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Background: Corneal lacerations mostly affect younger children, commonly males, who will constitute the majority of the workforce. Clinical outcomes are reviewed and compared so that measures to reduce their occurrence and improve outcome can be proffered., Methods: Records of all children between the ages of 1-18 yrs, who presented with penetrating eye injuries at the eye clinic of the University of Port Harcourt teaching Hospital, Rivers state, Nigeria between January 2002 and December 2009 were included. Information retrieved -patient's Bio data, presenting symptoms, presenting visual acuity (VA), source of injury, surgical intervention and outcome using VA. All data analysed with EPI Info version 6 with the aid of a statistician., Results: Folders of thirty-six children (36 eyes) between the ages of 0-18 years diagnosed with corneal laceration over a period of 8 years out of 65 cases managed within that period available. Other folders reported as missing. Male female ratio 3:1, the mean age is 8.7 years (SD ± 3.67). Only one presented within 24 hours. Objects causing injury mainly missiles with stones/catapult injuries (n = 8, 22.2%). Presenting VAs in those that could be measured, ranged from 6/24 to 6/60 (n = 4, 11%) to no light perception (NLP) (n = 5, 13.9%). Associated injuries include lid laceration, cataract, vitreous haemorrhage and retinal detachment. Twenty one patients had primary corneal repair (58.3%) carried out within 7 days of presentation. Four had endophthalmitis. After 3 months follow up, VA of 6/60 and better was achieved in 11 of 18 eyes left in follow up (6/60-6/24 in 8 eyes (22.2%), 6/18 and better in 3 eyes (8.3%)., Conclusion: Most eye injuries in children are preventable. In this study, the prognosis was better in those whose injuries were confined to a peripheral part of the cornea, with no other associated injury, who presented within 5 days and who did not have any intraocular infection at the time of presentation. The importance of health education, adult supervision of play and application of appropriate measures that is necessary for reducing the incidence and severity of trauma is emphasized.

The development of non-lethal weapons started in the 1960s. In France, they have been used by the police for about 10 years. We relate the cases of three French women, victims of stinger grenades, non-lethal weapons recently adopted by the French law enforcement to distract and disperse crowds. The three victims presented serious injuries requiring emergency surgical care. One lost her eye. Based on these cases, we discuss the lethal character of these weapons and propose measures to be taken to prevent their dramatic consequences. Although the danger is obviously less than for firearms, stinger grenades are nonetheless potentially lethal and cause serious physical injuries., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: We aimed to investigate the factors affecting the development of phthisis bulbi after penetrating eye injuries., Methods: The medical records of 132 patients admitted to our clinic between 2000-2006 with the diagnosis of penetrating eye injury were collected. The records of the eight patients who developed phthisis bulbi were evaluated retrospectively. The aspects of anatomic localization, type of trauma, associated events, and development of phthisis bulbi were also investigated., Results: The mean age of the eight patients (5 males, 3 females) was 7.12±4.70 years (range: 2-16 years) and the mean follow-up time was 2.06±1.47 years (range: 6 months-5 years). Three of eight patients developed post-perforation endophthalmitis. Three patients had zone 2-3 scleral perforation and associated retinal detachment and the remaining two patients had proliferative vitreoretinopathy according to the trauma; all eight patients eventually developed phthisis bulbi. The mean time for the development of phthisis bulbi was 5.5±2.13 months (range: 3-10 months)., Conclusion: After penetrating eye injuries, visual prognosis and development of phthisis bulbi were affected significantly by the factors including anatomic localization, size of the injury, associated anterior or posterior segment pathologies, and endophthalmitis secondary to the trauma.

Purpose: We analyzed whether lymphatic vessels can be detected in eyes enucleated after an open globe injury., Methods: The presence of lymphatic vessels was analyzed immunohistochemically using podoplanin as a specific lymphatic endothelial marker in 21 globes that had been enucleated after open globe injury. The localization of pathologic lymphatic vessels (within the eye wall or inside the eye) was correlated with the mechanism of trauma, anatomic site of perforation or rupture, and time interval between trauma and enucleation., Results: Pathologic lymphatic vessels were detected in 15 of 21 eyes (71%) enucleated after an open globe injury. In 5 globes (24%) they were found within the eye, located in retrocorneal membranes, underneath the sclera, and adjacent to uveal tissue (ciliary body, iris). No significant association was observed between the presence of pathologic lymphatic vessels and the mechanism of trauma (P = 0.598), anatomic site of perforation or rupture (P = 0.303), and time interval between trauma and enucleation (P = 0.145)., Conclusions: The human eye can be invaded secondarily by lymphatic vessels if the eye wall is opened by trauma. This mechanism could be important for wound healing, immunologic defense against intruding microorganisms, and autoimmune reactions against intraocular antigens.

