Tag: trauma

Fish-hook eye perforation

In EnglishEN: A case of June 2016. A 10yo boy injured himself with a fish-hook during fishing. With these hooks people catch the tasty “mbufu” fish und occasionally even a tiger-fish in Zambesi river. The hook entered through sclera near limbus and left the eye through central cornea.

Treatment was both surgical (in 3 stages) and medical.

  1. Surgical extraction of the fish-hook with a help of pliers (that is what reported by the majority of papers on fish-hook eye trauma). The corneal and scleral wounds were closed with 10-0 nylon. Intravitreal antibiotic was necessary due to the extemely high endophthalmitis rate in such type of traumas. Intravitreal ceftriaxone was given due to lack of vancomycin. Lens wash-out was not performed due to poor view (central corneal wound and incipient infiltrate).
  2. Due to subsequent corneal infiltrate melting additional sutures were applied centrally in the cornea. Due to the limbus infiltrate melting scleral autograft closure was implemented at the limbus. Patient received systemic antibiotic and NSAID and topical antibiotic/cycloplegic treatment. Severe anterior uveitis with fibrin was resolved in a course of two weeks.
  3. Upon relative clearance of corneal infiltrate, lens wash-out was performed and IOL implanted.

The patient was discharged with a Vision of around 6/36, which made both of us and also his father very happy. The chance of eye loss was huge.

in Russian / по-русскиRU: Случай от июня 2016 г. 10-летний мальчик подцепил свой собственный глаз во время рыбалки рыболовным крючком. Крючок перфорировал склеру и вышел через роговицу. Курс лечения включал три этапа хирургического лечения, включая 1) удаление крючка (перекусыванием кусачками), ушивание раны и интравитреальное введение цефтриаксона, и 2) последующее ушивание  вторичной перфорации расплавившегося роговичного инфильтрата и закрытие расплавившегося инфильтрата у лимба с помощью склерального аутотрансплантата. В финале по мере относительного очищения центра роговицы от инфильтрата было произведено 3) вымывание хрусталика и имплантация ИОЛ. Лечение на всём протяжении включало системную антибиотикотерапию и НПВС-терапию, а также местную антибиотико- и циклоплегикотерапию. Пациент выписан со зрением 6/36, что для этой ситуации было высшим благом: риск потерять всё был крайне велик. Шансы на эндофтальмит у такой травмы самые высокие.

Fish-hook eye perforation

Fish-hook eye perforation wound closure

Fish-hook eye perforation wound closure

Fish-hook eye perforation - corneal scar and traumatic cataract

Fish-hook eye perforation – corneal scar and traumatic cataract

27.05.2019 Add Comment

Corneal perforation after cobra spit

In English

In EnglishCase of March 2016. A corneal perforation, 4 months after cobra attack and spit into the eye. These cobras are well-known for their ability to aim good and straight into the eye. Neurotoxin from the venom causes so called cobra spit ophthalmia. Those, who deal with them in bush should know, that Black-necked cobra gets it into the eye 8 out of 10 times! And Mozambique cobra makes it 10 out of 10! There are real studies for that in pubmed, whereby people made a special photographs with human faces, and cobras still made it exactly in the faces’ eyes. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123280/ and others).
In this case, the patient was not treated until the visit to the hospital 4 months after the attack. Perforation was closed successfully with scleral autograft.

in Russian / по-русскиСлучай от марта 2016 года. Состояние глаза после попадания в него ядовитого плевка кобры четыре месяца назад. Пациентка не лечилась. Перфорация была закрыта склеральным аутотрансплантатом.
Интересно: черношеяя кобра попадает в глаз 8 раз из 10, а мозамбикская кобра – все 10 раз попадает строго в глаз! Было показано в исследованиях, где кобрам демонстрировали фотографии с лицами людей.

Corneal perforation, status 4 months after cobra attack and spit with venom into the eye.

25.01.2019 Add Comment

Traumatic posterior lens dislocation

In English

In EnglishYoung gentleman 30 yo with blunt trauma in history (October 2015). His vision went bad immediately after the injury and persisted at the same level up to the visit to the hospital in December 2015. The eye does not bother the patient (no pain, no irritation). IOP 12. VA FC@2m. BCVA with thick plus lenses should be totally fine, as disc and macula are normal. He also had vitreous prolapse into the pupil (partial pupillary block).
There was no uveitis signs, no ocular hypertension or glaucoma, despite 3 months post episode of injury. The patient was prescribed aphakic glasses, as recommended in some textbooks (Parson’s Diseases of the Eye). There was no vitreoretinal service for public patients in the country at the time. Ideally this is of course the case for vitrectomy, lensectomy and IOL with scleral fixation.

in Russian / по-русскиПациент осмотрен в декабре 2015 года.

“Молодой мужчина 30 лет с тупой травмой в анамнезе от октября 2015 г. Зрение ухудшилось мгновенно после травмы и с тех пор стабильно. Глаз спокоен и не болит. Глазное давление 12 мм по Гольдманну. Острота зрения без коррекции счёт пальцев на паре метров. С коррекцией, скорее всего, близко к единице, насколько это смогут позволить толстые плюсовые линзы. Диск, макула и доступная периферия без патологии. Стекловидное тело в зрачке (не полная окклюзия).

Итого, имеем случай травматической дислокации хрусталика в стекловидное тело. Данный случай интересен тем, что ни увеит, ни офтальмогипертензия за дислокацией не последовали, хотя прошло уже почти 3 месяца. Некоторые книги (Parson’s Diseases of the Eye н-р) рекомендуют оставлять такие хрусталики на месте. У меня нет особых других опций, и я планирую отпустить пациента с афакическими очками на один глаз, будет пользовать по переносимости.

На фото – взгляд прямо, чуть вниз, сильно вниз.”

Traumatic posterior lens dislocation. Gaze straight, lower and even full down gaze.

24.01.2019 Add Comment

Traumatic anterior staphyloma

In EnglishI am about to start uploading my pictures collection to the website. Starting from today these posts will randomly reveal interesting pictures from 2014-2017.

First is traumatic anterior staphyloma, male 60 yo. Undergone plain evisceration in December 2015. That time, no implant was used for one or another reason. Note the tape over his left eyebrow. This is meant to caution the nurse and the surgeon to operate on this, and not the other eye. Imagine, the cases of wrongfully amputated eyes are described in the literature!

Traumatic anterior staphyloma, male 60 yo. Undergone plain evisceration. That time, no implant was used. Note the tape over his left eye brow. This is meant to caution the nurse and the surgeon to operate on this, and not the other eye. 03/12/2015.

Traumatic anterior staphyloma

Of note, the golden standard for oculoplastic surgeons in such cases is evisceration with orbital implant. It provides better motility and appearance. See Comparing outcomes of enucleation and evisceration (Ophthalmology, 2006) for reference. Most oculoplastics textbooks would agree. The whole procedure is performed under local anesthesia (retrobulbar lignocaine). Variances of techniques for evisceration are known. The way with posterior incisions in scleral cup and separating optic nerve from the scleral cup are superior, as they provide the surgeon with more space for the bigger PMMA (in this case) orbital implant.

25.12.2018 Add Comment