Focal irradiation of perforating eye injuries

Plaques constructed with 125I were used to irradiate the sites of perforating ocular injuries in rabbits. An approximate dose of 16Gy given over a period of 6 days was shown to significantly reduce intraocular cellular proliferation when irradiation was commenced within 24 hours after injury. If irradiation was delayed until day 5, this reduction in cellular proliferation and intraocular membrane formation did not occur. Smaller radiation doses of approximately 6Gy given within 24 hours post-injury and administered over 6 days also reduced the extent of cellular proliferation but was not as effective as the 16Gy dose.

INVESTIGATION OF INTRAOCULAR PRESSURE AS A PREDICTOR OF TRAUMATIC EYE INJURIES

Eye injuries are a large societal problem in both the military and civilian sectors. Eye injury rates are increasing in recent military conflicts, and there are over 1.9 million eye injuries in the United States civilian sector annually. In order to develop a better understanding of eye injury risk, several previous studies have developed eye injury criteria based on projectile characteristics. While these injury criteria have been used to estimate eye injury potential of impact scenarios, they require that the mass, size and velocity of the projectile are known. It is desirable to develop a method to assess the severity of an eye impact in environments where it would be difficult or impossible to determine these projectile characteristics. The current study presents a measurement technique for monitoring intraocular pressure of the eye under impactloading. Through experimental tests with a custom pressure chamber, a subminiature pressure transducer was validated to be thermally stable and suitable for testing in an impact environment.Once validated, the transducer was utilized intraocularly, inserted through the optic nerve, to measure the pressure of the eye during blunt-projectile impacts. A total of 150 impact tests were performed using projectiles ranging from 3.2 mm to 17.5 mm in diameter. Investigation of the relationship between projectile energy and intraocular pressure lead to the identification of at least two distinct trends. Intraocular pressure and normalized energy measurements indicated a different response for penetrating-type globe rupture injuries with smaller diameter (d < 1 cm)projectiles, and blunt-type globe rupture injuries with larger diameter (d > 1 cm) projectiles. Furthermore, regression analysis indicates that relationships exist between intraocular pressureand projectile energy that may allow quantification of eye injury risk based on pressure data, and also that intraocular pressure measurements of impact may lead to a better understanding of thetransition between penetrating and blunt globe rupture injury mechanisms.

[Heterogeneity of costs and performance for penetrating eye injuries and suturing amniotic membranes under DRG conditions : Analysis of case constellations of the G-DRG C01B of the Regensburg University eye clinic]

Patients with penetrating eye injuries are a very heterogeneous group both medically and economically. Since 2009, treatment involving sutures for open eye injuries and cases requiring amniotic membrane transplantation (AMT) were allocated to DRG C01B of the German diagnosis-related group system. However, given the significant clinical differences between these treatments, an inhomogeneity of costs to performance is postulated. This analysis describes case allocation problems within the G-DRG C01B category and presents solutions.

Incidence and causative agents of chemical eye injuries in Switzerland

CONTEXT Chemical eye injuries are ophthalmological emergencies with a high risk of secondary complications and severe visual loss. Only limited epidemiological data for such injuries are available for many countries. PATIENTS AND METHODS We performed two independent studies. The cause of chemical eye injuries was assessed with a prospective questionnaire study. Questionnaires were sent to all ophthalmologists in Switzerland. A total of 163 patients (205 eyes) were included, between December 2012 and October 2014. Independent of the questionnaire study, the incidence of chemical eye injuries was assessed with a retrospective cohort study design using the database of the mandatory accident insurance. RESULTS Ophthalmological questionnaires revealed that plaster/cement (20.5%), alkaline (12.2%) and acid (10.2%) solutions caused the highest number of chemical injuries. Only 2% of all injuries were classified as grade III and none as grade IV (Roper-Hall classification). The official toxicological information phone-hotline was contacted in 4.3% of cases. Using data from the accident insurance, an incidence of chemical eye injuries of about 50/100 000/year was found in the working population. CONCLUSION Here, we present data on the involved agents of chemical eye injuries in Switzerland, and also the incidence of such injuries in the working population. This may also help to assess the need for further education programs and to improve and direct preventive measures.

Injuries of the eye, orbit, and eyelids : their immediate and remote effects /

Published in London in the same year.