The objective of this case report is to report two cases of fish-hook injury to the eye and ocular adnexa with review of literature. Both patients with fish-hook injuries were professional fishermen. The first subject was hit in his right eye by a hook which became embedded in the right cornea. He cut off the line but made no attempt to remove the hook and presented to the emergency department with the hook hanging from his right eye. Under general anaesthesia, the hook was rotated out without causing any further damage to the cornea and intraocular structures. The second subject was reeling the hook back to shore when it hit him in the face and embedded itself in the upper eyelid. He was immediately taken to the emergency department and after careful examination the eye was found to be unharmed and the hook was removed through a small incision under local anaesthesia. Fish-hook injuries, though rare, can result in visual morbidity. The hook should be removed under careful examination using the correct technique. The shaft of the hook should be left long and no attempt should be made by the subject or any non-trained person to remove it as doing so can result in further damage.

A 10-year-old girl suffering from a penetrating orbital stab wound with a knife on the inner canthus of her right eye is reported. Clinical examination of the patient displayed no signs of globe perforation or neurological deficits. The knife was removed slowly with careful and controlled motions. At the last visit three months after the surgery, visual acuity was 20/20, anterior and posterior segment findings were normal, and no binocular eye movement abnormalities were observed.

A 3½-year-old, female (spayed) working black Labrador Retriever was referred to the Unit of Comparative Ophthalmology at the Animal Health Trust after a penetrating lead gunshot injury to the right eye. Clinical examination revealed penetrating injuries to the right cornea, left lateral canthus, and left forelimb. Radiography revealed the presence of multiple metallic foreign bodies in the head and one in the left forelimb. B-mode ocular ultrasonography confirmed the presence of an intraocular metallic foreign body within the posterior tunics of the right eye. Medical treatment of the right eye over a period of 1 month resulted in a comfortable, visual eye. Long-term follow-up over 4½ years revealed a slow deterioration in vision because of progressive lens opacification and the presence of a localized area of chorioretinopathy., (© 2011 American College of Veterinary Ophthalmologists.)

Open globe injuries involving the posterior segment remain a major cause of visual loss in young adults. They occur more frequently in male than in female populations. The majority is due to domestic accidents, since work-related injuries have been decreasing due to proper education and use of safety equipment. However, leisure-related open globe injuries are on the increase. Prompt recognition and treatment of open globe injuries are essential. At presentation, it is necessary to collect etiological data such as cause, nature, time and place of injury. Anti-tetanus immunization must be confirmed. The presenting visual acuity and clinical examination data must be recorded. The lesion type is classified in accordance with the Birmingham Eye Trauma Terminology. Ocular ultrasound or computed tomography is performed for patients suspected of having an intra- or periocular foreign body. Functional prognosis is negatively influenced by a posterior or large rupture, the presence of an intraocular foreign body, the presence of retinal lacerations or retinal detachment, or the occurrence of posttraumatic infectious endophthalmitis. Recent advances in microsurgical techniques such as pars plana vitrectomy and new visualization techniques may improve the anatomical and functional prognosis for these patients. However, postoperative proliferative vitreoretinopathy remains a major concern: it is responsible for a significant rate of secondary retinal detachment with negative consequences for visual prognosis., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Connective Tissue Growth Factor (CTGF) and Transforming growth factor-β1 (TGF-β1) are key growth factors in regulating corneal scarring. Although CTGF was induced by TGF-β1 and mediated many of fibroproliferative effects of TGF-β1, the signaling pathway for CTGF production in corneal scarring remains to be clarified. In the present study, we firstly investigated the effects of c-Jun N-terminal kinase (JNK) on CTGF expression induce by TGF-β1 in Telomerase-immortalized human cornea stroma fibroblasts (THSF). Then, we created penetrating corneal wound model and determined the effect of JNK in the pathogenesis of corneal scarring. TGF-β1 activated MAPK pathways in THSF cells. JNK inhibitor significantly inhibited CTGF, fibronectin and collagen I expression induced by TGF-β1 in THSF. In corneal wound healing, the JNK inhibitor significantly inhibited CTGF expression, markedly improved the architecture of corneal stroma and reduced corneal scar formation, but did not have a measurable impact on corneal wound healing in vivo. Our results indicate that JNK mediates the expression of CTGF and corneal scarring in corneal wound healing, and might be considered as specific targets of drug therapy for corneal scarring.

