Epidemiology and etiology of chemical ocular injury:A brief review

Chemical ocular injury is one of the common ophthalmologic emergencies that can cause vision loss and serious complications.Despite all protective measures,it continues to be a serious public health problem,especially in young male patients.Although it is known that injuries occur most frequently in the workplace and in young male patients,there is a variable frequency and distribution in different regions around the world.In addition,with the coronavirus disease 2019 pandemic,there are changing trends in ocular chemical injuries.This review aims to specify an update on the epidemiological and etiological features of ocular chemical injuries.

Ocular injury resulting in eye removal at a large tertiary care center in China

AIM:To investigate the risk factors for eye removal following ocular trauma at a major ophthalmology department in China.METHODS:A retrospective study of patients who underwent eye removal surgery following ocular trauma was completed.Clinical outcomes were consulted in detail through the hospital’s computed medical data system.Patients’information including age,gender,cause of ocular trauma,affected eye,and education level was collected and recorded in a standardized database.Chi-squared test,Student’s t-test,Fisher’s exact test,and bivariate correlation analysis were used for statistical comparisons.RESULTS:The present study included 1675 removal eyes from 1674 patients over the 20-year period.Patients included 80.5%males and 19.5%females,with mean age of 38y.The majority of the patients(70.7%)were blue-collar workers(physical laborers),and 1098 patients(65.6%)did not receive high school education.Work-related injuries were the most common reason for eye removal(n=739,44.1%),of which 441 cases(59.7%)were related to metal/nail wounds.The most frequent injury type in males was work-related injuries(49.7%),whereas the most frequent injury type in females was home-related injuries(25.8%).CONCLUSION:Work-related injuries are a leading cause of severe ocular injury resulting in eye removal.In addition,men and undereducated patients are more likely to undergo eye removal surgery following ocular trauma.This study identified multiple high-risk factors leading to eye removal following ocular trauma,which is of great importance for preventing severe eye injuries.

Visualizing traumatic brain injury:ocular clues for diagnosis and assessment

Traumatic brain injury (TBI) is defined as damage to the brain resulting from an external sudden physical force or shock to the head.It is considered a silent public health epidemic causing significant death and disability globally.There were 64,000 TBI related deaths reported in the USA in 2020,with about US$76 billion in direct and indirect medical costs annually.

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.

Epidemiology of Child’s Ocular Globe Injury: A Retrospective Study at the University Teaching Hospital-Campus of Lomé(Togo)

Aim: To study clinical and epidemiological characteristics of child’s ocular injuries. Patients and Method: Retrospective study on medical records of children suffering from traumatic injuries of the ocular globe presented to the Campus Teaching Hospital (CHU Campus) of Lomé from 3 January 2015 to 30 June 2016 (18 months). Age, sex, nature of the traumatising agent, consultation delay and the width of the injury (zone I, II or III), the classification of ocular trauma, according to “Birmingham Eye Trauma Terminology (BETT) system”, connected lesions have been studied. Results: Twenty children about 46.51% children presented for ocular trauma have been suffering from a globe injury. The average age was 6.68 years with the extremes of 1 year and 12 years;the age bracket of 0 - 5 years was more represented (45%);predominance was more from the female with a sex-ratio = 0.67. Eighty percent of the children were from rural areas while twenty from urban areas. The delay of consultation was less than 24 hours in 40% of cases and 15% consulted between 24 h and 72 h after the trauma. Traumatisms were entirely unilateral and penetrating within a majority of 15 (75%) cases of which a “stick” is the traumatising agent of the most frequent (40%). The seat of the injury was the zone I (85.71%) and zone II (14.29%). Connected lesions were dominated by iris hernia 7 (35%) and traumatic cataract 6 (30%). Conclusion: children’s traumas were high predominantly and they came in majority from rural zones. Prevention through awareness remains the best treatment.

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.

Epidemiologic characteristics and outcomes of open globe injury in Shanghai

AIM： To investigate the epidemiologic characteristics and outcomes of open globe injury in Shanghai. METHODS： A retrospective study was conducted for 148 unilateral open globe injury cases presenting to a tertiary referral hospital of Shanghai. Electronic medical records were reviewed and phone surveys were conducted to collect and analyze 1） background of patient; 2） setting of injury and clinical signs at presentation; 3） treatment procedure and outcome; 4） quality of life after injury. RESULTS： There were more male patients （77.03%） than females （22.97%）, more temporary habitants （79.05%） than residents （20.95%）. The subjects in this study presented a significantly lower constitutional status of education than that of the whole Shanghai population （P〈0.001）. Occupational injury was the first cause of injuries （39.86%）, followed by home accident （20.27%）, road accident （16.80%）, violent behavior （16.89%） and outdoor injury （6,08%）. The 143 subjects （96.62%） were not wearing spectacles at the time of injury. Of all patients, 77 subjects （52.03%） had the outcome of no vision （including enucleation）. The classification and regression tree （CART） prognosis presents 59.58% sensitivity to predict visual survival correctly and 80.19% specificity to predict no vision correctly. The patients whose injured eye had no vision reported more reduction of life quality. CONCLUSION： We found that male subject, temporary habitants, low educational status and no eyewear are risk factors of open globe injury in Shanghai. Occupational injury is the leading cause. CART analysis presents a certain agreement to the actual visual outcome. The injury imposes negative impact on quality of life especially in no vision cases. The education of eye protection may help to avoid the injury.

