1/85. Isolated longitudinal rupture of the posterior tracheal wall following blunt neck trauma.The authors report 3 female children (4, 5 and 12 years old) who suffered an isolated rupture of the posterior tracheal wall (membranous part) following a minimal blunt trauma of the neck. Such tracheal ruptures often cause a mediastinal and a cutaneous thoraco-cervical emphysema, and can also be combined with a pneumothorax. The following diagnostic steps are necessary: X-ray and CT of the chest, tracheo-bronchoscopy and esophagoscopy. The most important examination is the tracheo-bronchoscopy to visualize especially the posterior wall of the trachea. Proper treatment of an isolated rupture of the posterior tracheal wall requires knowledge about the injury mechanisms. The decision concerning conservative treatment or a surgical intervention is discussed. In our 3 patients we chose the conservative approach for the following reasons: 1) The lesions of the posterior tracheal wall were relatively small (1 cm, 1.5 cm, 3 cm) and showed a good adaptation of the wound margins. 2) No cases showed an associated injury of the esophageal wall. All of our patients had an uneventful recovery, the lesion healed within 10 to 14 days, and follow-up showed no late complications.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
2/85. 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 = 1keywords = visual (Clic here for more details about this article) |
3/85. Traumatic subconjunctival dislocation of the crystalline lens and its surgical management.The authors report a case of a 40-year-old female who had sustained a blunt ocular trauma resulting in anterior scleral rupture and subconjunctival dislocation of the crystalline lens. Anterior segment ultrasound aided in the diagnosis. Surgical exploration revealed a 6 mm long anterior scleral rupture which was repaired. Postoperatively the patient had a best corrected visual acuity of 6/18.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
4/85. eye injuries associated with paintball guns.AIMS: This study identifies the various types of ocular injuries sustained after blunt trauma with a paintball fired from a paintball gun. methods: We report two patients who sustained injury to an eye after being shot with a paintball and review similar cases presented in the world literature. The type of injury sustained and the final visual acuity obtained after a paintball hit to the eye are examined. RESULTS: The two boys presented were hit in the eye with a paintball resulting in lens subluxation, hyphema formation, and angle recession. cataract extraction was required in both cases. One boy also had an optic neuropathy and a choroidal rupture. A review of the literature reveals a variety of injuries occur after a paintball hit to the eye. In some of the cases, the damage to the eye has led to loss of vision and at times loss of the eye. CONCLUSIONS: Paintball guns can cause devastating ocular injuries. Wearing protective eye and face gear during this game is essential. We recommend that an anti-fog face mask with a one-piece polycarbonate eye shield be worn by those participating in paintball games.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
5/85. Late traumatic intraocular lens extrusion after penetrating keratoplasty.BACKGROUND: Penetrating keratoplasty places a patient at risk for wound rupture from blunt trauma because the graft-host interface remains weakened for years after the surgery. Violent environments, contact sports, and strenuous activity put patients with compromised corneal structural integrity at high risk of traumatic injury. CASE REPORT: This case report presents a 42-year-old penetrating keratoplasty patient with a history of homelessness, polysubstance abuse, and domestic violence. This patient experienced a ruptured globe at the graft-host junction secondary to a direct blow by a fist, which extruded the intraocular lens from the eye. After emergency wound closure, the graft continued to degrade until bullous keratopathy developed. With little visual recovery potential for this graft, a Gunderson conjunctival flap procedure was implemented to decrease chronic ocular pain. CONCLUSIONS: After penetrating keratoplasty, patients should be periodically reminded of the susceptibility of the graft wound to injury from high-risk activity and violence. Constant use of protective eyewear should be recommended to corneal transplant recipients.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
6/85. Corneal intrastromal cyst following lamellar keratoplasty.A case is reported documenting formation of an intrastromal corneal cyst following lamellar keratoplasty. A patient with keratoglobus sustained trauma to the left eye. The trauma resulted in rupture of the cornea, which was repaired with an overlay conreal graft. Two and one-half years later, an intrastromal fluid-filled cyst of the cornea was found in the visual axis. Cytologic examination of the aspirated cyst fluid revealed epithelial cells.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
7/85. Radiologic case study. rupture of the long head of the biceps tendon.rupture of the long head of the biceps tendon frequently is encountered in the setting of coexisting rotator cuff pathology and chronic impingement, but traumatic rupture is occasionally seen, as in this case. signs and symptoms are not always diagnostic, and MRI or MR arthrography can be a useful tool for evaluation of the tendon in difficult cases. Ideally, an empty bicipital groove is seen, indicating absence of the tendon and rupture. Scar tissue within the groove can be problematic, and correlation with oblique coronal and sagittal images is always recommended. The superior labrum at the attachment of the bicipital anchor should always be inspected carefully, as this is the most common site of rupture, and there may be an associated tear of the superior labrum. Magnetic resonance arthrography is not necessary for diagnosis in most cases, but will provide better visualization of the tendon and bicipital-labral complex.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
8/85. rupture of spinal dermoid tumors with spread of fatty droplets in the cerebrospinal fluid pathways.Cranial and spinal MRI was carried out at 0.5 or 1.5 T in five patients with spinal dermoid tumours. Free fatty material was appreciated within the normally communicating cerebrospinal fluid pathways in all five cases and in one case fat droplets were also observed within a dilated central canal of the spinal cord. While dissemination of lipid within the subarachnoid space and ventricles is easily understandable, the presence of lipid droplets within the central canal is more difficult to explain, since the central canal is only potential in the adult. When a dermoid tumor is suspected, we recommend MRI of the entire central nervous system, to detect possible leakage of fat from rupture of a cystic portion of the tumour.- - - - - - - - - - ranking = 0.23457722008068keywords = pathway (Clic here for more details about this article) |
9/85. Epilenticular intraocular lens implantation in traumatic cataract with a ruptured posterior capsule.PURPOSE: To present a case of rapidly progressing traumatic cataract caused by posterior capsule rupture after nonpenetrating ocular injury, as well as a surgical procedure to safely implant the intraocular lens in such a traumatized eye. methods: In a 23-year-old man with traumatic cataract and posterior lens capsule rupture, a one-piece polymethylmethacrylate IOL was implanted before cataract extraction into the ciliary sulcus in front of the cataractous lens. Subsequently, the cataract was removed by pars plana lensectomy. RESULTS: The surgery and postoperative course were uneventful. Postoperative visual acuity was 20/20. CONCLUSION: We present a method of intraocular lens implantation in cases of rapidly progressing traumatic cataract caused by posterior capsule rupture after a blunt ocular trauma.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
10/85. indocyanine green staining in traumatic cataract.We report the first case of indocyanine green (ICG) being used in an eye with an anterior capsule that was not completely intact. We found that ICG seems to have a selective affinity for the anterior capsule over cortical lens material. The patient had a corneal perforation with a wire and developed endophthalmitis requiring pars plana vitrectomy with intravitreal antibiotics. He subsequently developed a white traumatic cataract with an anterior capsule tear. Five months after the injury, he had cataract extraction. indocyanine green was used to better visualize the anterior capsule before capsulotomy. The anterior capsule stained green, but the cortical material exposed to ICG did not stain.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
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