Magnetic resonance imaging: An accurate, radiation-free, alternative to computed tomography for the primary imaging and three-dimensional reconstruction of the bony orbit

Purpose: To determine the extent to which the accuracy of magnetic resonance imaging (MRI) based virtual 3-dimensional (3D) models of the intact orbit can approach that of the gold standard, computed tomography (CT) based models. The goal was to determine whether MRI is a viable alternative to CT scans in patients with isolated orbital fractures and penetrating eye injuries, pediatric patients, and patients requiring multiple scans in whom radiation exposure is ideally limited. Materials and Methods: Patients who presented with unilateral orbital fractures to the Royal Brisbane and Women’s Hospital from March 2011 to March 2012 were recruited to participate in this cross-sectional study. The primary predictor variable was the imaging technique (MRI vs CT). The outcome measurements were orbital volume (primary outcome) and geometric intraorbital surface deviations (secondary outcome)between the MRI- and CT-based 3D models. Results: Eleven subjects (9 male) were enrolled. The patients’ mean age was 30 years. On average, the MRI models underestimated the orbital volume of the CT models by 0.50 0.19 cm3 . The average intraorbital surface deviation between the MRI and CT models was 0.34 0.32 mm, with 78 2.7% of the surface within a tolerance of 0.5 mm. Conclusions: The volumetric differences of the MRI models are comparable to reported results from CT models. The intraorbital MRI surface deviations are smaller than the accepted tolerance for orbital surgical reconstructions. Therefore, the authors believe that MRI is an accurate radiation-free alternative to CT for the primary imaging and 3D reconstruction of the bony orbit. �

A light microscopic and autoradiographic study of non-irradiated and irradiated ocular wounds

Focal gamma irradiation was used to limit the intraocular extension of scar tissue which typically occurs after posterior perforating injury to the eye. Standard posterior perforating injuries were created in the right eye of forty-eight rabbits, half of which had the site of perforation focally irradiated using a Cobalt 60 ophthalmic plaque. Non-irradiated wounds healed with profuse formation of highly cellular and vascularised granulation tissue which invaded the vitreous to form contractile vitreo-retinal membranes. In irradiated eyes vitreo-retinal membrane formation was infrequent; the wounds showing only sparse granulation tissue with little or no extension into the vitreous cavity. Autoradiographic studies carried out in a second group of 40 animals showed that the episclera was the main source of the proliferating fibroblasts, and cell counts confirmed that the inflammatory and repair responses in irradiated wounds were both delayed and attenuated.

Localised gamma irradiation and experimental intraocular proliferation

A controlled study was undertaken to assess the effect of gamma irradiation on post-traumatic intraocular cellular proliferation. A standard perforating injury in the posterior segment of the rabbit eye was used to induce intraocular cellular proliferation and vitreo-retinal membrane formation. The site of injury was irradiated with an ophthalmic Cobalt60 applicator which provided a continuous source of gamma rays. Non-irradiated eyes developed traction retinal detachments associated with post-traumatic vitreo-retinal membranes. Irradiated eyes developed attenuated membranes or atrophic retinal scars, with the retina remaining attached. The membranes in non-irradiated eyes were highly cellular with abundant collagen, while irradiated membranes had fewer cells within a sparse collagen matrix. The episcleral fibroblasts, on autoradiographic studies appeared to be the main source of the cells that formed the proliferating tissue in both non-irradiated and irradiated eyes. In irradiated eyes both the inflammatory response and division of fibroblasts were delayed and reduced.

Are squash players protecting their eyes?

Methods: A survey of 303 players (aged ≥18 years) was conducted at three squash venues in Melbourne, Australia over a three week period in June 2000 to obtain information about protective eyewear use.

Results: Of 303 participants the response rate was 98.1%; 66.1% were males, with a mean age of 40.5 years. The majority (68.4%) had played squash for 10 years or more. Although 18.8% of players reported using protective eyewear, only 8.9% reported wearing approved eyewear. Both age group (p<0.05) and years of squash experience (p<0.01) were significantly associated with any eyewear use. The two main influences were personal experience of eye injuries (50.0%) and knowledge of eye injury risk (33.9%). A commonly reported barrier was restriction of vision (34.2%).

Conclusion: These findings demonstrate a low prevalence of voluntary use of appropriate protective eyewear. Future prevention strategies incorporating education campaigns should focus on increasing players' knowledge of risks. The barriers to use and misconceptions about which types of eyewear is most protective need to be addressed as a priority.

Loss of vision secondary to obsessive-compulsive disorder: a case report

Objective: To report a rare case of self-inflicted eye injury secondary to obsessive-compulsive disorder (OCD).Method: Case report.Results: A 41 year-old patient had significant bilateral visual loss and blunt trauma through touching his ocular cavities due to recurrent doubts regarding their shape and urges to check the format of bones and cartilages. Differential diagnosis with tic disorders is discussed, and the patient's treatment approach is described.Conclusion: Although rare, severe clinical complications can occur in OCD. (C) 2009 Elsevier B.V. All rights reserved.

