1/119. Cataracts, bilateral macular holes, and rhegmatogenous retinal detachment induced by lightning.PURPOSE: To report ocular injuries, including a unilateral rhegmatogenous retinal detachment, induced by lightning. METHOD: Case report. A 30-year-old man was injured by lightning. RESULTS: The patient developed a severe decrease in visual acuity in both eyes, an afferent pupillary defect in his left eye, bilateral cataracts, posterior vitreous detachments, macular holes, and an inferotemporal retinal detachment with an associated flap retinal tear in his left eye. CONCLUSIONS: This is a case of bilateral cataracts, posterior vitreous detachments, macular holes, and a unilateral retinal detachment associated with lightning. We postulate that the heating of the retinal surface, the concussive forces on the eye, and a sudden lateral contraction of the attached vitreous resulted in bilateral posterior vitreous detachments and a unilateral peripheral retinal break.- - - - - - - - - - ranking = 1keywords = detachment, retinal detachment (Clic here for more details about this article) |
2/119. Ocular explosion during cataract surgery: a clinical, histopathological, experimental, and biophysical study.INTRODUCTION: An increasing number of cases are being recognized in which a peribulbar anesthetic for cataract surgery has been inadvertently injected directly into the globe under high pressure until the globe ruptures or explodes. We reviewed the records of 6 such cases (one of which was reported previously by us), and one additional case has been reported in the literature. Surprisingly, 2 of these 7 cases went unrecognized at the time, and the surgeons proceeded with the cataract operation; all of the patients ultimately developed severe visual loss and/or loss of the eye. OBJECTIVES: To reproduce this eye explosion in a live anesthetized rabbit model and to perform a clinical, histopathological, experimental, biophysical, and mathematical analysis of this injury. methods: Eyes of live anesthetized rabbits were ruptured by means of the injection of saline directly into the globe under high pressure. The clinical and pathological findings of the ruptured human and animal eyes were documented photographically and/or histopathologically. An experimental, biophysical, and mathematical analysis of the pressures and forces required to rupture the globe via direct injection using human cadavers, human eye-bank eyes, and classic physics and ophthalmic formulas was performed. The laws of Bernoulli, LaPlace, Friedenwald, and Pascal were applied to the theoretical and experimental models of this phenomenon. RESULTS: The clinical and pathological findings of scleral rupture, retinal detachment, vitreous hemorrhage, and lens extrusion were observed. In the exploded human and rabbit eyes, the scleral ruptures appeared at the equator, the limbal area, or the posterior pole. In 2 of the 7 human eyes, the anterior segments appeared entirely normal despite the rupture, and cataract surgery was completed; surgery was canceled in the other 4 cases. In 4 of the 5 injected and ruptured rabbit eyes, the anterior segments appeared essentially normal. The experiments with human eye-bank eyes and the theoretical analyses of this entity show that the pressure required to produce such an injury is much more easily obtained with a 3- or 5-mL syringe than with a syringe 10 mL or larger. CONCLUSIONS: Explosion of an eyeball during the injection of anesthesia for ocular surgery is a devastating injury that may go unrecognized. The probability of an ocular explosion can be minimized by careful use of a syringe 10 mL or larger with a blunt needle, by discontinuing the injection if resistance is met, and by inspecting the globe prior to ocular massage or placement of a Honan balloon. When ocular explosion occurs, immediate referral to and intervention by a vitreoretinal surgeon is optimal. Practicing ophthalmologists should be aware of this blinding but preventable complication of ocular surgery.- - - - - - - - - - ranking = 0.11024193877838keywords = detachment, retinal detachment (Clic here for more details about this article) |
3/119. Focal retinal pigment epithelial dysplasia associated with fundus flavimaculatus.BACKGROUND: One or more focal dysplastic lesions of the retinal pigment epithelium (RPE) occurred in 15 eyes of 10 patients with fundus flavimaculatus. methods: review of patient records including an attempt to obtain follow-up information concerning a history of previous ocular trauma. RESULTS: Mild antecedent ocular trauma occurred to the eye with a dysplastic lesion in two patients. Dysplastic lesions were most frequently solitary and located temporal to the macula. Subretinal neovascularization accompanied two of the dysplastic lesions. The lesions were multifocal and present bilaterally in two patients. CONCLUSIONS: In fundus flavimaculatus, progressive lipofuscin storage is responsible for engorgement and hypertrophy of the RPE. Dysplastic lesions of the RPE probably result from reactive hyperplasia and fibrous metaplasia of RPE cells in response to acute disruption of fragile, hypertrophied RPE cells that may be enormously enlarged in the area of yellow flecks. This disruption may occur in response to trauma, focal inflammation, or other localized stimuli. patients with fundus flavimaculatus should be cautioned concerning the possible role of trauma in causing dysplastic changes in the RPE and visual loss.- - - - - - - - - - ranking = 0.087321878447257keywords = retinal pigment, pigment (Clic here for more details about this article) |
