1/13. Cyanoacrylate tissue adhesive augmented tenoplasty: a new surgical procedure for bilateral severe chemical eye burns.PURPOSE: To report on cyanoacrylate tissue adhesive augmented tenoplasty, a new surgical procedure for bilateral severe chemical eye injuries. methods: A 26-year-old man presented with bilateral severe (grade IV) chemical burns involving the eye, periorbital tissues, face, and neck. Despite adequate medical therapy, corneal, limbal, and scleral ulceration progressed in both eyes. Secondary pseudomonas keratitis necessitated therapeutic penetrating keratoplasty in the right eye. Tenoplasty and glued-on rigid gas permeable contact lens were unsuccessful to arrest progression of corneolimboscleral ulceration in the left eye. We applied n-butyl cyanoacrylate tissue adhesive directly on the ulcerating corneal, limbal, and scleral surface to augment tenoplasty. RESULTS: The left ocular surface healed with resultant massive fibrous tissue proliferation and symblepharon on the nasal side. Ocular surface rehabilitation resulted in a vascularized leukomatous corneal opacity with upper temporal clear cornea. The patient achieved visual acuity of 6/36 in the left eye. CONCLUSION: We suggest that cyanoacrylate tissue adhesive-augmented tenoplasty can be undertaken to preserve ocular integrity and retain visual potential in a severe chemical eye injury.- - - - - - - - - - ranking = 1keywords = gas (Clic here for more details about this article) |
2/13. Visual rehabilitation after severe alkali injury with piggyback hyper O2 contact lenses.PURPOSE: To report successful visual rehabilitation following severe bilateral alkali injury using piggyback hyperoxygen-transmissible (hyper O2) contact lenses. methods: Case report and literature review. RESULTS: More than 15 years after a severe bilateral alkali injury, multiple surgical procedures including repeat bilateral penetrating keratoplasty, severe tear deficiency, and chronic ocular surface disruption, the patient achieved 20/30 best-corrected vision through the simultaneous use of a hyper O2 rigid gas permeable contact lens over a hyper O2 soft contact lens in his right eye. The patient has tolerated this piggyback combination without any adverse reactions or complications, and his corneal graft remains clear and healthy. CONCLUSION: Visual rehabilitation for conditions that compromise the ocular surface can be accomplished by utilizing newer soft and rigid contact lens materials that facilitate oxygen transmission, thereby promoting epithelial healing and improving safety in extended wear situations. These newer materials may potentially reduce complications previously associated with extended wear therapeutic lenses.- - - - - - - - - - ranking = 1keywords = gas (Clic here for more details about this article) |
3/13. Toxic carriers in pepper sprays may cause corneal erosion.We describe four patients who developed corneal erosion after an exposure to a pepper spray containing toxic carriers. Two of these patients were exposed to a pepper gas containing 5% oleoresin capsicum (OC) as an irritant and 92% trichlorethylene or unknown amount of dichloromethane as a carrier. One patient was exposed to a mock (containing 92% trichlorethylene as a carrier) training pepper gas without OC. The fourth patient was exposed to an unidentified Russian pepper gas spray. Two of the patients were examined by in vivo confocal microscopy to demonstrate the depth and quality of the stromal damage. To test the toxicity of the commercial tear spray, it was analyzed and test sprayed on a soft contact lens and into a plastic cup. visual acuity was measured and the eyes were examined with a slit-lamp up to 5 months. Physical damage to a soft contact lens was visually acquired. All patients showed a long-lasting, deep corneal and conjuctival erosion, which resolved partly with medical therapy during the following weeks/months. Confocal microscopy revealed corneal nerve damage, and keratocyte activation reaching two-thirds of stroma for one patient. The spray caused serious damage to both the soft contact lens and the plastic cup. The safety of the commercially available pepper sprays should be assessed before marketing, and a list of acceptable ingredients created. The sprays should also have instructions on the use of the compound as well as on the first aid measures after the exposure. solvents known to be toxic should not be used.- - - - - - - - - - ranking = 3keywords = gas (Clic here for more details about this article) |
4/13. Alkaline chemical keratitis: eye injury from airbags.Inflation of an automobile airbag is accomplished by converting sodium azide to nitrogen gas. The bags are vented so that nitrogen and residual byproducts of combustion, such as alkaline gas, are released into the passenger compartment. We report the case of a patient who incurred a chemical keratitis after the driver's-side airbag deployed. The importance of recognition and management is discussed.- - - - - - - - - - ranking = 2keywords = gas (Clic here for more details about this article) |
5/13. descemet membrane detachment with hemorrhage after alkali burn to the cornea.PURPOSE: To report two cases of descemet membrane detachment associated with hemorrhage after alkali burn to the cornea. DESIGN: Observational case reports. methods: We describe two patients with detachment of descemet membrane associated with hemorrhage after alkali burns to the cornea. RESULTS: Patient 1 received a splash of caustic soda to the face. descemet membrane detachment with hemorrhage was present. An attempt at reattachment using intraocular gases failed. Patient 2 sustained a chemical burn secondary to an airbag injury. A thickened, detached descemet membrane associated with a hyphema was evident. CONCLUSIONS: Detachments of descemet membrane associated with alkali burns are often accompanied by irreversible endothelial cell damage.- - - - - - - - - - ranking = 1keywords = gas (Clic here for more details about this article) |
6/13. descemet membrane detachment caused by hydrogen peroxide injury.OBJECTIVE: To describe a patient who developed a descemet membrane detachment after hydrogen peroxide injury with successful reattachment by intracameral injection of sulfur hexafluoride gas. methods: Case report. RESULTS: The right eye of a 40-year-old man was exposed to 35% hydrogen peroxide. This resulted in a central corneal epithelial defect, corneal edema, a localized detachment of descemet membrane, and a gas bubble between the posterior corneal stroma and descemet membrane. The descemet membrane detachment persisted after reabsorption of the gas bubble. Successful reattachment of descemet membrane was achieved with injection of 0.15 mL of 20% sulfur hexafluoride gas into the anterior chamber. CONCLUSION: hydrogen peroxide ocular injury may cause descemet membrane detachment, and successful reattachment may be achieved with intracameral injection of 20% sulfur hexafluoride gas.- - - - - - - - - - ranking = 5keywords = gas (Clic here for more details about this article) |