Comparison of the effects of intravitreal bevacizumab and dexamethasone in experimental posterior penetrating eye injury

AIM： To compare the effects of intravitreal anti-vascular endothelial growth factor（VEGF） and dexamethasone in an experimental rabbit model of posterior penetrating ocular injury.METHODS： Thirty white New Zealand rabbits were included in the study. A posterior penetrating ocular injury was performed at the superotemporal quadrant. They were randomly divided into three groups. The rabbits in group 1 received intravitreal dexamethasone, in group 2 they received intravitreal bevacizumab and those in group 3 received intravitreal physiological saline solution in both eyes. All eyes were examined ophthalmologically on the 1^st, 3^rd, 7^th, 14^th and 28^th days following the injury and the clinical findings were scored. On the day 28, the eyes were enucleated, evaluated and scored macroscopically, histopathologically and scanning electron microscopically.RESULTS： The median clinical score on the 14 th and 28 th days and the median macroscopic score of the dexamethasone group was significantly better than that of control（P=0.004, 0.018）. Dexamethasone group was also better than that of bevacizumab group but the differences did not reach statistical significance. Retinal detachment rate was 8.3%, 16.6% and 12.5% in the dexamethasone group, bevacizumab group and control group, respectively（P=0.476）. More extensive fibrocelluler proliferations were observed in controls compared with dexamethasone and bevacizumab groups. But these differences did not reach the statistical significance（P=0.538）. In scanning electron microscopy all groups showed fibreous stalk and dense collagen fibrils in vitreous. CONCLUSION： This study shows that intravitreal injection of both dexamethasone and bevacizumab may reduce the intraocular fibrous proliferation after an experimental posterior penetrating ocular injury in rabbits.

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.

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.

Growth hormone-releasing hormone receptor signaling in experimental ocular inflammation and neuroprotection

Both inflammation and anti-inflammation are involved in the protection of retinal cells.Antagonists of the hypothalamic growth hormone-releasing hormone receptor(GHRHR)have been shown to possess potent anti-inflammatory properties in experimental disease models of various organs,some with systemic complications.Such effects are also found in ocular inflammatory and neurologic injury studies.In experimental models of mice and rats,both growth hormone-releasing hormone receptor agonists and antagonists may alleviate death of ocular neural cells under certain experimental conditions.This review explores the properties of growth hormone-releasing hormone receptor agonists and antagonists that lead to its protection against inflammatory responses induced by extrinsic agents or neurologic injures in ocular animal models.

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.

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.

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.

眼部移植物抗宿主病患者的角结膜特征

目的探讨眼部移植物抗宿主病患者角结膜特征。方法选取2022年10月至2023年8月期间,就诊安徽医科大学第一附属医院血液科,合并眼部移植物抗宿主病患者28例,分析其不同眼表不同区域角膜荧光素钠染色以及结膜充血分数。结果眼部移植物抗宿主病患者其鼻下象限角膜染色分数显著高于颞下象限[2.000(1.0,2.0)vs 1.000(1.0,1.0),Z=-2.132,P=0.033]及鼻上象限[2.000(1.0,2.0)vs 0.000(0.0,1.0),Z=-3.650,P<0.001],颞下象限角膜染色分数显著高于颞上象限[1.000(1.0,1.0)vs 1.000(0.0,1.0),Z=-1.995,P=0.045],颞侧结膜充血分数高于颞侧近角膜部[0.600(0.4,1.0)vs 0.250(0.2,0.6),Z=-3.967,P<0.001],鼻侧结膜充血分数高于鼻侧近角膜部[0.850(0.4,1.4)vs 0.400(0.2,0.7),Z=-2.827,P=0.005],鼻侧结膜充血分数高于颞侧[0.850(0.4,1.4)vs 0.600(0.4,1.0),Z=-0.699,P=0.485]。结论下方角膜染色分数较上方更显著,鼻下方角膜荧光素钠染色较颞下方更显著,球结膜充血程度较近角膜缘处结膜更显著,鼻侧结膜充血程度较颞侧更显著。

