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.

CORRELATION BETWEEN FUNCTIONAL AND STRUCTURAL LOSS IN GLAUCOMA

Purpose: To study the correlation between functional and structural loss in chronic glaucoma, as detected by Frequency Doubling Technology (FDT) and Heilderberg Retina Tomograph (HRT). Material and Methods: 60 eyes of 60 patients with either ocular hypertension or chronic open-angle glaucoma underwent visual field testing with both standard

特异性睑结膜炎患者泪液中ⅡA组磷脂酶A2的含量

Background: To determine the concentration of group IIA phospholipase A2 (GIIAPLA2) in tears of patients with atopic blepharoconjunctivitis (ABC), and to compare it with the GIIAPLA2 conce ntration of tears in age-matched healthy controls. Methods: The diagnosis of AB C was confirmed with a positive skin prick test and the presence of atopic derma titis in lids. Conjunctival brush cytology was taken, and the cells including eo sinophils, neutrophils, lymphocytes, squamous epithelial cells, columnar epithel ial cells, metaplastic changes and the goblet cells were calculated separately. The GIIAPLA2 concentration of tears was measured with a time-resolved fluoroimm unoassay in 29 patients with ABC (mean age 36.3±12.7 years) and 29 normal subje cts (mean age 37.0±12.0 years). Results: The GIIAPLA2 concentration of tears in patients with ABC was 43.8±33.0 μg/ml, and in normal subjects it was 67.1±23 .3 μg/ml. The difference was statistically significant (P=0.001 8). The concent ration of GIIAPLA2 of tears was lowest in the subgroup of patients with ABC and dry eye (25.8 ±23.6 μg/ml), whereas it was only slightly decreased in patients with ABC and normal tear secretion (56.6±33.3 μg/ml). The difference between these two subgroups was statistically significant (P=0.011). There was no statis tically significant correlation between the GIIAPLA2 concentration of tears and the quantity of different conjunctival cells gathered by the brush cytology. How ever, an almost significant correlation was found between the GIIAPLA2 concentra tion in tears and conjunctival eosinophils. Conclusions: The results indicate th at in patients with ABC the GIIAPLA2 content of tears was decreased, without any dependence on the quantity of different conjunctival cells.

成人卵黄样黄斑变性的OCT3改变

Purpose To report the morphologic data of adult-onset foveomacular vitelliform dystrophy(AFVD)provided by thirdgeneration optical coherence tomography(OCT 3).Design Observational case report.Methods An 85-year-old woman presenting with AFVD underwen t fundus biomi-croscopy,fluorescein angiography,and OCT examination.Results Fundus examination disclosed a round,elevated yellowish lesion,centered by a pigm ented spot,in the macula of the left eye.Examination with OCT disclosed an area of hyperreflectivity located b etween the retinal pigment epithelium layer and the photorecep tor layer,compatible in size with the yellowish elevated lesion.The hyperreflective line corresponding to the photoreceptor layer was elevated by the material and separated from th e retinal pigment ep-ithelium layer.Conclusions In AFVD,examination with OCT 3demonstrates elevation of the p hotoreceptor layer by the material and supports the previo us hypothesis that the material is located between the photoreceptor and the reti-nal pigment epithelium layer.

白内障对倍频视野计检测结果的影响

Purpose To determine the effect of cataract on the results of frequency-doubl ing technology (FDT) perimetry. Design Consecutive cohort study. Participants Forty-four patients with normal ophtha lmic examinations, with the exception of cataract, scheduled to undergo phacoemu lsification and posterior chamber lens implantation were prospectively identifie d and completed the study. Methods All subjects underwent FDT perimetry using th e full-threshold C-20 strategy. Both eyes were tested within 1 month before ca taract surgery and up to 3 months after surgery. The unoperated fellow eyes serv ed as controls. Main outcome measures Changes in visual acuity (VA), mean deviat ion (MD), and pattern standard deviation (PSD) were evaluated. For each subject, the change in MD and PSD in the eye that underwent cataract surgery was adjuste d for change in the control eye that is thought to occur due to a learning effec t. Results Among the eyes that underwent cataract surgery, the median preoperati ve VA was 20/60 (range, 20/30-20/800) and the mean preoperative MD was -4.00± 3.72 decibels (dB). Postoperatively, the median VA improved to 20/30 (range, 20/ 20-20/70) and the mean postoperative MD was-0.26±3.09 dB (P< 0.001). Among th e control eyes, MDs were -1.74±3.71 dB preoperatively and-0.94±3.85 dB posto peratively (P=0.019). The adjusted improvement in MD among eyes that underwent c ataract surgery was 2.94±3.44 dB (P< 0.001). There was no significant change in PSD. Preoperative VA correlated significantly with preoperative MD (r= 0.39, P= 0.01). The improvement in VA correlated significantly with the adjusted improvem ent in MD (r=0.38, P=0.01). Conclusions Cataract has an adverse effect on the MD but not the PSD in FDT perimetry. Among eyes with visually significant cataract , the MD correlates significantly with VA. After cataract surgery, the change in VA correlates significantly with the adjusted change in MD.

