1/52. siderosis bulbi resulting from an intralenticular foreign body.PURPOSE: To report a case of siderosis bulbi that resulted from a small intralenticular foreign body. METHOD: Case report. RESULTS: A 36-year-old man with normal visual acuity and a peripheral intralenticular iron foreign body in the left eye was treated conservatively. Nine weeks after the injury, he had ocular signs of siderosis bulbi, with changes in the electroretinogram. A clear lens aspiration with removal of the foreign body was performed. After removal of the iron foreign body, no progression or regression of the ocular signs of siderosis bulbi has occurred, and the electroretinogram has not changed over a 2-year period. CONCLUSIONS: Even in the presence of good vision, a patient with an intralenticular ferrous foreign body should be followed closely, and the foreign body should be removed before irreversible siderosis bulbi occurs.- - - - - - - - - - ranking = 1keywords = vision (Clic here for more details about this article) |
2/52. clostridium beijerinckii endophthalmitis secondary to penetrating ocular injury.endophthalmitis occurs in five to 10% of injuries involving intraocular foreign bodies. A 52 year old abattoir worker sustained such penetrating ocular trauma and developed fulminant endophthalmitis. clostridium beijerinckii was isolated from the vitreous humor. Intravitreal vancomycin and amikacin and intravenous penicillin and clindamycin were given. Despite therapeutic vancomycin and amikacin levels in the vitreous, vision was lost and enucleation was ultimately required.- - - - - - - - - - ranking = 1keywords = vision (Clic here for more details about this article) |
3/52. Surgical management of strabismus after rupture of the inferior rectus muscle.BACKGROUND: rupture of an inferior rectus muscle is an uncommon problem. The resulting absence of infraduction and large hypertropia that result when the muscle cannot be repaired are challenging to manage surgically. methods: We treated 2 patients who had traumatic rupture of the inferior rectus muscle. Both patients underwent an inferior transposition of the inferior halves of the medial and lateral rectus muscles without disinsertion (modified Jensen transposition procedure). RESULTS: Both patients had a persistent small overcorrection in the primary gaze position. One patient was treated with a second strabismus surgery consisting of a recession of the contralateral superior rectus muscle; the other was treated with prism glasses. Both achieved restoration of depression to approximately 40 degrees and single binocular vision in the primary position at distance, near, and in the reading position. CONCLUSION: This modified Jensen transposition procedure of the horizontal rectus muscles appears to be highly effective in the treatment of the hypertropia and infraduction deficit produced by rupture of the inferior rectus muscle. It also appears to be suitable for use in situations when other rectus muscles are absent or unavailable for surgical manipulation.- - - - - - - - - - ranking = 1keywords = vision (Clic here for more details about this article) |
4/52. Recurrent fungal keratitis and endophthalmitis.PURPOSE: To report a case of recurrent fungal sclerokeratitis and endophthalmitis with a very successful outcome due to aggressive combined surgical and medical therapy. To discuss the management of this potentially devastating infection. methods: A 65-year-old man presented with 6 months of left eye redness and irritation after injury from organic matter propelled from an airboat. Initially, he had been treated with foreign body removal, antibiotics, and steroids. He was diagnosed with reactive sclerokeratitis at presentation and was treated with steroids. However, when he did not improve, cultures were obtained and acremonium species filamentous fungi was identified. Despite treatment with appropriate topical and systemic antifungals, his fungal sclerokeratitis progressed to endophthalmitis. Two therapeutic penetrating keratoplasties (PKs) with iridectomy and intraocular amphotericin b were necessary to eradicate the fungal infection. RESULTS: visual acuity was restored to 20/25-3 with correction 9 months after initial presentation. There was no recurrence of fungal infection after the second therapeutic PK. CONCLUSION: The possible reasons for recurrence of fungal infection are discussed. The role of timely and aggressive medical and surgical intervention for fungal sclerokeratitis and endophthalmitis in restoring excellent vision is emphasized.- - - - - - - - - - ranking = 1keywords = vision (Clic here for more details about this article) |
5/52. Delayed presentation of transorbital intracranial pen.A 13 year old Fijian boy sustained a stab wound to the left orbit 3 years ago. It was not appreciated by the treating physicians in fiji that the plastic pen had crossed from the left orbit, through the nose, right orbit and right optic nerve, into the right middle cranial fossa and lodged in the right temporal lobe and that the pen remained in situ for the past 3 years. The boy presented to australia with a discharge from the entry wound in his left lower eyelid. The retained foreign body was not detected on computed tomography imaging, but was detected on subsequent magnetic resonance image. A combined neurosurgery/plastic surgery craniofacial approach was undertaken with successful complete removal of the retained pen, and preservation of vision in his only seeing eye.- - - - - - - - - - ranking = 1keywords = vision (Clic here for more details about this article) |