军事训练和军事作业眼外伤流行病学调查

目的了解我军军事训练和军事作业眼外伤的流行病学特征。方法将2005年1月1日-2009年12月31日在全军训练伤监测网点11所后送医院住院的军人眼外伤资料填入"部队医院军人眼外伤登记表"。眼外伤患者的流行病学资料包括受伤时间、地点、外伤类型、原因、检查、治疗和康复水平等,所有数据录入数据库进行统计分析。结果共有军事训练和军事作业眼外伤患者189例,约占全部眼外伤的45.5%,受伤年龄23.4±5.4岁,均为男性;军官占9.0%,战士占91.0%。2006年比2005年发病人数降低,后逐年升高;合并全身伤情者4.2%,伤前有眼部病史或者手术史者4.2%,单眼受伤91.0%,双眼受伤9.0%;伤后视力1级者35.0%,2级20.6%,3级13.6%,4级25.7%,5级4.4%;机械性眼外伤者87.3%,非机械性眼外伤12.7%。大多数军事训练和军事作业眼外伤患者能得到及时后送救治,大部分预后良好。结论军事训练和军事作业眼外伤是我军多发的眼外伤,应该重视预防,应提高全军官兵预防意识,进一步深入研究详细的预防策略。

眼球钝挫伤后眼底损伤的表现及分型探讨

目的:探讨眼球钝挫伤后眼底损害的表现以及分类。方法:185例(185眼)眼球钝挫伤完整资料,对直接检眼镜和眼底荧光血管造影检查结果,结合中心视力损害程度进行分析。结果:眼球钝挫伤后影响视功能的眼底常见损害有视网膜震荡、视网膜出血、黄斑裂孔、脉络膜破裂、视网膜脱离和视神经损伤等。依据造影检查提供的视网膜组织损伤的形态学特点、部位,结合中心视力损害的程度,临床大体分为轻度、中度和重度三型。其中轻度31例,占16%;中度101例,占55%;重度53例,占29%。结论:眼球挫伤后眼底损害表现复杂多样,造影检查提供图像资料有利于对照观察和治疗。依据眼底造影图像、中心视力检查结合视网膜解剖学特点进行分型有利于判定病情,指导预后。

复杂性眼外伤玻璃体切除手术时机的选择

目的探讨玻璃体切除术治疗复杂性眼外伤手术时机和治疗效果.方法应用玻璃体切除术治疗复杂性眼外伤94例(95眼),总结临床资料,对手术时机和治疗效果进行分析、评价.结果 94例(95眼)术后视力提高78眼(82.11%),视力不变15眼(15.79%),视力下降2眼(2.11%).外伤后11～20天行玻璃体切除手术治疗的55眼,功能治愈48眼(87.27%),解剖治愈7眼(12.73%),没有未愈眼.无感染和交感性眼炎的发生.结论眼外伤后14天是选择玻璃体切除手术的最佳时机.

Research progress about the effect and prevention of blue light on eyes

In recent years, people have become increasingly attentive to light pollution influences on their eyes. In the visible spectrum, short-wave blue light with wavelength between 415 nm and 455 nm is closely related to eye light damage. This high energy blue light passes through the cornea and lens to the retina causing diseases such as dry eye, cataract, age-related macular degeneration, even stimulating the brain, inhibiting melatonin secretion, and enhancing adrenocortical hormone production, which will destroy the hormonal balance and directly affect sleep quality. Therefore, the effect of Blu-rays on ocular is becoming an important concern for the future. We describe blue light’s effects on eye tissues, summarize the research on eye injury and its physical prevention and medical treatment.

眼外伤评分法在机械性眼损伤中的法医学应用

目的探讨眼外伤评分(ocular trauma score,OTS)在机械性眼损伤视力预后评估中的应用价值。方法对411例机械性眼外伤(449眼,其中闭合性眼损伤317眼,开放性眼损伤132眼)进行OTS(以就诊初视力分级、眼球破裂伤、眼内炎、贯通伤或穿通伤、视网膜脱离、相对传入性瞳孔阻滞为评估指标),比较本组资料实际终视力比例与OTS标准终视力概率的差异,分析OTS分级与终视力之间的相关性,并对眼损伤的不同类型进行比较分析。结果实际终视力比例与OTS标准终视力概率分布相比,除OTS-3级有所差异外,其余各级均无明显差异。实际终视力与OTS分级、OTS总积分均呈线性相关(r值分别为0.71、0.73)。开放性眼损伤往往较闭合性眼损伤评分低、预后差,其中眼球破裂伤较眼球穿通伤预后更差。结论对眼外伤伤情进行OTS,可为法医学视力评估提供较为可靠的预测信息。