Aesthetic and functional ocular rehabilitation

The ocular losses are embarrassing to the bearer because they commit the face which has the essential organs for the human relationship. The present study shows the multidiscipline interaction in the treatment of a child who lost his left eye victim of a fire gun and needed an ocular plastic surgery for a correct prosthesis insertion. The ocular prosthesis fills in the ocular cavity simulating the facial growth and restoring its symmetry. Therefore, there are aesthetics, anatomic and physiological improvement on the child's face that allows her to be reinstated in society without being discriminated for her differences. © 2005 Elsevier Ltd. All rights reserved.

Extrusão dos implantes em portadores de cavidade anoftálmica

Purpose: To evaluate the characteristics of patients with anophthalmic cavity who developed sphere extrusion. Methods: A retrospective observational study was done evaluating 37 patients with anophthalmic cavity and sphere extrusion at the Faculdade de Medicina de Botucatu-UNESP. Results: Extrusion was observed in enucleated and eviscerated cavities. The majority of the patients had the eye removed because of phthisis bulbi or trauma and the extrusion happened 1 or 2 years after the surgery. Extrusion was preceded by conjunctival dehiscence and exposure of the sphere and occurred with all used implants. Conclusion: Complications after orbital implant placement are a possibility. Dehiscence and sphere extrusion may happen and another surgery would be necessary. The patient and the ophthalmologist have to be prepared for this.

Psychosocial impact on anophthalmic patients wearing ocular prosthesis

The aim of this study was to assess the improvement in psychosocial awareness of anophthalmic patients wearing ocular prostheses and its relationship with demographic characteristics, factors of loss/treatment, social activity, and relationship between professional and patient. Surveys including a form for evaluation of psychosocial pattern were conducted with 40 anophthalmic patients rehabilitated with ocular prosthesis at the Center of Oral Oncology in the authors' dental school from January 1998 to November 2010. The improvement in psychosocial awareness was assessed by comparing the perception of some feelings reported in the period of eye loss and currently. Wilcoxon tests were applied for comparison of patients' perception between the periods. χ2 tests were used to assess the relationship between the improvement in psychosocial awareness and the variables of the study. In addition, the logistic regression model measured this relationship with the measure of odds ratio. The feelings of shame, shyness, preoccupation with hiding it, sadness, insecurity and fear were significant for improvement in psychosocial awareness. It was concluded that the anophthalmic patients wearing an ocular prosthesis has significant improvement in psychosocial awareness after rehabilitation. © 2012 International Association of Oral and Maxillofacial Surgeons.

Genetic networks controlling retinal injury.

PURPOSE: The present study defines genomic loci underlying coordinate changes in gene expression following retinal injury. METHODS: A group of acute phase genes expressed in diverse nervous system tissues was defined by combining microarray results from injury studies from rat retina, brain, and spinal cord. Genomic loci regulating the brain expression of acute phase genes were identified using a panel of BXD recombinant inbred (RI) mouse strains. Candidate upstream regulators within a locus were defined using single nucleotide polymorphism databases and promoter motif databases. RESULTS: The acute phase response of rat retina, brain, and spinal cord was dominated by transcription factors. Three genomic loci control transcript expression of acute phase genes in brains of BXD RI mouse strains. One locus was identified on chromosome 12 and was highly correlated with the expression of classic acute phase genes. Within the locus we identified the inhibitor of DNA binding 2 (Id2) as a candidate upstream regulator. Id2 was upregulated as an acute phase transcript in injury models of rat retina, brain, and spinal cord. CONCLUSIONS: We defined a group of transcriptional changes associated with the retinal acute injury response. Using genetic linkage analysis of natural transcript variation, we identified regulatory loci and candidate regulators that control transcript levels of acute phase genes.

Protective Eyewear Promotion: Applying Principles of Behaviour Change in the Design of a Squash Injury Prevention Programme

Eye injuries in squash have the potential to be severe. Although these injuries can be prevented through the use of protective eyewear, few players wear such eyewear. The aim of this paper is, to outline the behavioural principles guiding the design of a squash eyewear promotion initiative, the Protective Eyewear Promotion (PEP). Ecological principles of behaviour change were used to provide a comprehensive perspective on intrapersonal factors, policies and physical environmental influences of protective eyewear use. Results of baseline player surveys and venue manager inter-views were used to provide relevant and specific intervention content. At baseline, protective eyewear was not found to be readily available, and players' behaviours, knowledge and attitudes did not favour its use. The main components of PEP involved informing and educating both players and squash venue operators of the risk of eye injury and of appropriate protective eyewear, as well as assisting with the availability of the eyewear and offering incentives for players to use it. A structural strength of PEP was the strong collaborative links with the researchers of different disciplines, the squash governing body, eyewear manufacturers, squash venue personnel, as well as players. Attempts were made within the project structure to make provision for the future dissemination and sustainability of more widespread eye injury prevention measures in the sport of squash.