Predicting visual acuity with machine learning in treated ocular trauma patients

AIM:To predict best-corrected visual acuity(BCVA)by machine learning in patients with ocular trauma who were treated for at least 6mo.METHODS:The internal dataset consisted of 850 patients with 1589 eyes and an average age of 44.29y.The initial visual acuity was 0.99 log MAR.The test dataset consisted of 60 patients with 100 eyes collected while the model was optimized.Four different machine-learning algorithms(Extreme Gradient Boosting,support vector regression,Bayesian ridge,and random forest regressor)were used to predict BCVA,and four algorithms(Extreme Gradient Boosting,support vector machine,logistic regression,and random forest classifier)were used to classify BCVA in patients with ocular trauma after treatment for 6mo or longer.Clinical features were obtained from outpatient records,and ocular parameters were extracted from optical coherence tomography images and fundus photographs.These features were put into different machine-learning models,and the obtained predicted values were compared with the actual BCVA values.The best-performing model and the best variable selected were further evaluated in the test dataset.RESULTS:There was a significant correlation between the predicted and actual values[all Pearson correlation coefficient(PCC)>0.6].Considering only the data from the traumatic group(group A)into account,the lowest mean absolute error(MAE)and root mean square error(RMSE)were 0.30 and 0.40 log MAR,respectively.In the traumatic and healthy groups(group B),the lowest MAE and RMSE were 0.20 and 0.33 log MAR,respectively.The sensitivity was always higher than the specificity in group A,in contrast to the results in group B.The classification accuracy and precision were above 0.80 in both groups.The MAE,RMSE,and PCC of the test dataset were 0.20,0.29,and 0.96,respectively.The sensitivity,precision,specificity,and accuracy of the test dataset were 0.83,0.92,0.95,and 0.90,respectively.CONCLUSION:Predicting BCVA using machine-learning models in patients with treated ocular trauma is accurate and helpful in the identification of visual dysfunction.

Panscleritis After Blunt Ocular Trauma in A Child with Epididymitis

We reported an 8-year-old boy with panscleritis in left eye and right epididymitis after falling on the ground.Etiologic diagnosis played a key role in this case.Systemic examinations ruled out systemic autoimmune diseases,tumors,and infections as the cause of scleritis and suggested that the disease was caused by a local delayedtype hypersensitivity(DTH)induced by ocular trauma and was non-infectious.Still,the right epididymitis was infectious.Both conditions were treated successfully using steroids and antibiotics,respectively.Thus,early etiologic diagnosis and reasonable treatment are crucial to prevent visual loss.

Comparison of ocular trauma between normalized and the COVID-19 epidemic periods in China:a multi-center cross-sectional study

AIM:To compare the feature of ocular trauma between normalized period and the COVID-19 epidemic period in China,and to provide a profile for eye injuries in special times in future.METHODS:This is a multi-center cross-sectional study with 30 participated hospitals involving the China Ocular Trauma Society members.All hospitalized cases who visited the Ophthalmology Department in participated hospitals with eye injuries during the normalized period(2019)and the COVID-19 epidemic period(2020)were included in this study.Demographic characteristic of cases,date of injury,sites and types of injury were collected.RESULTS:This study involved 13525(61 cases with both eyes)injured cases.There were 7269(53.74%)eyeinjured cases and 6256(46.26%)eye-injured cases in 2019 and 2020 separately.Compared with 2019,the incidence of ocular trauma in retirees,housewives and unemployed increased with year-on-year of 4.96%,102.67%,and 11.64%among all occupations.In 2020,the incidence of eye injuries decreased in all injury sites except for an increase in home(30.29%year-on-year).The incidence of mechanical eye injuries decreased,while that of nonmechanical eye injuries(chemical/thermal/radiation)increased(47.45%year-on-year).There were 255(3.51%,255/7269)and 376(6.01%,376/6256)non-mechanical injured cases in 2019 and 2020(Pearson Chi^(2)=47.33,P<0.001)separately.CONCLUSION:During the COVID-19 epidemic period,the total cases of ocular trauma decrease but the proportion of non-mechanical ocular trauma increase.Penetrating is still the highest proportion among all types of mechanical ocular trauma.From a preventive point of view,protection for retired persons,housewives and unemployed persons should be improved during public health events period.