7/13. Chronic and delayed-onset mustard gas keratitis: report of 48 patients and review of literature.PURPOSE: To report the clinical features of 93 eyes of 48 patients with chronic and delayed-onset mustard gas keratitis. Clinicopathologic correlation in 5 eyes and a review of related literature are presented. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Forty-eight Iranian survivors of Iraqi chemical warfare with chronic or delayed-onset mustard gas keratitis. methods: We reviewed the symptoms, clinical findings, course, and treatment of our patients and reviewed the literature. In 5 patients, histopathologic features of corneal and conjunctival specimens were evaluated. MAIN OUTCOME MEASURES: Ocular findings, clinical course, treatment measures, and histopathologic studies. RESULTS: Of 48 patients, 31 (64.6%) had chronic symptomatology, whereas 17 (35.4%) experienced delayed-onset lesions. visual acuity at referral ranged from hand motions to 20/20. Ocular surface changes included chronic blepharitis and decreased tear meniscus in all patients, limbal ischemia (81.3%), and conjunctival vascular abnormalities (50%). Corneal signs in order of frequency were: scar or opacity (87.5%), neovascularization (70.8%), thinning (58.3%), lipoid deposits (52.1%), amyloid deposits (43.8%), and epithelial defects and irregularity (31.3%). Many patients received conservative treatment; others underwent allograft stem cell transplantation (20 eyes of 17 patients), penetrating keratoplasty (12 eyes of 12 patients), and lamellar keratoplasty (4 eyes of 3 patients). Conjunctival specimens were evaluated by light microscopy. Decreased goblet cell density, attenuated or thickened epithelium, scarring in the substantia propria associated with plasmacytic and lymphocytic infiltration, and dilated lymphatic vessels were noted. Excised corneal buttons disclosed absence of epithelium and Bowman's layer, fibrovascular pannus, stromal scarring, and vascularization. CONCLUSIONS: mustard gas causes chronic and delayed destructive lesions in the ocular surface and cornea, leading to progressive visual deterioration and ocular irritation. The pathophysiologic features of these changes are not clearly identified. Excised conjunctival and corneal specimens revealed a mixed inflammatory response without any specific features. Based on the clinical appearance of the lesions and the histopathologic findings, an immune-mediated component seems possible. This article contains additional online-only material available at.- - - - - - - - - - ranking = 7keywords = gas (Clic here for more details about this article) |
8/13. Keratoplasty after mustard gas injury: clinical outcome and histology.PURPOSE: Ocular injury by mustard gas can lead to severe eye damage with a delayed course. We report the corneal histology and follow-up after keratoplasty in a patient with mustard gas injury. methods: The patient presented with recurrent painful corneal inflammation in both eyes not improving under local therapy. visual acuity impaired to handmovements. A penetrating keratoplasty was performed on the left eye and afterwards an autorotation keratoplasty on the right eye with a later corneal graft. RESULTS: After the operation of the left eye the patient was immediately painfree and the visual acuity improved to 0,4. So far there have been no signs for transplant rejection or inflammation. histology of the cornea revealed massive stromal necrosis, and signs of chronic inflammation. Despite denervation of the cornea after autorotation keratoplasty the right eye was still painful and became only painfree after corneal transplantation. CONCLUSION: There has been not much experience with corneal transplantation after mustard gas injury and there is a high risk for transplant rejection due to inflammation and vascularisation of the cornea. Successful and painfree healing with keratoplasty seems only possible after complete removal of the necrotic material.- - - - - - - - - - ranking = 7keywords = gas (Clic here for more details about this article) |
9/13. Eyelid gas gangrene.A case of eyelid gas gangrene caused by clostridium hastiforme is reported. The infection followed an alkali injury that probably aided proliferation of the organism by inducing local tissue ischemia. debridement combined with antibiotic therapy controlled the infection, and the large lid defect healed satisfactorily by secondary intention.- - - - - - - - - - ranking = 5keywords = gas (Clic here for more details about this article) |
10/13. Retinal burns caused by exposure to MIG-welding arcs: report of two cases.A new generation of arc welder has recently become widely available at a price which is within reach of most amateurs and part-time mechanics, known as the MIG welder (metal-arc inert gas welder). In MIG welding the arc is ensheathed in a stream of inert gas which prevents the molten metal from oxidising. The stream of gas changes the character of the emitted radiation, and it is possible that this type of welder poses a greater threat to sight than previously recognised. radiation in the ultraviolet range emitted by arc welders is absorbed by the unprotected cornea and lens, giving rise to a keratoconjunctivitis, or 'arc-eye,' which, though intensely painful, is not considered a threat to sight. radiation in the visible and near infrared spectrum, however, penetrates the eye to be absorbed by the retina and may cause thermal or photochemical damage which may be permanent and sight-threatening. Retinal injuries resulting from exposure to ordinary electric welding arcs have been reported, but such injuries are uncommon. Two cases of retinal burns resulting from exposure to MIG welder emissions which presented on consecutive days to the Leicester Royal Infirmary are presented. This is the first report of such injuries relating specifically to MIG welding.- - - - - - - - - - ranking = 3keywords = gas (Clic here for more details about this article) |
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