GFAP expression in the optic nerve and increased Н2S generation in the integration centers of the rainbow trout（Oncorhynchus mykiss） brain after unilateral eye injury

Hydrogen sulfide(H2S)is considered as a protective factor against cardiovascular disorders.However,there are few reports on the effects of H2S in the central nervous system during stress or injury.Previous studies on goldfish have shown that astrocytic response occurs in the damaged and contralateral optic nerves.Glial fibrillary acidic protein(GFAP)concentration in the optic nerves of rainbow trout has not been measured previously.This study further characterized the astrocytic response in the optic nerve and the brain of a rainbow trout(Oncorhynchus mykiss)after unilateral eye injury and estimated the amount of H2S-producing enzyme cystathionineβ-synthase(CBS)in the brain of the rainbow trout.Within 1 week after unilateral eye injury,a protein band corresponding to a molecular weight of 50 kDa was identified in the ipsi-and contralateral optic nerves of the rainbow trout.The concentration of GFAP in the injured optic nerve increased compared to the protein concentration on the contralateral side.The results of a quantitative analysis of GFAP+cell distribution in the contralateral optic nerve showed the largest number of GFAP+cells and fibers in the optic nerve head.In the damaged optic nerve,patterns of GFAP+cell migration and large GFAP+bipolar activated astrocytes were detected at 1 week after unilateral eye injury.The study of H2S-producing system after unilateral eye injury in the rainbow trout was conducted using enzyme-linked immunosorbent assay,western blot analysis,and immunohistochemistry of polyclonal antibodies again st CBS in the integrative centers of the brain:telencephalon,optic tectum,and cerebellum.Enzyme-linked immunosorbent assay results showed a 1.7-fold increase in CBS expression in the rainbow trout brain at 1 week after unilateral eye injury compared with that in intact animals.In the ventricular and subventricular regions of the rainbow trout telencephalon,CBS+radial glia and neuroepithelial cells were identified.After unilateral eye injury,the number of CBS+neuroepithelial cells in the pallial and subpallial periventricular regions of the telencephalon increased.In the optic tectum,unilateral eye injury led to an increase in CBS expression in radial glial cells;simultaneously,the number of CBS+neuroepithelial cells decreased in intact animals.In the cerebellum of the rainbow trout,neuroglial interrelationships were revealed,where H2S was released,apparently,from astrocyte-like cells.The organization of H2S-producing cell complexes suggests that,the amount of glutamate produced in the rainbow trout cerebellum and its reuptake was controlled by astrocyte-like cells,reducing its excitotoxicity.In the dorsal matrix zone and granular eminences of the rainbow trout cerebellum,CBS was expressed in neuroepithelial cells.After unilateral eye injury,the level of CBS activity increased in all parts of the cerebellum.An increase in the number of H2S-producing cells was a response to oxidative stress after unilateral eye injury,and the overproduction of H2S in the cerebellum occurred to neutralize reactive oxygen species,providing the cells of the rainbow trout cerebellum with a protective effect.A structural reorganization in the dorsal matrix zone,associated with the appearance of an additional CBS+apical zone,and a decrease in the enzyme activity in the dorsal matrix zone,was revealed in the zones of constitutive neurogenesis.All experiments were approved by the Commission on Biomedical Ethics,A.V.Zhirmunsky National Scientific Center of Marine Biology(NSCMB),Far Eastern Branch,Russian Academy of Science(FEB RAS)(approval No.1)on July 31,2019.

Epidemiology and risk factors for sports-and recreation-related eye injury:a multicenter prospective observational study

AIM:To identify the epidemiologic characteristics of sportsand recreation-related eye injuries in a large metropolitan city and investigate risk factors associated with visual impairment.METHODS:We performed a multicenter prospective observational study on patients using the regional eye injury registry data.This study included patients with sportsand recreation-related eye injury in four tertiary teaching hospitals in Daegu,Republic of Korea,from August 2016 to July 2018.The primary outcome was visual impairment at the first hospital visit.Distributions of sex,age,place,and causative materials were analyzed according to causative activities.To examine the association between causative activities and visual impairment,a Logistic regression analysis was used.RESULTS:Of the 349 sports-and recreation-related eye injuries,soccer was the most common causative activity,with 21.8%(n=76).Sports-and recreation-related eye injuries occurred mainly in teenagers,individuals in their 20 s,and men.Badminton and soccer were significantly associated with visual impairment at the first hospital visit compared with combat sports[(adjusted odds ratio(AOR),5.18;95%confidence interval(CI),1.67-16.09 for badminton and AOR,3.87;95%CI,1.36-10.99 for soccer].CONCLUSION:Intervention efforts such as deployment of protective eyewear in sports facilities and schools and promotion of wearing protective eyewear during these activities in teenagers and individuals in their 20 s are mandatory.