玻璃体腔内注射曲安奈德治疗非缺血性中央静脉阻塞引起的黄斑水肿

Objective:To evaluate the efficacy of intravitreal triam-cinolone acetonide in the managemen t of persistent mac-ular edema secondary to nonischemic central retinal vein occlusion(CRVO).Methods:Twenty consecutive pa-tients were selected with a 3-to 4-mo nth history of nonischemic CRVO and persistent mac ular edema.These patients received a single intravitreal injection of 4mg of triamcinolone acetonide(40mg /mL).The follow-up period ranged from 10to 12months.The amount of macular edema was assessed by the amo unt of retinal thickening on clinical examination using the Goldmann contact lens and by the area and inten sity of staining on fluorescein angiography.Treated p atients were compared with a retrospectively matched grou p of patients who were managed with observation only.Main Outcome Mea-sures:Changes in visual acuity and a mount of macular edema were assessed in the treated patients and com-pared with the observation group.Re sults:The mean baseline visual acuity in the treatm ent group was 20/132vs20/123for the observation group(P=.57).After 1week,the treated group had a mean vis ual acuity of 20/51.At final follow-up,the treated g roup had a mean visual acuity of 20/37while the obse rvation group had a mean visual acuity of 20/110(P=.001).Sixty per-cent of treated patients had a final v isual acuity of 20/40or better vs only 20%in the observation group(P=.01).Forty percent of the untreated pati ents had a final visual acuity worse than 20/200whil e none of the treated patients did(P<.001).At final follow-up,75%of treated patients had complete resolution of mac-ular edema on clinical examination vs only 20%of the untreated patients(P<.001).Two of the treated pa-tients had recurrence of macular edema at 6months,and3had elevated intraocular pressure.Conclusion:This study shows a treatment benefit from intravitreal triamci-nolone in terms of visual acuity and m acular edema for nonischemic CRVO.

1例日本白点状视网膜炎患者的RLBP1基因新突变

PURPOSE: To report a novel mutation in the RLBP1 gene and optical coherence to mographic findings in a Japanese patient with retinitis punctata albescens. DESI GN: Observational case report. METHODS: The RLBP1 gene was analyzed by direct ge nomic sequencing. A complete ophthalmologic examination was performed. RESULTS: Compound heterozygous mutations in the RLBP1 gene were identified in the patient . The mutations were a novel missense Arg103Trp mutation and a missense Arg234Tr p mutation, the causative mutation of Bothnia dystrophy. The patient’s fundi sh owed numerouswhite dots with diffuse retinalmottling and bilateralmacular degene ration. Her visual function deteriorated progressively during 12-year follow-u p. Optical coherence tomography demonstrated decreased retinal thickness, especi ally the photoreceptor layer. CONCLUSION: A novel mutation in RLBP1 gene was fou nd in a Japanese patient with retinitis punctata albescens. Degenerative changes of the outer retina were detected by optical coherence tomography.

1例Wernicke脑病患者从上视性到下视性眼球震颤的转变

Background: We report an unusual case of Wernicke’s encephalopathy presenting with transient upbeat nystagmus that changed to a persistent downbeat nystagmus . Case: A 27-year-old man presented with upbeat nystagmus. Three months earlie r, he had been diagnosed with Wernicke’s encephalopathy after fasting for a mon th. Observations: This diagnosis was supported by his symptoms (ataxia, a confus ed state). Clinical recovery followed thiamine therapy. His upbeat nystagmus had linear slow phases with average amplitude and frequency (±SD) during fixation straight ahead of 2.8±0.7°and 4.6±2.2Hz. respectively. Two months later, the primary position upbeat nystagmus had diminished and down beat nystagmus (0.9 + 0.5°and 3.2±0.7 Hz on average) for a 20°downward gaze had developed. Then, 8 months later, he showed only downbeat nystagmus, which obeyed Alexander’s law. His primary position downbeat nystagmus was completely suppressed by clonazepam, a γ-aminobutyric acid (GABA) agonist. Conclusions: Owing to an underlying cen tral vestibular imbalance, even after the recovery of acute neurological symptom s, Wernicke’s encephalopathy can be complicated by persistent downbeat nystagmu s, which can be treated by a GABA agonist.