The aim of the study was to determine temporal TGFB1, TGFB2 and TGFB3 gene expression profiles in the anterior lens capsule of paediatric patients with posttraumatic cataract. The patient group comprised 22 children selected with a fragment of anterior lens capsule obtained during elective cataract surgery and sampled for molecular analysis. The levels of TGF-β isoforms in the anterior lens capsule were determined based on the number of mRNA copies per 1 μg total RNA by real-time qRTPCR. Three time-related result clusters were identified based on hierarchical cluster analysis: 2.2, 4.4 and 15.0 months (time span from injury to anterior capsule sampling during surgery) and compared with regard to temporal gene expression profile and quantitative relations of TGF-β1, 2 and 3 mRNAs. TGF-β1, TGF-β2, and TGF-β3 mRNAs were detected in all anterior lens capsule samples. A comparative analysis revealed: TGF-β1>TGF-β2>TGF-β3 during the entire observation period. The TGF-β mRNA levels continued to increase up to four months after injury, then returning close to the base levels after around 15 months. The expression patterns of TGF-β isoforms showed a similar tendency. Differences in the expression levels of TGF-β1 and TGF-β2 between the particular clusters were statistically significant. Posttraumatic transcriptional activities of TGF-β1 and TGF-β2 in the anterior lens capsule of paediatric patients depend on the time elapsing from injury. Our findings indicate that the transcriptional activities of TGFB family genes show a transient period of over-expression during the months after injury. TGF-β1 is a dominant isoform expressed in lens epithelial cells following injury.

Transorbital intracranial injuries due to a wooden foreign body traversing superior orbital fissure is an extremely rare condition. A 9-year-old boy was struck by a tree branch in the left eye while playing in the garden two months ago. On physical examination, the patient had only a hypertrophic scar on his medial side of left upper eyelid at the admission. A history of recurrent cutaneous fistula from the puncture site due to a retained foreign body was suspected, and the patient was hospitalized to evaluate and remove the object to prevent severe infection. Afterwards, the child was operated successfully via the left transcranial route to detect and remove the foreign body. The authors described an unusual case of wooden foreign body that traversed the superior orbital fissure yet caused no deficit and was associated with no fracture. Even if symptoms are absent, removal of a wooden foreign body should be immediately performed to prevent sight-threatening and life-threatening complications.

Purpose: The analysis of ten unusual eye injuries, and the discussion of appropriate preventive measures., Case Outline: Ten patients hospitalized at the Clinic of Eye Diseases, Clinical Center of Serbia, Belgrade, in the period from January 2000. to December 2009. were presented. Following data were taken in account: sex and age of the patient, injured eye, the mechanism of injury, type of the injury, applied treatment and final visual acuity. The circumstances of the eye injuring of ten patients were described. The eye injuries in all cases occurred in a bizarre way and they were severe enough to require hospital admission. The surgery was necessary in seven patients. Three injured eyes resulted in blindness, and two additional had subnormal vision., Conclusion: In three quarters of discussed cases injuries can be avoided. It is necessary to implement protective measures constantly and consistently and to think about the possible consequences of certain activities. Particular attention should be paid on safety of children. The iatrogenic injuries require special consideration.

Purpose: To observe the pathological changes in rabbit retinas and the measure of glutamic acid levels in the vitreous body after suffering from high-speed bullet injuries., Methods: Rabbits eyeball contusion models were established with high-speed bullets, i.e., the rabbits eyes were shot with a fixed air rifle at a speed of 90m/s (using plastic bullets, weighing 0.20122g, on average). Retinal tissues treated with HE staining and were prepared for light microscopy examination and glutamate levels were tested at different points in time after the injury., Results: Edema, exudation, hemorrhage, and rupture were evident in rabbit retinas following bullet injuries. Meanwhile, glutamate levels gradually increased as time proceeded., Conclusion: Visual impairment is related with retinal damages after high-speed bullet injuries. Increased glutamate concentration serves as a potential factor for aggravating retinal injuries.

We report a case of an accidental death or potential suicide by revolver with subsequent injury of another person. A 44-year-old man shot himself in the head while manipulating his .38 caliber special revolver in the kitchen in the presence of his wife, standing approximately 1.5 m next to him. After passing through the husband's head, the lead round-nose bullet entered the region underneath his wife's left eye. When the bullet left the man's head, it retained the energy to penetrate the soft tissue at this distance, including the skin and thin bone plates like the orbital wall. Owing to the low energy of the projectile, the entry wound was of atypical in shape and without loss of tissue. Only a small line--resembling a cut--was externally visible. The man died in the hospital from his injuries; his wife suffered visual loss of her left eye.