COVID-19 pandemic impact on ocular trauma in a tertiary hospital

AIM:To analyze the impact of the coronavirus disease-2019(COVID-19)pandemic on the presentation and characteristics of patients hospitalized for ocular trauma in a tertiary hospital in China between 2019 and 2020.METHODS:A retrospective case study was designed to collect information on all cases of ocular trauma in a tertiary hospital from 2019 to 2020 and compare differences in inpatients’data(age,sex,admission vision acuity,type of diagnosis,hospital stays,mechanism of injury and location of injury).RESULTS:The total number of patients admitted to the Ophthalmology Department was 883(mean 73.58±11.25patients per month)in 2019 and 714(59.50±17.92patients per month)in 2020.The injury number of in work was also the most within the four types of location in this two year(42.36%in 2019,43.84%in 2020).The mean hospital stays were 12.66d in 2019 and 10.81d in 2020.The highest incidence of ocular trauma was the middleaged(41-65y)groups in 2019 and 2020.The most common cause of ocular trauma was sharp object in 2019(47.34%)and 2020(47.58%).The mechanical ocular trauma reaches98.98%in 2019 and 99.72%in 2020.CONCLUSION:The number of patients with ocular trauma decreased in 2020,but middle-aged(41-65y)are still high incident groups.Mechanical ocular trauma remains the leading cause of hospitalization for ocular trauma patients and the proportion of patients injured at home increases.It is necessary to arouse social attention and the public’s awareness of eye trauma protection should be strengthened during the pandemic.

Necroptosis plays a crucial role in the exacerbation of retinal injury after blunt ocular trauma

Retinal injury after blunt ocular trauma may directly affect prognosis and lead to vision loss.To investigate the pathological changes and molecular mechanisms involved in retinal injury after blunt ocular trauma,we established a weight drop injury model of blunt ocular trauma in male Beagle dogs.Hematoxylin-eosin staining,immunofluorescence staining,western blotting,and TUNEL assays were performed to investigate retinal injury within 14 days after blunt ocular trauma.Compared with the control group,the thicknesses of the inner and outer nuclear layers,as well as the number of retinal ganglion cells,gradually decreased within 14 days after injury.The number of bipolar cells in the inner nuclear layer began to decrease 1 day after injury,while the numbers of cholinergic and amacrine cells in the inner nuclear layer did not decrease until 7 days after injury.Moreover,retinal cell necroptosis increased with time after injury;it progressed from the ganglion cell layer to the outer nuclear layer.Visual electrophysiological findings indicated that visual impairment began on the first day after injury and worsened over time.Additionally,blunt ocular trauma induced nerve regeneration and Müller glial hyperplasia;it also resulted in the recruitment of microglia to the retina and polarization of those microglia to the M1 phenotype.These findings suggest that necroptosis plays an important role in exacerbating retinal injury after blunt ocular trauma via gliosis and neuroinflammation.Such a role has important implications for the development of therapeutic strategies.

Characteristics and visual outcomes of patients hospitalized for ocular trauma in central China: 2006-2011

AIM: To complete the data of ocular trauma in central China, as a well-known tertiary referral center for ocular trauma, we documented the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in this region.METHODS: A retrospective study of patients hospitalized for ocular trauma in central China from 2006 to 2011 was performed.· RESULTS: This study included 5964 eyes of 5799 patients. The average age was 35.5 ±21.8y with a male-to-female ratio of 2.8:1. The most common age was 45-59 y age group. Most patients were farmers and workers(51.9%). The most common injuries were firework related(24.5%), road traffic related(24.2%), and work related(15.0%). Among the most common causative agents were firecrackers(24.5%), followed by metal/knife/scissors(21.4%). Most injuries occurred in January(14.2%),February(27.0%), and August(10.0%). There were 8.5%patients with ocular injuries combined with other injuries.The incidence of open ocular injuries(4585 eyes, 76.9%)was higher than closed ocular injuries(939 eyes, 15.7%).The incidences of chemical and thermal ocular injuries were 1.2% and 0.6%. Ocular trauma score(OTS)predicted final visual acuity at non light perception(NLP), 20/200-20/50 and 20/40 with a sensitivity of 100%,and light perception(LP) /hand motion(HM) and 1/200-19/200 with a specificity of 100%.· CONCLUSION: This study provides recent epidemiological data of patients hospitalized for ocular trauma in central China. Some factors influencing the visual outcome include time interval between injury and visit to the clinic, wound location, open or closed globe injury, initial visual acuity, and OTS.