一对患有眼底病和视锥细胞营养不良的年轻单卵双生姊妹

Objective:To describe young monozy gotic twin sisters with fundus albipunctatus(a type of autosomal recessive sta-tionary night blindness caused by mu tations of the 11-cis retinol dehydrogenase geneRDH5)associated with cone dystrophy,previously reported in e lderly men.Methods:Ophthalmologic examinations were p erformed,and the RDH5gene was analyzed by direct genomic sequencing.Results:Twin 23-year-old sisters with high myopic refrac-tive errors of approximately -13dio pters were diagnosed as having fundus albipunctatus.Their photopic electroretino-graphic responses were markedly red uced,and cone dys-trophy was diagnosed.One twin had ma cular degeneration with reduced best-corrected visual acuity,while the other twin had normal maculae with good vis ual acuity.A com-pound heterozygous mutation,Val132Met and Arg280His,in the RDH5gene was found in both sisters.Conclusions:Cone dystrophy can be present in pati ents with fundus al-bipunctatus,not only elderly men bu t also young women.The clinical severity differed betw een monozygotic twins with fundus albipunctatus and cone d ystrophy.Clinical Relevance:The patients sex is not critical for the presence of cone dystrophy in patients with fu ndus albipunctatus.The discordant findings in the twins indicate that factors other than genetics influenced the p henotype.

疑似的视网膜激光损伤的诊断

Accidental retinal laser injuries a re easily diagnosed when there are known laser sources,typic al macular injuries,and visual deficits consistent with retinal findings.Deci-sions are more difficult when retinal findings are subtle or absent,despite reported visual pro blems and somatic complaints.Inaccurate diagnosis o f an ocular laser injury can precipitate a costly,lengthy se quence of medical and legal problems.Analysis of laser-tissue interactions and the characteristics of unambiguous retinal laser injuries provide6key questions to facilitate diffic ult diagnoses.Case reports demonstrate the usefulness of answering these questions before making diagnostic decisions.Retinal laser lesions that cause serious visual pr oblems are readily ap-parent ophthalmoscopically and angiographically.Acci-dental,intentional,or clinical re tinal laser lesions do not cause chronic eye,face,or head pain s.Diagnosis of a retinal laser injury should be evidence based,not a matter of conjecture or speculation.

泪液体积与泪液凹面曲率的关系

Objective: To investigate the relationship between tear volume and tear menisc us curvature by means of the video meniscometer. Methods: Eleven eyes of 11 pati ents with severe dry eye were studied (all female; mean ±SD age, 66.2 ±7.7 yea rs; 7 left eyes and 4 right eyes), each of whose puncta had been therapeutically occluded. Four instillations of balanced salt solution were given at intervals of 1 minute in each studied eye, with the concentration increasing in 5-μL ste ps from 5 to 20 μL. Before and after the instillation of balanced salt solution , tear meniscus changes were recorded by video meniscometer and radius of the me niscus was calculated from the printed images by means of the concave mirror for mula. Results: The mean radius of the meniscus increased linearly with increased drop volume (r 2=0.65, P < 0.001), with mean±SD radius values of 0.24±0.08 mm at baseline and 0.48±0.13, 0.62±0.13, 0.84±0 .26, and 1.00±0.32 mm after separate instillations of 5, 10, 15, and 20 μL of balanced salt solution, respectively. For each subject, a significantly differen t slope defining the relationship between instilled volume and meniscus radius w as seen (0.016-0.063 mm/μl; mean±SD, 0.039±0.015 mm/μl), which was thought to depend on the difference in capacity of the fluid reservoir over the ocular s urface. Conclusions: This study confirmed that the volume of instilled eyedrops is linearly related to the resulting radius of the tear meniscus, suggesting tha t this radius is a useful measure in monitoring the tear volume. This is likely to have implications both for dry eye diagnosis and for confirming the efficacy of punctal occlusion in this condition.