Orchard Sports Injury and Illness Classification System (OSIICS) Version 15

Background:Sports medicine(injury and illnesses)requires distinct coding systems because the International Classification of Diseases is insuf-ficient for sports medicine coding.The Orchard Sports Injury and Illness Classification System(OSIICS)is one of two sports medicine coding systems recommended by the International Olympic Committee.Regular updates of coding systems are required.Methods:For Version 15,updates for mental health conditions in athletes,sports cardiology,concussion sub-types,infectious diseases,and skin and eye conditions were considered particularly important.Results:Recommended codes were added from a recent International Olympic Committee consensus statement on mental health conditions in athletes.Two landmark sports cardiology papers were used to update a more comprehensive list of sports cardiology codes.Rugby union protocols on head injury assessment were used to create additional concussion codes.Conclusion:It is planned that OSIICS Version 15 will be translated into multiple new languages in a timely fashion to facilitate international accessibility.The large number of recently published sport-specific and discipline-specific consensus statements on athlete surveillance warrant regular updating of OSIICS.

Explosive eye injuries: characteristics, traumatic mechanisms, and prognostic factors for poor visual outcomes

Background: Explosions can produce blast waves, high-speed medium, thermal radiation, and chemical spatter,leading to complex and compound eye injuries. However, few studies have comprehensively investigated the clinical features of different eye injury types or possible risk factors for poor prognosis.Methods: We retrospectively reviewed all consecutive records of explosive eye injuries(1449 eyes in 1115 inpatients)in 14 tertiary referral hospitals in China over 12 years(between January 1, 2008 and December 31, 2019). Data on demographics, eye injury types, ocular findings, treatments, and factors affecting visual prognosis were extracted from a standardized database of eye injuries and statistically analyzed.Results: Mechanical ocular trauma accounted for 94.00% of explosion-related eye injuries, among which intraocular foreign bodies(IOFBs) resulted in 55.17% of open globe injuries(OGIs) and contusion caused 60.22% of close globe injuries(CGIs). Proliferative vitreous retinopathy(PVR) was more common in perforating(47.06%) and IOFB(26.84%)than in penetrating(8.79%) injuries, and more common with laceration(24.25%) than rupture(9.22%, P<0.01).However, no difference was observed between rupture and contusion. Ultimately, 9.59% of eyes were removed and the final vision was ≤4/200 in 45.82% of patients. Poor presenting vision [odds ratio(OR)=5.789], full-thickness laceration of the eyeball ≥5 mm(OR=3.665), vitreous hemorrhage(OR=3.474), IOFB(OR=3.510), non-mechanical eye injury(NMEI, OR=2.622), rupture(OR=2.362), traumatic optic neuropathy(OR=2.102), retinal detachment(RD,OR=2.033), endophthalmitis(OR=3.281), contusion(OR=1.679), ciliary body detachment(OR=6.592), zone Ⅲ OGI(OR=1.940), and PVR(OR=1.615) were significant negative predictors for poor visual outcomes(P<0.05).Conclusions: Explosion ocular trauma has complex mechanisms, with multiple eyes involved and poor prognosis. In lethal level Ⅰ explosion injuries, eyeball rupture is a serious condition, whereas contusion is more likely to improve. In level Ⅱ injuries, IOFBs are more harmful than penetrating injuries, and level Ⅳ represents burn-related eye injuries.PVR is more associated with penetrating mechanisms than with OGI. Identifying the risk predictors for visual prognosis can guide clinicians in the evaluation and treatment of ocular blast injuries.