Visual outcomes in patients with open globe injuries compared to predicted outcomes using the Ocular Trauma Scoring system

AIMTo determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes according to the Ocular Trauma Score (OTS) study. A secondary aim was to establish the evisceration rate for these injuries and assess how this form of intervention affected outcomes in comparison to the OTS.METHODSA prospective case series of all patients admitted with open globe injuries over a two-year (July 2009 to June 2011) period. Injuries were scored using the OTS and the surgical intervention was recorded. The best corrected visual acuity at three months was regarded as visual outcome.RESULTSThere were 249 open globe injuries, of which 169 patients (169 eyes) completed the 3-month follow-up. All patients underwent primary surgery, 175 (70.3%) repairs, 61 (24.5%) eviscerations and 13 (5.2%) other procedures. Globe eviscerations were mainly done on OTS Category 1 cases, but outcomes in this category were not found to be different from OTS outcomes. Outcomes were significantly worse in Category 2, but when the entire distribution was tested, the differences were not statistically significant. The overall association between OTS outcomes and the final visual outcomes in this study was found to be a strong (P&#x0003c;0.005).CONCLUSIONReliable information regarding the expected outcomes of eye injuries will influence management decisions and patient expectations. The OTS is a valuable tool, the use of which has been validated in many parts of the world-it may also be a valid predictor in an African setting.

Predictive value and applicability of ocular trauma scores and pediatric ocular trauma scores in pediatric globe injuries

AIM: To evaluate the predictive value and applicability of Ocular Trauma Score(OTS) and Pediatric Ocular Trauma Score(POTS) for closed and open globe injuries in the pediatric group.METHODS: A retrospective study of closed and open globe injuries in children age of 0-18-year-old between 2012-2019 was conducted.Medical records were collected,and injuries were classified using Birmingham Eye Trauma Terminology System(BETTS).The predictive value and applicability of both OTS and POTS to final visual acuity(VA) were analyzed.RESULTS: Of 84 patients,59(70.2%) presented with closed globe injuries(CGI) and 25(29.8%) with open globe injuries(OGI).The mean of initial VA was 0.832±0.904 log MAR.OTS and POTS was calculated.Initial VA(P<0.001) and traumatic cataract(P<0.001) were significantly associated with visual outcome,followed by organic/unclean wound (P=0.001),delay of surger y(P=0.001),iris prolapse(P=0.003),and globe rupture(P=0.008).A strong correlation between OTS and POTS and final VA(r=-0.798,P<0.001;r=-0.612,P<0.001) was found.OTS was more applicable in all age group of pediatric and in contrast to POTS,it was designed for 0-15 years old.POTS requires eleven parameters and OTS six parameters.Even though initial VA was not available,we could still calculate into POTS equation.CONCLUSION: OTS and POTS are highly predictive prognostic tools for final VA in CGI and OGI's in children.