6/52. Gaze-evoked amaurosis produced by intraorbital buckshot pellet.OBJECTIVE: To report the first case of gaze-evoked amaurosis secondary to an intraocular foreign body and to highlight the characteristic clinical findings of patients with this symptom. DESIGN: Case report and review of the literature. methods: Case review, clinical history, electrophysiologic testing, and follow-up. MAIN OUTCOME MEASURES: visual acuity, automated perimetry, and visual fields. RESULTS: A case of gaze-evoked amaurosis as a result of an intraorbital foreign body is described, and 19 additional cases of gaze-evoked amaurosis are reviewed from the English language literature. These cases share certain characteristics including good vision in primary position with deterioration of vision in eccentric gaze; concurrent objective pupillary abnormalities in eccentric gaze; stereotypic onset and recovery of vision; and funduscopic abnormalities consisting of disc edema and chorioretinal folds. CONCLUSIONS: Gaze-evoked amaurosis is a reliable sign of intraconal mass lesion. We report the first case of gaze-evoked amaurosis secondary to an intraorbital foreign body.- - - - - - - - - - ranking = 3keywords = vision (Clic here for more details about this article) |
7/52. Fluorescein angiographic findings in ocular siderosis.PURPOSE: To report a case of siderosis from a retained intraocular iron foreign body manifesting localized retinal capillary nonperfusion documented by fluorescein angiography. methods: Case Report. In a 35-year-old man with decreased vision in the left eye, studies included fundus photography, fluorescein angiography, visual field testing, and electrophysiology. Surgical foreign body extraction and histopathologic examination were performed. RESULTS: Preoperatively, in the left eye, humphrey visual fields and electrophysiology testing revealed marked depression. fluorescein angiography demonstrated nasal capillary nonperfusion with occlusion of the second- and third-order arterioles extending along a gradient from the foreign body. Microscopic examination of the lens capsule confirmed the diagnosis of siderosis secondary to a retained iron foreign body. CONCLUSION: Extensive capillary nonperfusion may be associated with a retained iron intraocular foreign body, as documented by fluorescein angiography.- - - - - - - - - - ranking = 1keywords = vision (Clic here for more details about this article) |
8/52. Surgical outcomes in adult patients after repair of anterior segment trauma sustained during childhood.PURPOSE: To evaluate the outcomes and possible benefit of surgery performed on adults for anterior segment trauma sustained during childhood. SETTING: private practice. methods: A retrospective review of patient records was performed. adult patients who had anterior segment surgery for injuries that occurred during childhood were identified. The surgical outcomes were evaluated to determine whether intervention was beneficial in this subgroup of patients. RESULTS: Six patients were identified. Preoperative best corrected visual acuity (BCVA) was 20/200 or worse in all patients. After surgery, the BCVA in 3 patients had improved to 20/30 or better and in 1 patient, to 20/60. The other 2 patients had less improvement; however, each noted subjective improvement in vision. No major intraoperative or postoperative complications occurred. CONCLUSION: In the absence of evidence of accompanying posterior segment trauma, surgery in adults to correct anterior segment damage from childhood trauma was safe and often beneficial.- - - - - - - - - - ranking = 1keywords = vision (Clic here for more details about this article) |
9/52. Ocular fishhook injuries.Ocular fishhook injuries are rare, yet potentially vision threatening as complications such as corneal scarring, retinal detachment and endophthalmitis may result. The surgical management of these cases is challenging due to the construction of barbed fishhooks.- - - - - - - - - - ranking = 1keywords = vision (Clic here for more details about this article) |
10/52. Topography-guided excimer laser ablation of irregular cornea resulting from penetrating injury.A 26-year-old woman with irregular astigmatism caused by ocular perforation became aphakic in the injured left eye 2 years after the initial trauma. The initial corneoscleral wound repair was performed without intraocular lens implantation. The patient's uncorrected visual acuity in the right eye was 20/20 and in the left eye, counting fingers at 50 cm. The vision in the left eye could not be corrected with a spectacle because of high corneal astigmatism so a rigid gas-permeable contact lens was tried. With a contact lens, the acuity improved to 20/80; however, the patient could not wear the lens because of intolerance and severe astigmatism. As an alternative, topography-guided ablation was performed to correct the corneal astigmatism. Treatment of the irregular central cornea reduced the astigmatism. Three months postoperatively, the corrected visual acuity was 20/20 with a refraction of 8.00 -1.50 x 26. This case indicates that topography-guided ablation can be a useful surgical method for correcting surgically induced irregular astigmatism.- - - - - - - - - - ranking = 1keywords = vision (Clic here for more details about this article) |
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