Epidemiology of children and adolescent eye injuries in British Columbia

AIM To quantify and characterize children and adolescent eye injuries treated in trauma department.METHODS A retrospective analysis was conducted of children and adolescent patients(0-19 years of age) with eye injuries using the British Columbia Trauma Registry(BCTR) data. BCTR data was obtained from January 1,2000 to December 31,2008. The BCTR provides the most detailed information on severe injuries throughout the province of BC. There are 12 trauma-receiving facilities in BC from which BCTR collects data.RESULTS A total of 162 patients with eye injuries were registered in BCTR during the data collection period. The highest number of injuries occurred in the 15-19 age group,followed by 10-14 and 5-9 age groups. Seventy-one point six percent of all patients were male. The mean age for all patients was 12.9(SD = 5.8) years. Vehicular crash was by far the most common mechanism of injury among all patients(42.0%) followed by blunt injury(14.2%) and cuts(12.3%). The child and adolescent eyeinjury data set we used for our study indicated that there were in total,50 patients that were tested for alcohol and drug use. The majority of them were 15-19 years of age(n = 38). Among the tested eye injury patients in the 15-19 age group,47%(18/38) tested positive for alcohol. There were approximately 30 cases of physical fighting(assault) and fighting-related injury among adolescents. Some injuries were caused by use of fire arms and knife during the assaults. Out of all patients,62(38%) were seen by an Ophthalmologist on admission,whereas 100(62%) patients were not seen by an eye specialist on admission. The most common injury diagnosis among the patients not consulted by ophthalmologist was conjunctiva injury(53%),whereas almost 9 out of 10 patients with ophthalmological consultation had laceration of cornea injury diagnoses. Using Glasgow Coma Scale(GCS)-based classification of brain injury severity,3.7% of all patients were classified with severe brain injury(GCS ≤ 8),while more than 64% had diagnosed with a mild brain injury(GCS ≥ 13).CONCLUSION This study suggests that most child and adolescent eye injuries in BC occur at street/highway locations followed by incidents at home. Vehicular crash was by far the most common mechanism of injury among all patients(42%). Sixty-four point two percent of child and adolescent eye injury patients also had mild brain injuries. Further,the child and adolescent eye injury data set we used for our study indicated that there were in total,50 patients tested for alcohol and drug use. There is an urgent need for a child and adolescent eye injury prevention plan in our province.

Mechanical Eye Trauma Epidemiology, Prognostic Factors, and Management Controversies—An Update

Purpose of Review: The management of eye injuries is both difficult and argumentative. This study attempts to highlight the management of ocular trauma using currently available information in the literature and author experience. This review presents a workable framework from the first presentation, epidemiology, classification, investigations, management principles, complications, prognostic factors, final visual outcome and management debates. Review Findings: Mechanical ocular trauma is a leading cause of monocular blindness and possible handicap worldwide. Among several classification systems, the most widely accepted is Birmingham Eye Trauma Terminology (BETT). Mechanical ocular trauma is a topic of unsolved controversy. Patching for corneal abrasion, paracentesis for hyphema, the timing of cataract surgery and intraocular lens implantation are all issues in anterior segment injuries. Regarding posterior segment controversies, the timing of vitrectomy, use of prophylactic cryotherapy, the necessity of intravitreal antibiotics in the absence of infection, the use of vitrectomy vs vitreous tap in traumatic endophthalmitis is the issues. The pediatric age group needs to be approached by a different protocol due to the risk of amblyopia, intraocular inflammation, and significant vitreoretinal adhesions. The various prognostic factors have a role in the final visual outcome. B scan is used to exclude R.D, Intraocular foreign body (IOFB), and vitreous haemorrhage in hazy media. Individual surgical strategies are used for every patient according to the classification and extent of the injuries. Conclusion: This article examines relevant evidence on the management challenges and controversies of mechanical trauma of the eye and offers treatment recommendations based on published research and the authors’ own experience.