Ocular trauma treated with pars plana vitrectomy: early outcome report

AIM： To evaluate demographic variables and visual outcomes, among patients with ocular injuries involving the posterior segment, managed with pars plana vitrectomy.· METHODS： The records of patients were studied retrospectively from March to September 2010, to determine the age, gender, place of occurrence of trauma, visual acuity, anatomical site, nature of injury,wound length, the presence of an afferent pupillary defect, and the timing of vitrectomy. The Ocular Trauma Score was measured. The minimum follow-up from presentation was 6mo.·RESULTS： Ninety patients（77 males, 13 females）, with a mean age of 32.7 ±15.8y were included over the 6-month period. The majority of cases occurred in the workplace（47 patients）, followed by home（14 patients）.The mean visual acuity（log MAR） of patients significantly improved from 2.36 ±0.72 preoperatively to 1.50 ±1.14 postoperatively. Twenty-three patients had preoperative vision better than 2.0 log MAR, the postoperative visual acuity was significantly better among these patients than patients with worse than 2.0 log MAR（P 〈0.001）. Visual improvement between groups with early vitrectomy（〉7d）and delayed vitrectomy（〉7d） was not significantly different（P =0.66）. Postoperative visual acuity was not significantly different between patients with injury in Zone I and II（P =0.64）, but patients with injury in Zone III had significantly poorer visual acuity（P =0.02）. Patients with relative afferent pupillary defect had significantly poorer postoperative visual acuity（P =0.02）. Preoperative visual acuity, the difference of preoperative and postoperative visual acuity, and postoperative visualacuity were significantly different between groups with different ocular trauma scores（P〈 0.001）.·CONCLUSION： Trauma is more likely to occur in men under 40 y of age and in the workplace. The favorable final visual outcome is associated with the absence of afferent pupillary defect, ocular trauma score and presenting visual acuity as well as the zone of injury, and not associated with the timing of vitrectomy.

Ocular Trauma in a Rural Population of North China:The Handan Eye Study

Objective To determine the prevalence of ocular trauma and the proportion of blindness and visua impairment due to trauma in a rural population in northern China. Methods The Handan Eye Study is a population-based cross-sectional study that surveyed 6830 Chinese people aged 30＋ years from 13 randomly selected villages in Yongnian County, city of Handan, Hebei Province, in July, 2006. All participants underwent a standardized interview and extensive examinations. A structured questionnaire was used to collect information on ocular trauma. Results Of the 5837 participants who filled out the questionnaire, 124 subjects [2.1%; 95% confidence interval （CI）, 1.8%-2.5%] reported a history of ocular trauma in either eye, including 19 （0.3%） persons reporting trauma in both eyes. Men were more likely to have an eye injury than women [odds ratio （OR）, 3.3; 2.2-4.9]. In multiple logistic regression models, ocular trauma was significantly more frequent among normotensive participants when compared with hypertensive participants （hypertensive vs. normotensive＂ OR, 0.6; 0.4-0.9） and among participants who had a history of falls （OR, 2.4; 1.2-4.8）. The proportion of unilateral visual impairment and unilateral blindness due to trauma were 10.5% （13 subjects） and 21.0% （26 subjects）, respectively. Conclusion Our study reports the prevalence of severe ocular trauma among adults in rural China, revealing a high proportion of blindness and visual impairment due to trauma. These findings suggest the need for educational strategies to increase eye health awareness in this rural population with focus on providing at least appropriate first aid care to reduce blindness due to trauma.

Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury

AIM: To elucidate the question of whether the ocular trauma score(OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment(RD) in patients with open globe injury(OGI).METHODS: A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI. RESULTS: Totally 102 patients with traumatic OGI with a minimum of 12 mo follow-up and a median age at of 48.6 y(range: 3-104 y) were identified. Final best corrected visual acuity(BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score Ⅰ(P<0.0001) or Ⅱ(P<0.0001) revealed a significantly worse BCVA at last follow up when compared to the cohort with an OTS score >Ⅲ. OGI associated RD was observed in 36/102 patients(35.3%), whereas post traumatic RD(defined as RD following 14 d after OGI) occurred in 37 patients(36.3%). OGI associated RD did not correlate with the OTS and the zone of injury(P=0.193), yet post traumatic RD correlated significantly with zone Ⅲ injuries(P=0.013). CONCLUSION: The study shows a significant association between lower OTS score and zone Ⅲ injury with lower final BCVA and a higher number of surgeries, but only zone Ⅲ could be significantly associated with a higher rate of RD.