This article reports the unusual radiographic findings of 2 cases of a shotgun shooting incident involving the homicide of a plant manager and the subsequent suicide of the assailant. Radiologic examination of wounds produced by the no. 00 copper-plated buckshot used in the incident revealed images with striking similarity to the lead snowstorm appearance generally associated with high-velocity, soft-point rifle bullets.

Background: We aimed to review the epidemiology and visual outcome of patients with open globe injuries in the northwest part of Turkey., Methods: All patients admitted to the Department of Ophthalmology, Kocaeli University Faculty of Medicine with open globe injuries between 2004-2008 were reviewed retrospectively., Results: Ninety-five eyes of 95 patients, aged between 3 and 79 years, were reviewed. The type of open eye injury was laceration in 76 eyes (80%) and rupture in 19 eyes (20%). In all age groups, projectile objects were the most common cause of injury. In patients 18 years and older, sharp objects (11.1%) were the least prevalent cause of open globe injuries; however, traumas with sharp objects were common in patients younger than 18 years (38.1%) (p=0.01). In patients younger than 18 years, most injuries occurred at home (68.3%), while in patients 18 years and older, the majority of ocular traumas occurred at work (59.2%) (p=0.000). Isolated Zone I lesions showed more improvement in visual acuity than other zones (p=0.043)., Conclusion: Open globe injury in northwest Turkey varied with age and gender. Education and safety precautions are essential to prevent open eye injuries.

A detailed analysis of ultrasound biomicroscopy (UBM) scanogramms of 4 patients with a history of trauma and signs of metallosis is performed. In all cases foreign body was found and its precise localization in relation to anterior segment structures was identified. The following changes were revealed and described: pathological changes of cornea, lens and its fibers, uveal tract in silent zone, zone of retinal periphery and secondary vitreous changes due to trauma itself and chemically active foreign body invasion and long persistence. UBM is recommended to be the part of examination algorithm in patients with penetrating ocular trauma and screening of latent metallosis.

To satisfy the Criminal Code of Canada's definition of a firearm, a barreled weapon must be capable of causing serious bodily injury or death to a person. Canadian courts have accepted the forensically established criteria of "penetration or rupture of an eye" as serious bodily injury. The minimal velocity of nonconventional ammunition required to penetrate the eye including airsoft projectiles has yet to be established. To establish minimal threshold requirements for eye penetration, empirical tests were conducted using a variety of airsoft projectiles. Using the data obtained from these tests, and previous research using "air gun" projectiles, an "energy density" parameter was calculated for the minimum penetration threshold of an eye. Airsoft guns capable of achieving velocities in excess of 99 m/s (325 ft/s) using conventional 6-mm airsoft ammunition will satisfy the forensically established criteria of "serious bodily injury." The energy density parameter for typical 6-mm plastic airsoft projectiles is 4.3 to 4.8 J/cm². This calculation also encompasses 4.5-mm steel BBs.

We report a case of tectonic corneal transplantation for impending corneal perforation to preserve anatomic integrity using cryopreserved donor tissue. An 82-year-old woman exhibiting impending corneal perforation suffered from moderate ocular pain in the left eye for one week. After abnormal tissues around the impending perforation area were carefully peeled away using a Crescent blade and Vannas scissors, the patient received tectonic deep anterior lamellar keratoplasty using a cryopreserved cornea stored in Optisol GS® solution at -70℃ for four weeks. At six months after surgery, the cornea remained transparent and restored the normal corneal thickness. There were no complications such as corneal haze or scars, graft rejection, recurrent corneal ulcer, and postoperative rise of intraocular pressure. Cryopreserved donor lamellar tissue is an effective substitute in emergency tectonic lamellar keratoplasty, such as impending corneal perforation and severe necrotic corneal keratitis., (© 2011 The Korean Ophthalmological Society)

Metal foreign bodies located in the optic nerve are a rare clinical picture and sooner or later often associated with vision loss. We report on a patient who had a foreign body in the optic nerve for 30 years. Histochemical analysis of the optic nerve after the requisite enucleation with complete functional loss of the eye revealed amazing results. Even 30 years after entry of the foreign body into the optic nerve neuronal structures with organized axons surrounded by cytoblasts, glial cells, and immunocompetent cells still remoined. These findings hold out hope and may serve as the starting point for regenerative medicine to potentially restore neuronal function.