Open globe injury in Hospital Universiti Sains Malaysia- a 10-year review

AIM:To identify the aetiology of open globe injuries at Hospital Universiti Sains Malaysia over a period of 10y and the prognostic factors for visual outcome.METHODS:Retrospective review of medical records of open globe injury cases that presented from January2000 to December 2009.Classification of open globe injury was based on the Birmingham Eye Trauma Terminology(BETT).Records were obtained with hospital permission via the in-house electronic patient management system,and the case notes of all patients with a diagnosis of open globe injury were scrutinised.Patients with prior ocular trauma,pre-existing ocular conditions affecting the visual acuity,contrast sensitivity,central vision or corneal thickness,as well as those with a history of previous intraocular or refractive surgery were excluded.Analysis of data was with SPSS version20.0.Ordinal logistic regression analysis was used to examine the association between prognostic factors and visual outcome.RESULTS:This study involved 220 patients(n=222eyes).The most common place of injury was the home(51.8%),followed by the workplace(23.4%).Among children aged less than 16y of age,domestic-related injury was the predominant cause(54.6%),while in those aged 16y and above,occupational injuries were the most common cause(40.0%).Most eyes(76.5%)had an initial visual acuity worse than 3/60,and in half of these,the visual acuity improved.The visual outcome was found to be significantly associated with the initial visual acuity(P【0.005),posterior extent of wound(P【0.001),length of wound(P【0.001),presence of hyphaema(P【0.001)and presence of vitreous prolapse(P【0.005).CONCLUSION:The most common causes of open globe injury are domestic accidents and occupational injuries.Significant prognostic factors for final visual outcome in patients with open globe injury are initial visual acuity,posterior extent and length of wound,presence of hyphaema and presence of vitreous prolapse.Awareness of the factors predicting a poor visual outcome may be helpful during counselling of patients with open globe injuries.

Analysis on sports and recreation activity-related eye injuries presenting to the Emergency Department

AIM：To investigate the incidence and general characteristics of sports-related eye injuries in patients visiting the Emergency Department. METHODS： A cross-sectional,multi-center,observational study.Patients with an injured eye who visited the Emergency Department at one of nine hospitals in Korea were enrolled.All data were prospectively collected between March and September 2010 using a questionnaire.Eye injuries that occurred during risky sports were examined by gender and age.Additionally,the rate of open globe injuries that occurred with and without protective eyewear was examined for each activity.Continuous variables were compared using Student＇s t-test and categorical variables were compared using Chi-square test.RESULTS： A total of 446 patients had sports-related eye injuries.Teenagers（10-19 years old） and young adults（20-29 years old） had the most eye injuries.Eye injuries accounted for 0.2% of Emergency Department patients.Baseball was the most common cause of sports-related eye injuries,followed by soccer and hiking.Protective gear was worn by 9.4% of all patients.Patients that were 30-39 years of age had the highest rate of protective gear use,followed by patients that were 40-49 years of age.The proportion of sports-related eye injuries that were open-globe injuries was highest for soccer and hiking.CONCLUSION： Although injuries were most common in patients below the age of 10 years,these patients had the lowest rate of protective eyewear use.Injuries in adults over 40 years of age most commonly occurred during hiking,but the rate of protective eyewear use was low.Young athletes should be educated on and provided with protective eyewear and policies protective gear use should be established.For older adults,eye protection should be encouraged,especially during hiking.

A 10-Year Survey of Severe Eye Injuries in Sport in Belgrade,Serbia 2000-2009

Introduction: The eye injuries inflicted in different sport activities are relatively rare and depend upon the type of sport. They are more common in recreational sport activities. These injuries are generally minor but may be very severe and result in permanent vision impairment. One must be aware of the fact that these sport activities, either recreative or professional, are exercised by young people. Methods: All analyzed patients were hospitalized at the Clinic of Eye Diseases, Clinical Center of Serbia, Belgrade, for severe eye injuries which occurred in sport activities. The analyzed period included 10 years, from the beginning of 2000 to the end of 2009. Results: In this period, a total of 117 patients with eye injuries sustained in some of sport activities were hospitalized. There were 114 (97.5%) injured males. Mean age of the injured was 25.8 years, and there were no individuals older than 50 years of age. Closed eyeball injures were reported in 96.6% and open injuries were seen in the remaining 3.4% of cases. During recreational sports, the eye injuries occurred in 76.1%, in the school—19.6%, and in professional sport—4.3% of the time. The injured individuals were as follows: pupils—35.0%, students—17.9%, workers—22.2%, clerks—20.6% and professional players—4.3% of cases. Upon completed treatment, visual acuity was normal in 77.8%, subnormal in 16.2%, impaired in 3.4% and amaurosis in 2.6% of cases.