Application of pediatric ocular trauma score in pediatric open globe injuries

AIM:To evaluate the predictive value of pediatric penetrating ocular trauma score(POTS)on the visual outcome in children with open globe injury.METHODS:A retrospective study in 90 children(60 males and 30 females)aged 1-15 y(average,7.48±2.86 y)with penetrating ocular trauma was performed.Each patient’s POTS was calculated.The effects of POTS on final visual acuity(FVA)were examined.Correlation between factors affecting POTS and the FVA was established.RESULTS:All patients presented with single-eye trauma.The follow-up time was 3-21 mo(average,10.23±3.54 mo).Among the 90 cases of penetrating wounds,71 eyes(78.89%)were injured in Zone I(wound involvement limited to the cornea,including the corneoscleral limbus),17 eyes(18.89%)were injured in Zone II(wound involving the sclera and no more posterior than 5 mm from the corneoscleral limbus),and 2 eyes(2.22%)were injured in Zone III(wound involvement posterior to the anterior 5 mm of the sclera).Analysis of POTS and FVA showed important correlation between them(r=0.414,P=0.000).Initial visual acuity(P=0.00),age(P=0.02),injury location(P=0.002),traumatic cataract(P=0.00),vitreous hemorrhage(P=0.027),retinal detachment(P=0.003),and endophthalmitis(P=0.03)were found to be statistically significant factors for the FVA outcome.CONCLUSION:Ocular trauma presents serious consequences and poor prognosis in children.The POTS may be a reliable prognostic tool in children with open globe injury.

Central retinal artery occlusion and traumatic optic neuropathy following blunt ocular trauma

Dear Editor,We are writing to present a case report of central retinal artery occlusion（CRAO）and traumatic optic neuropathy（TON）with immediate visual loss caused by blunt facial trauma with a soccer ball.CRAO is an ophthalmic emergency with an estimated incidence of 10 in 1 million.

Pediatric ocular trauma with pars plana vitrectomy in Southwest of China:clinical characteristics and outcomes

AIM:To investigate the clinical characteristics and predictive factors of pediatric ocular trauma patients with vitrectomy.METHODS:Pediatric ocular trauma patients(aged 14 y or younger)who received vitrectomy in Southwest Hospital between January 2007 and December 2017 were reviewed retrospectively.Age,gender,mechanism of injury,final visual acuity(VA),and prognostic factors were analyzed.RESULTS:A total of 139 eyes in 139 pediatric patients were included in the study.The mean age was 7.4±3.7 years old and the male-to-female ratio was 5:1.There were 104(74.8%)open globe injuries and 35(25.2%)closed globe injuries.The top one traumatic eye injuries were penetrating injuries occur through sharp metal objects(43.9%).After vitrectomy,116 patients had favorable anatomic outcome at the last follow-up,and 30 eyes(21.6%)achieved VA of 20/200 or better.Following univariate analysis,we found zone III injuries(P=0.021),poor initial VA(P=0.005),endophthalmitis(P=0.024),and recurrent retinal detachment(P<0.001)were poor prognostic factors for pediatric ocular trauma.After Logistic regression analysis,the poor initial VA(odds ratio:8.276,95%CI:1.597-42.897,P=0.012)and recurrent retinal detachment(odds ratio:6.455,95%CI:2.372-17.562,P<0.001)were significantly correlated with unfavorable vision outcome in pediatric ocular trauma.CONCLUSION:The treatment of vitrectomy for severe ocular trauma results in favorable anatomic outcomes,but VA improvement is not as good as anatomic outcomes.Initial VA and recurrent retinal detachment are the independent prognostic indicators for unfavorable visual outcome of severe pediatric ocular trauma.

