, and post removal patching
or bandage contact lens use were not associated with a significant
difference in patient outcomes. Treatment with fluoroquinolone
antibiotics after foreign body removal was associated with a
statistically significant reduction in poor outcomes (p=0.0198), as
was delayed treatment with topical steroids (OR 0.427, p=0.0298).
Conclusions: The incidence of poor outcomes is low in patients
suffering from a corneal foreign body injury. Patients should be
treated with fluoroquinolone antibiotics and delayed topical steroids
following foreign body removal in order to reduce the incidence of
poor outcomes.
Commercial Relationships: Amy M. Cherof, None; Jeffrey B.
Kennedy, None; Ronald Wise, None
Outcomes of Traumatic Injury with Posterior Intraocular
Foreign Bodies
Lekha Mukkamala1, Nishant G. Soni2, Paul D. Langer1, Marco A.
Zarbin1, Neelakshi Bhagat1. 1Department of Ophthalmology & Visual
Sci, New Jersey Medical School-Rutgers University, Newark, NJ;
2
Ophthalmology, University of Maryland Medical Center, Baltimore,
MD.
Purpose: Penetrating eye trauma with posterior chamber (PC)
intraocular foreign bodies (IOFB) may cause devastating sequelae of
loss of vision or globe. In this retrospective chart review we aim to
describe the presenting features, management, and outcomes of eyes
with PC IOFB.
Methods: Chart review of patients with PC IOFB who presented to
IOVS from 2003-June 2014 was conducted. Patient demographics,
type of injury and IOFB, presenting exam [i.e. visual acuity (VA),
Ocular Trauma Score (OTS), status of vitreous hemorrhage (VH)
and retinal detachment (RD)], surgery and post-operative outcomes
were analyzed. Numerical VA was calculated using LogMAR scale.
Significance was based on p<0.05 with power of at least 80%.
Results: Thirty one patients (28 males, 3 females; mean age 37
years) were identified. Type of IOFB is shown in Figure 1 and was
diagnosed by CT in 67%. Most eyes had Zone 1 entry and OTS of 3
or 4 (8 and 7 respectively). One eye presented with endophthalmitis
6 days after injury. Mean follow up time was 17 months (range <1 to
84 mo).
PC IOFB was removed within 24 hours of presentation in 28 of 31
patients. One patient opted for no removal and in 2 cases cilia were
found 4 and 6 days later during RD repair. Characteristics of patients
based on retinal status on presentation are shown in Table 1. RD was
repaired with silicone oil tamponade in 56% of cases, with recurrence
noted in 35% (Table 1). All patients received IV antibiotics during a
mean hospital stay of 4 days; 3 also received intravitreal antibiotics
(1 with endophthalmitis on presentation, 2 for prophylaxis).
Mean presenting VA was CF; mean final VA was 20/200. Sixty
percent of patients achieved VA predicted by OTS (3 better and 5
worse than expected). There was no correlation between initial and
final VA (r2=0.11). Patients with RD on presentation had worse final
VA than patients with no RD (p<0.05) (Table 1); however power was
not adequate to prove significance. The most common complication
was RD. One patient in which a second IOFB (cilia) was found 6
days later developed sympathetic ophthalmia. There were no cases of
post-operative endophthalmitis. No eyes were enucleated.
Conclusions: Patients with posterior IOFBs have guarded visual
prognosis, especially when presenting with concurrent RD. Final VA
is well predicted by the OTS. Enucleations are rare.
Figure 1. Type of PC IOFB
Table 1. Characteristics of patients by retinal status on presentation
Commercial Relationships: Lekha Mukkamala, None; Nishant
G. Soni, None; Paul D. Langer, None; Marco A. Zarbin, None;
Neelakshi Bhagat, None
Surgical and visual outcomes in traumatic cataract following
phacoemulsification, in a mexican pediatric population
Pablo J. Guzman-Salas, Ivo Ferreira-Rios, Humberto Matiz-Moreno,
Marisol Garzon, Eduardo Chavez-Mondragon. Anterior Segment,
Instituto de Oftalmologia - Conde de Valenciana, Mexico City,
Mexico.
Purpose: Report the number of pediatric patients with traumatic
cataracts, attending a reference center in Mexico City, to analyze
different epidemiologic characteristics, and their surgical and visual
outcomes.