4/119. Macular injury by a military range finder.OBJECTIVE: The authors report the clinical findings of a civilian patient who unintentionally looked into the laser beam of a military range finder. Detailed information on the range finder is given. The objective is to illustrate the potential danger of such devices and to give detailed information on the device, the clinical findings associated with exposure, and the laser-tissue interaction mechanism. methods: The patient was examined with fluorescein angiography, indocyanine green angiography, microperimetry, and optical coherence tomography, both in the acute stage (2 hours) and 4 weeks later. fluorescein angiography was performed again 4 months later. A total of 100 mg prednisone tapered over 9 days was prescribed. Additionally, 50 microg tissue plasminogen activator (TPA) and 0.5 mL pure C2F6 were injected in the vitreous. RESULTS: In the acute phase, hemorrhage was located beneath the retina, primarily beneath the retinal pigment epithelium. Retinal defects as seen initially over the subretinal blood were reduced after 4 weeks, but a retinal defect ranging from the lasered site toward the fovea remained. visual acuity slightly increased from 20/100 to 20/63 after 4 weeks. indocyanine green angiography showed a large hypofluorescent spot in the macula. Four months after the accident, a classic choroidal neovascularization developed, originating from the lasered site. The technical parameters of the range finder were: Nd:YAG laser (1,064 nm), pulse duration 10 ns, beam divergence 1.5 mrad, energy 10 mJ. CONCLUSION: A range finder can produce severe macular injury. The primary laser-tissue interaction mechanism seems to be explosive disruption of choroidal tissue. Intravitreal injection of TPA and C2F6 did not show a clear benefit to such laser lesions. A late complication can be secondary choroidal neovascularization.- - - - - - - - - - ranking = 0.017464375689451keywords = retinal pigment, pigment (Clic here for more details about this article) |
5/119. Retinal opacification after blunt non-perforating concussional injuries to the globe. A clinical and retinal fluorescein angiographic study.Fluorescein angiographic studies are reported on fifteen patients presenting with retinal opacification after blunt mechanical non-perforating injuries involving the eye. In patients who subsequently regained full visual function and in whom complete resolution of the retinal changes occurred, retinal fluorography carried out less than 24 hours after injury revealed no abnormal features. In cases with more prolonged visual disability, retinal fluorescein examinations may, however, reveal damage to the retinal pigment epithelium before this becomes apparent on routine ophthalmoscopy, or the existence of impaired perfusion through the retinal vessels. It is suggested, therefore, that retinal fluorescein angiography has a role in assessing the visual prognosis in patients presenting with traumatic retinal oedema.- - - - - - - - - - ranking = 0.017464375689451keywords = retinal pigment, pigment (Clic here for more details about this article) |
6/119. indocyanine green angiographic features of choroidal rupture and choroidal vascular injury after contusion ocular injury.PURPOSE: To report features of choroidal rupture and choroidal vascular injury after contusion ocular injury on indocyanine green angiography. methods: In a prospective study, nine patients (nine eyes) with choroidal rupture after ocular contusion underwent initial fluorescein angiography and indocyanine green angiography within 19 days after trauma. Eyes that had a distinct abnormality of the retinal pigment epithelium were excluded from this study. Subtraction indocyanine green angiography was also performed. Follow-up fluorescein angiographic and indocyanine green angiographic findings were also studied. RESULTS: Initial ophthalmoscopic examination revealed subretinal hemorrhage in all nine eyes. In five of the nine eyes, choroidal rupture was not seen on initial ophthalmoscopic or fluorescein angiographic examination because it was hidden beneath the subretinal hemorrhage, but it was detected on subsequent examinations. In the remaining four eyes, choroidal rupture was observed by ophthalmoscopy at the time of initial examination, and these eyes exhibited hyperfluorescent streaks on fluorescein angiography in the region of the subretinal hemorrhage. On initial indocyanine green angiography of all nine eyes, observed hypofluorescent streaks became more obvious with time. For each eye, there were more hypofluorescent streaks on indocyanine green angiography than hyperfluorescent streaks on fluorescein angiography. In one eye, the location of indocyanine green leakage nearly coincided with the location of a hyperfluorescent streak on fluorescein angiography. In this case, crescentic streaks of hypofluorescence were seen on the temporal side of the subretinal hemorrhage on indocyanine green angiography, although choroidal rupture was not observed in that region by ophthalmoscopy or fluorescein angiography. In two of the nine eyes, indocyanine green angiography and the subtraction technique demonstrated disturbance of flow into choroidal vessels, especially at the choroidal rupture site. CONCLUSION: After ocular contusion injury, various features of choroidal rupture and choroidal vascular injury were observed on indocyanine green angiography. This technique may contribute to the diagnosis of choroidal rupture and to the understanding of the clinical course after injury.- - - - - - - - - - ranking = 0.017464375689451keywords = retinal pigment, pigment (Clic here for more details about this article) |