Ocular trauma in an urban Spanish population:epidemiology and visual outcome

AIM:To describe epidemiological aspects,clinical findings,and visual results in eye trauma patients requiring urgent surgery at a tertiary hospital.METHODS:Retrospective review of adult patients requiring urgent surgery for trauma to the eyeball from January 2010 and April 2020.Data was collected relative to age,gender,mechanism of the injury,type of wound,initial and final visual acuity,number and type of surgeries carried out.Injuries were classed according to the Birmingham Eye Trauma Terminology(BETT)and the Ocular Trauma Score(OTS)categories.RESULTS:The survey included 92 eyes.Mean age was 54.76±22.18 y.The most frequent cause was domestic accidents(44.6%),followed by aggression(22.80%)and occupational accidents(17.4%).Trauma from aggression was more frequent in men(P=0.006)and accidents in the home more common in women(P=0.011).Patients over 65 y presented an odds ratio(OR)of 10.71 for suffering a domestic accident.Patients between 15-45 and 46-65 y were at higher risk of trauma from aggression(OR=17.52 and OR=10.94,respectively).As for the type of injury,63.04%were open-globe lesions,Zone II being the most frequently affected(27.2%).In Logistic regression analysis,old age(P=0.05)and retinal involvement(P=0.001)were found to be associated with higher rate of unfavourable visual outcome.CONCLUSION:The epidemiological aspects of eye trauma are highly dependent on the area of population studied.Domestic accidents are more relevant than workplace accidents in older urban areas with high socioeconomic status.A better knowledge of the epidemiological characteristics is useful for implementing specific prevention measures and appropriate treatment strategies.

Establishment of a prediction tool for ocular trauma patients with machine learning algorithm

AIM:To predict final visual acuity and analyze significant factors influencing open globe injury prognosis.METHODS:Prediction models were built using a supervised classification algorithm from Microsoft Azure Machine Learning Studio.The best algorithm was selected to analyze the predicted final visual acuity.We retrospectively reviewed the data of 171 patients with open globe injury who visited the Pusan National University Hospital between January 2010 and July 2020.We then applied cross-validation,the permutation feature importance method,and the synthetic minority over-sampling technique to enhance tool performance.RESULTS:The two-class boosted decision tree model showed the best predictive performance.The accuracy,precision,recall,F1 score,and area under the receiver operating characteristic curve were 0.925,0.962,0.833,0.893,and 0.971,respectively.To increase the efficiency and efficacy of the prognostic tool,the top 14 features were finally selected using the permutation feature importance method:(listed in the order of importance)retinal detachment,location of laceration,initial visual acuity,iris damage,surgeon,past history,size of the scleral laceration,vitreous hemorrhage,trauma characteristics,age,corneal injury,primary diagnosis,wound location,and lid laceration.CONCLUSION:Here we devise a highly accurate model to predict the final visual acuity of patients with open globe injury.This tool is useful and easily accessible to doctors and patients,reducing the socioeconomic burden.With further multicenter verification using larger datasets and external validation,we expect this model to become useful worldwide.

Dislocation,fold and striae of comeal flap with laser assisted in situ keratomileusis after ocular trauma:a case report

Objective： To report the occurrence, management and outcome ot late-onset traumauc aemscence ana dislocation of laser assisted in situ keratomileusis （LASIK） flaps. Treatment and Results： One patient occurred late-onset LASIK corneal flap dislocation after ocular trauma 7days after surgery. The flap was lifted, stretched, and repositioned after irrigation and scraping of the stromal bed and the underside of the flap. A bandage contact lens was placed, and topical antibiotic and corticosteroids were given postoperatively. The dislocated corneal flap was successfully repositioned in the case. The dislocated flap was repositioned 7 days after the trauma, and the patient recovered his uncorrected visual acuity （UCVA） of 10/20, 20/20 day 1 and day 20 after the procedure, of 20/20 20 days later and had a well-positioned flap with a clear interface. Diffuse lamellar keratitis developed in the patients that resolved with the use of topical corticosteroids. Conclusion： Laser in situ keratomileusis corneal flaps are vulnerable to traumatic dehiscence and dislocation, which should be pay more attention to it for us.