Methods: Retrospective, observational case series study was
performed. We reviewed clinical data from January 1st 2013, to
December 1st 2014. Clinical electronic records were reviewed of
patients with diagnosis of Traumatic Cataract, with ages from 0
to 17 years and 364 days. Patient record had to comply with this
diagnostic: history of trauma to the eye, with development of
cataract, and further surgical intervention, with a minimum of 1 year
of follow up.
Information from clinical records: gender, age, medical history, type
of trauma, residence, time between trauma and surgery, visual acuity
in all visits, findings in exploration, axial length, type of surgery and
complications, final refraction, capsular bag opacification, need of
referral to other Departments.
Results: We analyzed 22 patients. Average age was 9.55 ± 4.16
years. Six female (27.3%) and 16 males (72.7%). 1 patient (4.6%)
had history of previous disease. 6 patients (27.3%) had open-globe
penetrating injury, and 16 patients (72.8%) had closed-globe blunt
trauma. 8 patients (36.3%) lived in the city, while 14 (63.7%) lived
in rural communities. Time between trauma and surgery: average of
3.99 ± 7.43 months. Visual acuity in first visit: 5 patients (22.8%)
with light perception, 10 (45.5%) with hand movement, 5 (22.8%)
with an average of 1.78 ± 0.83 logMAR. At one-year follow up, 1
(4.6%) patient had no light perception; two (9.1%) hand movement.
The rest, average of 0.35 ± 0.43 logMAR. Axial length average:
22,86 ± 1.09mm. All patients underwent phacoemulsification, in 21
(95.6%) surgeon was able to place an IOL, and 1 patient (4.6%) was
left in aphakia. Capsular bag opacification developed in 4 patients
(18.2%). In 20 (91%) the final refraction was obtained, with a mean
spherical equivalent of -0.41 ± 0.84 D. 6 patients (27.3%) had to be
referred to another Department.
Conclusions: Traumatic cataract had higher prevalence in male
children, with predominant blunt trauma, from rural communities.
Most achieved vision at 1 year follow up better than 0.35 logMAR.
This shows us better ways to understand the approach to traumatic
cataracts in children, with an ultimate goal to give better quality of
life.
Commercial Relationships: Pablo J. Guzman-Salas, None; Ivo
Ferreira-Rios, None; Humberto Matiz-Moreno, None; Marisol
Garzon, None; Eduardo Chavez-Mondragon, None
Treatment options for pediatric traumatic cataract
Dora Kovacs, Zsolt Biro. Department of Ophthalmology, University
of Pécs, Pécs, Hungary.
Purpose: Controversy exists regarding the best possible treatment
options for pediatric traumatic cataract cases. Our goal was to
retrospectively analyse the results of traumatic cataract cases in
children treated at our department.
Methods: At the Department of Ophthalmology, University of Pécs,
Faculty of Medicine, Hungary, 31 patients were treated under the
age of 18 with the diagnosis of traumatic cataract between 1998 and
2014. The mean age at the time of treatment was 8,88 years. 74,2% of
our patients were male, 25,8% female.
Results: Sixty-five percent of our patients suffered penetrating/
perforating eye injury and 35% suffered blunt trauma in one eye.
In 16% of the cases intraocular foreign body was also present. Due
to patients’ or caretakers’ negligance only 50% of the patients were
treated within 24 hours after the trauma. The primary treatment
consisted of corneal or scleral wound closure with sutures and
extraction of the cataractous lens. 3 patients required a simultaneous
pars plana vitrectomy, and iris reposition. Primary IOL implantation
was performed in 6 cases and secondary implantation in 13
cases. Postoperative complications included iritis fibrinosa and
retinal detachment in 6%, hyphema, epiretinal membrane and
endophthalmitis in 3% of the cases. Postoperative care included
topical antiinflammatory agents and amblyopia treatment when it was
necessary. A postoperative best corrected visual acuity of 0,6 or better
was achieved in 35% of the cases.
Conclusions: Treatment of pediatric traumatic cataract requires
a complex approach. With meticulous surgical techniques,
postoperative antiinflammatory and amblyopia treatment satisfactory
visual functions may be achieved even after severe trauma to the eye.
Commercial Relationships: Dora Kovacs, None; Zsolt Biro, None

Ocular injuries and trauma

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