7/119. A 12-year ophthalmologic experience with the shaken baby syndrome at a regional children's hospital.PURPOSE: To examine the ophthalmologic experience with the shaken baby syndrome (SBS) at one medical center, including clinical findings, autopsy findings, and the visual outcome of survivors. methods: One hundred sixteen patients admitted from 1987 to 1998 for subdural hematomas of the brain secondary to abuse were included. RESULTS: Retinal hemorrhages were detected in 84% of the children, but this important finding had been missed often by nonophthalmologists. Poor visual response, poor pupillary response, and retinal hemorrhage correlated strongly with demise of the child. One child who died had pigmented retinal scars from previous abuse, a condition not previously observed histopathologically. The clinical and autopsy findings varied somewhat, probably because of the differing conditions for examination. No correlation could be made between computerized tomography scans done during life and the subdural hemorrhage of the optic nerve found on autopsy. Half of the surviving patients were known to have good vision. One fourth of the patients had poor vision, largely due to cerebral visual impairment from bilateral injury posterior to the optic chiasm. Severe neurologic impairment correlated highly with loss of vision. CONCLUSION: This series provides information on the frequency of eye findings in SBS patients. No fundus finding is pathognomonic for SBS. When retinal hemorrhages are found in young children, the likelihood that abuse occurred is very high. The difficulty that nonophthalmologists have in detecting retinal hemorrhage may be an important limiting factor in finding these children so they may be protected from further abuse.- - - - - - - - - - ranking = 0.0012360571084565keywords = pigment (Clic here for more details about this article) |
8/119. Nocardia keratitis after traumatic detachment of a laser in situ keratomileusis flap.PURPOSE: Nocardia are gram-positive bacteria existing ubiquitously in the environment; they can cause keratitis. nocardia asteroides keratitis occurred in the interface between the stromal bed and flap after traumatic detachment of the flap 4 months after an initially uncomplicated laser in situ keratomileusis (LASIK) procedure. methods: nocardia asteroides keratitis was confirmed by culture. Therapy included topical and oral trimethoprim-sulfamethoxazole. RESULTS: Thirteen months after the trauma, the patient's spectacle-corrected visual acuity was 20/20 with a manifest refraction of -2.25 -1.00 x 30 degrees. CONCLUSIONS: The immediate steps of management consisting of surgically lifting the corneal flap, rapid microbial identification, and proper treatment with specific antibiotics resulted in the successful treatment of nocardia asteroides keratitis in a traumatized eye after LASIK.- - - - - - - - - - ranking = 0.38051071425229keywords = detachment (Clic here for more details about this article) |
9/119. Retinal pigment epithelial tear and extensive exudative retinal detachment following blunt trauma.BACKGROUND: A peripheral retinal pigment epithelial tear and an extensive exudative retinal detachment caused by choroidal leakage from the denuded Bruch's membrane are extremely rare. A peripheral retinal pigment epithelial tear has not been reported in an eye with retinochoroidal folds after blunt ocular trauma. methods: Case report. RESULTS: The course of a large nasal peripheral retinal pigment epithelial tear that occurred after blunt ocular trauma in a patient with retinochoroidal folds was followed. The inferior retinal detachment caused by leakage from the denuded Bruch's membrane following the development of the tear gradually worsened. Initial treatment with cryotherapy was ineffective, but the retinal detachment eventually resolved after the patient underwent sclerectomy and sclerostomy. CONCLUSION: A large peripheral retinal pigment epithelial tear can occur in patients with retinochoroidal folds following blunt ocular trauma, and extensive retinal detachment can be induced. Sclerectomy and sclerostomy can be beneficial in patients with an extensive exudative retinal detachment caused by choroidal leakage from the denuded Bruch's membrane.- - - - - - - - - - ranking = 1.066979180197keywords = detachment, retinal detachment, retinal pigment, pigment (Clic here for more details about this article) |
10/119. Laser pointers and the human eye: a clinicopathologic study.We report the absence of photic retinal injury after exposing the retina to light from class 3A laser pointers for durations of up to 15 minutes. Three patients with uveal melanomas were scheduled to have an enucleation. Each agreed to have his or her retina exposed to laser light from a class 3A laser pointer prior to enucleation. Continuous exposure was directed to the fovea for 1 minute, to the retina 5 degrees below fixation for 5 minutes, and to the retina 5 degrees above fixation for 15 minutes. Ophthalmoscopic evaluation of the cornea, lens, and retina and fluorescein angiographic studies of the retina were conducted before, 24 hours after, and 11 days after laser exposure in the first case; before and 86 hours after exposure in the second case; and before, 96 hours after, and 15 days after exposure in the third case. Other than transient afterimages that lasted only a few minutes, we were unable to document any functional, ophthalmoscopic, fluorescein angiographic, or histologic evidence of damage to any structures of the eyes. Transmission electron microscopic studies of retinal sites targeted by the laser pointers in the second and third cases revealed ultrastructural abnormalities in the outer retina and the pigment epithelium that were similar to abnormalities seen in the retina approximately 8 mm away from the targeted sites. The risk to the human eye from transient exposure to light from commercially available class 3A laser pointers having powers of 1, 2, and 5 mW seems negligible.- - - - - - - - - - ranking = 0.0012360571084565keywords = pigment (Clic here for more details about this article) |
| | Next -> |