Penetrating Ocular Trauma in a Goldfish Model after Chloramphenicol or Traditional Medicine Angong Niuhuang Pill Treatment: An Analysis of Retinal Responses after 7 Days

Purpose: While there were numerous clinical examples of ocular damage, the histopathology of retinal responses was poorly characterized, and animal model research was limited. The consequences of retinal lesions with traditional medicine treatment were mostly unknown. In this work, goldfish was employed as a model for penetrating injury of the eyes to study the ocular trauma with antibiotic and traditional medicine treatments. Materials and Methods: The penetration of the eyes was performed at 2mm above the midline of the limbus in the superior quadrant with an 18-gauge sterile needle, all the way to the retina but avoiding the lens while the animals were anaesthetized in water containing 100 mg/L ethyl 3-aminobenzoate methanesulfonate (MS-222). The animals were divided into three groups and received treatments of saline, chloramphenicol, and Angong Niuhuang pill (Angong) eyedrops twice a day respectively. Angong after seven days, the animals were sacrificed. Immunohistochemical evaluation of proliferative cell nuclear antigen (PCNA), brain-derived neurotrophic factor (BDNF), catalase, and cleaved caspase-3, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) for apoptotic cells were performed on the fish’s superior quadrants of the retinae. The whole experiment was repeated two times. Result: It was evident that both the retinae treated with chloramphenicol and Angong had fewer apoptotic cells and more proliferative cells, particularly in the cases of the Angong treatment. BDNF was in the inner nuclear layer and ganglion cell layer of all groups. In the chloramphenicol and Angong groups, some cells in the outer nuclear layer displayed BDNF. Catalase reactions confirmed equivalent findings that the treated retinae with chloramphenicol or Angong treatment had less catalase. Conclusion: Angong Niuhuang pill is a traditional medicine composite formula with antibiotic and neuroprotective effects on the brain and the eyes, and this work also pointed out its possible pharmaceutical potential.

A survey of incidental ocular trauma by pencil and pen

AIM：To determine characteristic features of ocular trauma resulted from self-trauma by writing instruments among pediatric population.METHODS：Thirty-six children who suffered from selfinflicted ocular trauma with a writing instrument were included in this prospective cross-sectional study.RESULTS：The mean age was 5.6±2.7y with male：female ratio of 1.77.The right eye was involved two times more than the left eye.The superomedial（55.5%）and inferomedial（30.6%）quadrants were the most common sites of injury.The leading culprit was colored pencils（44.4%）.During surgical exploration,no foreign body（FB）was found in 25（69.4%）patients while an FB was found in 11（30.5%）patients.Brain injury was present in two patients（5.6%）and only in superomedial quadrant injuries.Zone 1 was the most common site for ocular trauma associated with penetrating injury.The mean ocular trauma score（OTS）in penetrating injuries was 3.8±1.2.The best corrected visual acuity（BCVA）was 0.3±0.6 upon admittance and 0.08±0.21 after one year.The final BCVA was significantly correlated with the entrance site,better final BCVA was found in nasal entrance site（P〈0.05）.CONCLUSION：The ophthalmologists should keep a high index of suspicion to rule out penetrating eye injuries related to writing instruments in a young uncooperative child.Brain injury is a life-threatening event that should be ruled out by appropriate imaging.Medial canthal area as the most common site needs an especial attention in writing instrument injuries.

Influence of Psychological Intervention before Emergent Ocular Trauma Surgery on Patients' Negative Emotions

Purpose:.To investigate the effect of preoperative psychological intervention on alleviating negative emotions in patients undergoing emergent ocular trauma surgery.Methods:..A total of 100 patients undergoing emergent ocular trauma surgery were selected using convenience sampling and randomly divided into control(n=49) and experimental(n =51) groups. Patients in the control group received conventional nursing and their counterparts in the observation group were treated with individualized psychological interventions including psychological support, relaxation training, and humanistic care based on conventional nursing care..Self-rating anxiety scale(SAS), self-rating depression scale(SDS), and fear visual analog scale(FVAS) scores were statistically compared between the two groups.Results:.The scores of SAS, SDS, and FAVS were significantly lower in the experimental group than in the control group(all P<0.001).Conclusion:.Comprehensive psychological intervention effectively eliminates negative emotions in patients undergoing emergent ocular trauma surgery and accelerates their physical and mental recovery.