Purpose: The purpose of this study was to investigate the effect of intravitreal bevacizumab on an experimental rabbit model of penetrating posterior ocular injury., Methods: The right eyes of 40 white New Zealand rabbits were included in a penetrating posterior ocular injury model that was consisted of a 5-mm circumferential incision placed 8 mm behind the limbus at the supratemporal quadrant. They were randomly divided into two groups. The rabbits in Group 1 (n = 20) received 1.25 mg (0.05 mL) of intravitreal bevacizumab via pars plana injection and those in Group 2 (control group, n = 20) received 0.05 mL of intravitreal balanced salt solution. On Day 28, the eyes were enucleated and evaluated by gross inspection and light microscopy. Clearance time of vitreous hemorrhage, presence of fibrous proliferation or retinal detachment, greatest linear dimension of fibrosis, and grade of fibrous extension were regarded as outcome measures. Nominal variables were evaluated by the chi-square or the Fisher's exact test; continuous variables were evaluated using the Mann-Whitney U test., Results: At the end of the surgery, all the eyes had moderate (n = 9 and 7 in the case and control groups, respectively) or severe vitreous hemorrhage (n = 11 and 13 in the case and control groups, respectively) (P = 0.52). Average clearance time of vitreous hemorrhage was 3.42 ± 2.71 and 6.47 ± 3.58 days in bevacizumab and control groups, respectively (P = 0.01). The incidence of ophthalmoscopically visible fibrous proliferation was 31.6% in the bevacizumab group and 63.2% in the control group (P = 0.05). The greatest linear dimension of fibrosis was 0.91 ± 1.14 mm in the bevacizumab group and 2.00 ± 1.58 mm in the control group (P = 0.02). Retinal detachment rate was 11% (n = 2, all rhegmatogenous) and 21% (n = 4, 2 rhegmatogenous and 2 tractional) in the bevacizumab and control groups, respectively (P = 0.66). Choroidal congestion, optic disk edema, and macular edema were seen in 1 eye (5.5%) of the bevacizumab group, whereas they were found in 4 (22%), 4 (22%) and 3 (16.5%) eyes of the control group, respectively. These differences, however, did not reach statistical significance., Conclusion: This study showed that intravitreal injection of bevacizumab may reduce the extent of fibrovascular and/or fibrocellular proliferation and may accentuate the clearance of vitreous hemorrhage after an experimental model of posterior penetrating ocular injury in rabbits. These alterations may affect the long-term anatomical and/or functional success rate of posterior segment surgeries in these eyes.

Ocular snake-bite injuries are quite rare away from natural habitats. However, when exotic animals are kept in captivity, the injuries sustained and their management can pose challenges when they present to their local eye department. This report describes an atypical eye injury inflicted by a python and its successful management involving surgical, laser and medical interventions. The case highlights the possible pitfalls resulting from the unusual mechanism of injury and the steps to avoid them. The article goes on to discuss the background of the injuries that can be caused by venomous and non-venomous snakes.

In this article we describe two separate cases of serious eye injuries that were the result of two teenagers´ attempts to make home-made explosives out of fireworks. They had tampered with the same brand of fireworks, Víti, that appears to be popular for this purpose and instructions are available on the internet. One boy got an intraocular glass splinter and underwent vitrectomy for removal. The other boy suffered burns on his corneas that were treated with amniotic membranes. In both cases the outcome was better than expected at first. The objective of this article is to draw attention to the danger of tampering with fireworks and the necessity of preventive measures to minimize the risk of serious eye injuries.

Background: Epithelial invasion is a rare but severe complication after penetrating eye trauma or intraocular surgery. Cystic ingrowth can occur even after decades., Casuistics: A 53-year-old woman developed two epithelial cysts in the left eye 48 years after penetrating trauma with a dart. After primary wound closure the intraocular status remained stable for 48 years before symptoms appeared. Preoperative diagnostics (e.g. ultrasound biomicroscopy) detected the origin of the epithelial downgrowth from an intracorneal cyst. Histology confirmed the clinical suspicion of a cystic epithelial ingrowth., Conclusion: The latency of our case is the longest reported interval between penetrating eye trauma and appearance of epithelial ingrowth to be described in detail. Ultrasound biomicroscopy is able to detect the origin of epithelial ingrowth.