Common eye drops and their implications for p H measurements in the management of chemical eye injuries

Dear Sir,Eye drops(single use)commonly used in clinics do have varying pH values.The use of such drops in the initial management of chemical eye injury may influence the accuracy of pH measurement of the eye,and subsequently influence its management.Chemical eye injury is an ophthalmic emergency,which may be caused by exposure to an acidic(pH【4)or an alkali(pH】10)solution to the eye.Rinsing the eye decreases the concentration of these solutions on ocular surface.The initial management would be copious irrigation with clean or sterile water or Ringer’s solution(pH 7.3-7.4)or its equivalent,of a

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.

Intralenticular metallic foreign body: a case report

A case of retained intralenticular iron piece with signs of mild anterior uveitis at the time of presentation is reported in a 45 year-old man. His vision improved with topical cycloplegics and corticosteroids. After six months, his vision deteriorated grossly due to cataract formation. He regained good vision following removal of foreign body, extracapsular extraction with posterior chamber intraocular lens implantation. This case highlights the conservative management of the condition till the patient develops cataract resulting in visual disability; and good visual recovery following cataract surgery with intraocular lens implantation.

Disappeared intralenticular foreign body:A case report

BACKGROUND Intralenticular foreign body is rarely encountered in ophthalmic practice.In most cases,subsequent traumatic cataract requires cataract surgery for visual rehabilitation.CASE SUMMARY A 35-year-old man was injured by iron filings in his left eye.After the injury,the patient tried to draw the object out by himself using a magnet;however,the foreign body(FB)was pushed to the equator of the lens.The FB was removed by a magnet through the anterior chamber accessed through the original capsular wound.Since most of the lens was transparent and only partially opaque after the operation,the lens was kept under close observation.After the surgery,the patient’s visual acuity reached 20/20 from 2/20,visual function recovered very well,and local opacity of the lens remained stable.CONCLUSION For intralenticular FB in the anterior cortex under the capsule,magnet may be a more advantageous way to remove the object.

Epidemiological aspects of ocular superglue injuries

AIM： To report the frequency, associated risk factors and characteristics of cases referred to Farabi Eye Hospital with ocular superglue injuries. METHODS： In a descriptive cross-sectional study conducted between December 2012 and February 2013, patients with ocular superglue injuries were evaluated. Age, sex, educational level, location, time, mechanism, type, site and time of eye injury were gathered through interview using a customized questionnaire. All participants had given consent to undergo thorough eye examination. RESULTS： Over the course of three months, 105 patients with ocular superglue injuries enrolled in the study, including 56 （53.3%） men and 49 （46.7%） women with the mean age of 24.7±11.6 （range, 2 to 53）y. The right eye, left eye and both eyes were involved in 52%, 42% and 6% of the patients, respectively. Most of injuries had occurred at home （72.4%） and at night （55%）. More than half of patients （52.4%） did not take any primary aids following the ocular injury. Patient carelessness （78.1%）, childhood curiosity and lack of parental supervision （11.4%）, storing superglue in inappropriate places and inadvertently using superglue as eye drops due to poor vision （2.9%）, inadequate awareness of superglue applications [used to stick on artificial nails （3.8%）, artificial eyelashes （1.9%） and broken tooth （1%）] and being assaulted with glue （1%） were common risk factors. CONCLUSION： The frequency of ocular superglue injuries in patients referred to Farabi Eye Hospital is relatively high. This finding underlines the importance of public education and awareness about superglue injuries to the eye and taking protective measures and safety strategies in order to prevent these injures.

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.

Lower Lid Entropion Secondary to Missed Intraorbital Foreign Body in a Child

Background: Intraorbital foreign bodies can result in various complications if not appropriately managed. Aim: To report a case of lower lid entropion secondary to a missed intraorbital foreign body. Case Presentation: A 7-year-old boy presented with inward turning of the left lower lid for three days prior to admission. A week before, the child was in the garden when part of the roof of their home suddenly broke off, with pieces of the debris falling near him. He complained of left eye irritation, but a visit to a general practitioner found no eye abnormalities. Three days after that, the mother sought an ophthalmology opinion as she noticed inversion of the left lower lid. On examination, visual acuity in both eyes was 6/6. There was left lower lid entropion, and a deeply embedded foreign body seen in the lower lid. No other eye abnormalities noted. Computed tomography scan of the orbits revealed a welldefined foreign object in the lower orbit, fracturing the antero-superior wall of the left maxillary sinus. The left eye foreign body was removed uneventfully via a transconjunctival approach. Conclusion: A thorough examination is mandatory in any case of ocular trauma especially in young children, who are usually unable to provide a clear history of the injury.