Purpose: To report the clinical presentation, treatment approach and natural course of a series of chorioretinitis sclopetaria patients., Methods: Thirteen consecutive patients with clinical diagnosis of chorioretinitis sclopetaria were included in a case series study during 2000-2006. All patients underwent clinical examination, including the best-corrected Snellen visual acuity, slit-lamp examination, applanation tonometry, funduscopy and fundus photography. Three-port standard vitrectomy was performed in two patients due to dense vitreous haemorrhage and suspected retinal detachment in both cases. All patients were followed up at week 4, months 2 and 6 and then every 6 months., Results: The mean age of the patients was 16+/-6 (range: 5-27) years and 11 patients (84.6%) were male. The mean follow-up period was 37+/-18 (range: 17-82) months. Baseline best-corrected visual acuity ranged from no light perception (NLP) to 20/1600, and final visual acuity range was from NLP to 20/1200. Only one patient developed acute retinal detachment, and the retina remained attached in others through follow-up., Conclusion: In spite of severe retinal and choroidal injuries in chorioretinitis sclopetaria, retinal detachment does not usually occur, probably due to spontaneous retinopexy and scar formation. Whilst dealing with chorioretinitis sclopetaria, it is important to make an accurate diagnosis to prevent unwarranted surgical intervention.

Facial impalement injuries involve the danger of diagnostic pitfalls. Even if the penetrating object extends into the cranial cavity, the clinical symptoms and the radiological signs may be uncharacteristic. In order to illustrate the diagnostic problems, two cases of accidental impalement are reported. In both of them, a wooden foreign body penetrated via the orbita into the cranium and remained undetected at first. Imaging by CT and MRI is presented and compared with regard to the respective diagnostic validity of these methods. Due to its specific anatomic configuration, the orbita constitutes a predilective pathway for low-velocity foreign bodies entering the skull. Based on the clinical data and the radiological findings, transorbital impalement wounds inflicted by wooden objects are discussed under neurosurgical and medicolegal aspects.

Introduction: The optical coherence tomography (OCT) exploration of the retina has become almost routine and its semiology is well known. In contrast, the OCT exploration of the anterior segment is still in its preliminary stages., Case Report: We report the clinical aspects and the OCT Visante((R)) imaging of the anterior segment in a 35-year-old patient, victim of a penetrating injury of the left eye who required several operations including iterative vitrectomy for recurrent retinal detachment caused by proliferative vitreoretinopathy, use of high-density silicone oil, cataract surgery with in-the-bag intraocular lens implantation, and YAG-laser capsulotomy., Discussion: The correlation between slit lamp examination and OCT imaging is very good. We debate in a nonexhaustive manner the different imaging possibilities of this new technology and discuss its advantages in the postsurgical exam and its value in medicolegal expert reports as well as in comparison with pictures acquired by OCT normally used to image the posterior segment., Conclusion: Future research will undoubtedly confirm the contribution of this new tool to explore the anterior segment in numerous contexts, including ophthalmological trauma medicine.

This study aims to examine trends of injuries due to landmines and unexploded ordnance (UXO) and to determine problems during and after the treatment of children and adolescent victims in Turkey. Data from the records of 23 children injured from landmines and UXO were analyzed from April 2001 to October 2008. Cases consist of 21 (91.3%) males and two (8.7%) females with a mean age of 12.8 years. Cause of injury was landmine explosion in 20 (87.0%) and UXO in three (13.0%) cases. Injuries in upper and lower extremities were determined in eight (34.8%) children. Hand amputation was the result in 10 (43.5%) children where in two cases a leg, in one case an eye, in one case a hand and arm, in two cases a hand and leg, in one case an eye and a leg and in three cases a hand and eye were lost. One case of death was recorded from UXO with an autopsy performed. Contaminated areas in our region should be cleared according to international contracts to prevent injuries in children, centers providing rehabilitation services should be established and policies regarding social support for child victims should be ascertained.

Traumatic rupture of an extraocular muscle is rare, and most commonly affects the horizontal and vertical rectus muscles. We report a case of a 45-year-old man injured by a metal hook, with rupture of the superior oblique tendon. The resulting deficit was less severe than expected, raising the question of whether a few superior oblique fibers remained intact.

Accidental transorbital head injuries are quite rare. Penetrating head injuries by blunt objects are possible when the site of penetration is through the orbit or the thin temporal bone. The present case is a rare case of transorbital penetrating head injury by a blunt object - bicycle brake handle. Minor external wounds may be misleading and fatal consequences may ensue if cerebral damage is missed on diagnosis. Proper antibiotic coverage to prevent meningitis and neurosurgical intervention can reduce mortality in such cases.

Objective: To evaluate morphological and functional results of therapy in patients with endophthalmitis associated with intraocular foreign bodies in posterior segment in retrospective study., Material and Methods: In the Department of Ophthalmology, School of Medicine, Comenius University Bratislava we treated 216 patients (216 eyes) with intraocular foreign bodies in posterior segment of the eye in the years 1989-2007. Endophthalmitis developed in 34 eyes (15.7%). Patients were in age between 7-59 years, average 35.6 years. Patients were examined in outpatient department, follow up ranged from 1 month to 5.6 years, average 1.6 years. We evaluated epidemiological factors, morphological and functional results in this study., Results: Good morphological results were achieved in 18 patients (52.9%) and bad morphological results in 16 patients (47.1%). Enucleation, evisceration of the globe, phthisis and retinal detachment were defined as bad morphological results. Initial visual acuity 5/50 and better had 4 patients (11.8%), less than 5/50 and better than hand movement had 4 patients (11.8%) and hand movement and less had 26 patients (76.5%). Final visual acuity 5/50 and better had 8 patients (23.5%), less 5/50 and better than hand movement had 4 patients (11.8%) and hand movement and less had 22 patients (64.7%)., Conclusion: Early recognition and correct treatment of posttraumatic endophthalmitis is necessary for maintaining of the eye and its functions. Initial visual acuity better than hand movement is a good prognostic factor.

Background: To determine the prognostic indicators of functional outcome in eyes with severe posterior segment trauma managed with pars plana vitrectomy., Methods: One hundred and six eyes of 101 patients were retrospectively reviewed to determine the accuracy of a number of factors in predicting functional outcome after surgery. These potential prognostic indicators included initial visual acuity (VA), retinal detachment (RD), type of trauma, presence of intraocular foreign body (IOFB), type of IOFB, posttraumatic endophthalmitis, hyphema, choroidal detachment, initial hypotonia, accompanying lens subluxation/dislocation, and severe vitreous hemorrhage. In our study, functional success was defined as VA > or =5/200. Fisher's exact and chi-square tests were used for statistical analysis., Results: The mean follow-up time was 12.8+/-0.52 (8-18) months. Thirty-three eyes (31.13%) had functional success. Forty-four (68.7%) of 64 eyes with preoperative RD had anatomical success (total retinal reattachment). Predictors of poor visual outcome (VA < or =5/200) were found to be poor initial VA (p<0.0001), presence of RD (p<0.001), and presence of endophthalmitis (p<0.05). No statistically significant correlation was found between the other predictors surveyed and visual outcome (p>0.05)., Conclusion: Vitreoretinal surgery can improve anatomical and functional success in eyes with severe posterior segment trauma. Poor initial VA, RD, and posttraumatic endophthalmitis are poor predictors of visual outcome.

Objective: To compare clinical and histologic healing of corneal lacerations repaired by sutures or a new polymeric adhesive., Methods: A central full-thickness 4.1-mm laceration was made in the right eyes of 60 white leghorn chickens. Half of the wounds were treated with biodendrimer polymer adhesive and half were closed with 3 interrupted 10-0 nylon sutures. Slitlamp examination was performed at 6 hours, daily for 7 days, and weekly for 21 days. Animals were humanely killed at days 1, 3, 7, and 28 for histologic examination to evaluate corneal healing., Results: Histologic observations on days 1, 3, and 7 showed glued wounds filled with fibrin, then hyperplastic epithelium, and subsequently scar tissue. Scarring was more prominent at day 7 in glued corneas; however, by day 28, sutured corneas exhibited more inflammation and scarring and much more irregular anterior corneal surfaces. Clinically, all glued corneas remained clear while nearly all sutured corneas had some degree of corneal scarring persisting through day 28. The procedure was about 5 times faster with sealant than with sutures., Conclusion: Corneal lacerations treated with adhesive heal favorably compared with sutures., Clinical Relevance: Biodendrimer adhesives represent a safe, effective, and technically easier alternative to traditional suture repair of corneal perforations.

Purpose: To evaluate the activation of ERK, a MAP kinase, in the regulation of proliferation and migration of rabbit corneal endothelial cells during the healing process after scrape wound injury., Methods: Cultured rabbit corneal endothelial cells were used in this study. Immunocytochemistry and Western blot analysis were performed to demonstrate the phosphorylation of ERK after scrape injury. The injured cell sheets were treated with different concentrations of ERK inhibitor, PD98059. The wound closure at 24, 48, and 72 hr following injury was evaluated. In order to evaluate the role of proliferation during wound healing, immunocytochemistry with Ki67 and 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium inner salt (MTS) assay were performed. The role of cell migration in wound healing was evaluated by quantification with the time lapse microscopic video imaging system., Results: Immunocytochemical and Western blot analysis revealed phosphorylation of ERK in the rabbit corneal endothelial cells after wounding. Inhibition of ERK phosphorylation by PD58059 resulted in a dose-dependent delay of wound closure. The inhibition of wound healing became significant from 48 to 72 hr in cells treated with 10 and 50 micro M of PD58059 (p < 0.05). ERK inhibition suppressed cell proliferation as indicated by Ki67 immunostaining and MTS assay. The time lapse microscopic video imaging analysis indicated delayed cell migration caused by PD98059., Conclusions: ERK activation regulates wound repair of rabbit corneal endothelial cells. Both cell proliferation and migration are involved in this process.