Development of sympathetic ophthalmia following globe injury

Background Sympathetic ophthalmia （SO）, a rare, bilateral, diffuse granulomatous uveitis, usually occurs after open globe injury or intraocular surgery. We sought to identify the risk factors for the development of SO after open globe injury and describe their demographic and clinical features and outcomes of treatments. Methods A retrospective study of inpatients with globe injury in 15 tertiary referral hospitals of China from January 2001 to December 2005 was conducted. The information of demography, nature and mechanism of injury, time and ways of treatments and outcomes was reviewed. Diagnosis of SO was made based on a history of ocular trauma or surgery and subsequent development of bilateral or contralateral uveitis consistent with SO. Any association between related parameters and development of SO was analyzed. Results Among 9103 patients （9776 eyes） of globe injury, SO occurred after open globe injury in 18 cases with an occurrence rate of 0.37%, vitrectomy of closed globe injury in 2 （0.37%） and perforation of burned eyes in another 2. For open globe injury, the median age （（36.72±13.59） years, P=0.01） was higher in patients with SO; there were no significant effects of sexes, injury type, uvea proplaps, once or multi-intraocular surgery, once or multi-vitrectomy and endophthalmitis on incidence of SO; 0.70% endophthalmitis concurred with SO; 83.33% of SO occurred within 1 year after injury or last ocular surgery. SO developed in a fellow eye one week after evisceration of the perforating burned eye. Good final visual acuity was obtained in sympathizing eyes with prompt treatment. Conclusions For open globe injuries, SO sufferers were relatively older and any injury type could induce SO with equal possibility. The initial open globe injury was more likely to be the trigger of SO than subsequent intraocular surgeries including vitrectomy. Prophylactic enucleation after injury is not recommended.

Ocular injuries,attention deficit and hyperactivity disorder,and maternal anxiety/depression levels:Is there a link?

Purpose:Given the increased risk of accidents in patients with attention deficit and hyperactivity dis-order(ADHD)or maternal anxiety/depression,we aimed to investigate the frequency of the two diseases in children with penetrating eye injury(PEI).Methods:Altogether 79 children,39 with PEIs and 40 healthy individuals(control group),aged 5-15 years,underwent a complete ophthalmologic examination.Afterwards,schedule for affective disorders and schizophrenia for school-aged children was conducted to assess the psychiatric diagnosis of all children.Turgay diagnostic and statistical manual of mental disorders(DSM-Ⅳ)-based child and adolescent behavior disorders screening and rating scale(T-DSM-Ⅳ-S)was flled by parents to evaluate the severity of ADHD symptoms.The depression and anxiety levels of mothers of each group were evaluated by two self-report measures:the Beck depression scale and the state-trait anxiety inventory(STAI),respectively.Data were analyzed by IBM SPSS version 22.0.The Chi-square and Fisher's exact test were used to determine whether there is a significant difference between qualitative variables while independent sample t and Mann-Whitney U tests to compare quantitative variables.Results:The only diagnostic difference was a significantly higher frequency of ADHD among patients with PEIs(48.7%in PEI vs.17.5%in control group,χ^2=7.359,p=0.007).The total scores of the T-DSM-Ⅳ-S(attention subscale U=418.000,p=0.006;hyperactivity subscale U=472.000,p=0.022)and maternal state-trait anxiety inventory(maternal STAI-state U=243.00,p=0.003;maternal STAl-trait U=298.000,p=0.021)were significantly higher in the PEI group than in control group.In logistic regression,children with PEI had a tendency to have a 3.5-fold increased risk for ADHD(OR=3.538,CI=0.960-13.039,p=0.058).Conclusion:ADHD was detected almost 1 in 2 children with PEls.Besides,the maternal anxiety level was significantly higher in the PEI group than in the control group.This association should be further explored via a future prospective longitudinal study.Since a proper treatment of ADHD in children and anxiety treatment in mothers may prevent vision loss following PEIs in children.