Purpose: To review clinical causes for ocular enucleations and the histopathological features of the enucleated globes in a large third-referral centre in China., Methods: The retrospective study included 1375 globes enucleated in the Beijing TongRen Hospital between January 2003 and November 2006. The medical records were reviewed, and the clinical indications for enucleation and histopathological findings were evaluated., Results: The enucleated eyes accounted for 0.97% of all operated patients registered in the hospital and for 29.5% of all surgical specimens received in the pathological department. The age distribution showed two peaks at an age group of 0-10 years (main enucleation cause: retinoblastoma) and at an age group of 30-40 years (main cause: trauma). In the whole study group, trauma was the most common clinical diagnosis (62.5%) leading to enucleation, followed by tumours (28.5%), surgically treated or untreated ocular diseases (5.7%), and infectious or inflammatory diseases (1.7%). With respect to the histopathological findings, phthisis bulbi (36.4%) was the most frequent finding followed by ocular malignant tumours (28.5%), and acute severe ocular injury (19.9%). Uveal metastases were the second most common intraocular malignant tumour in adults, in the majority of globes secondary to a primary lung cancer., Conclusions: The rate of 1% of enucleations per patient operated and the relatively high rate of ocular traumata as primary cause for enucleation suggest to improve further safety conditions and primary surgical care. The relatively high rate of ocular tumours as cause for enucleations suggests to promote the wide-spread clinical introduction of chemoradioactive tumour therapy.

Possession of firearms is limited because of the technological requirements in production and strict laws. However, anyone can manufacture a handmade firearm by following simple instructions and has no legal liability. A mole gun is an unusual weapon used to kill moles in agricultural areas. It propels pellets in a similar way as a shotgun. This study presents three cases of death caused by mole guns. Two of the cases were accidental, and the other case was suicidal. The first case involved a 51-year-old man who was checking the mole gun when it fired, injuring his left eye and the left region of his face. He died in the hospital after 3 days of medical treatment. The second case was a 78-year-old man, who had been intermittently treated for depression over the last 15 years. He died instantly after placing the mole gun vertically against his head and firing it. The third case was a 43-year-old man who had been trying to set up a mole gun device in his potato field when the weapon accidentally discharged. The victim was injured seriously and died in the hospital a short time later. In conclusion, because the mole gun may cause lethal wounds in humans when fired from a short distance, the researchers believe that its production and use should be in accordance with firearms laws.

Purpose: To describe the long-term clinical results of the implantation of the Artisan iris reconstruction IOL in 5 eyes of 5 children for aphakia and partial aniridia attributable to penetrating ocular trauma., Methods: The charts of 5 children were retrospectively reviewed. The nature and the extent of injury; age at IOL implantation; visual, refractive, and cosmetic outcome; endothelial cell density; and complications and subsequent surgical interventions were evaluated., Results: Mean follow-up period was 8.9 years (range, 4.9-12.4). Mean age at implantation of the Artisan iris reconstruction IOL was 9.5 years (range, 7.7-12.7). Visual acuity improved in 2 of 5 eyes, remained stable in 2 of 5 eyes, and decreased in 1 of 5 eyes. Complaints of photophobia were reduced, and a satisfactory cosmetic outcome was achieved in 3 of 5 patients. The mean spherical equivalent refraction error at last follow-up was -4.0 D. Mean endothelial cell loss when compared with the healthy fellow eye was 42%. Two cases were complicated by partial luxation of the IOL, one case by persistent anterior uveitis and secondary glaucoma. One eye developed a retinal detachment., Conclusions: The Artisan iris reconstruction IOL is a treatment option for the treatment of aniridia and aphakia due to penetrating ocular trauma in children. We emphasize the high-risk characteristics of the eyes treated and the importance of careful patient selection in the outcome of the implantation of the Artisan iris reconstruction IOL.

Adult retinal ganglion cells (RGCs) can survive axotomy and regrow lengthy axons when exposed to lens injury (LI). The neuroprotective and axon-growth-promoting effects of LI have been attributed to an infiltration of activated macrophages into the inner eye and recently also to astrocyte-derived CNTF. The present work reveals that certain purified lens proteins (crystallins) cause the effects of LI. Intravitreal injections of beta- or gamma-crystallins, but not of alpha-crystallin, strongly enhanced axon regeneration from retinal explants in culture, within peripheral nerve grafts or the crushed optic nerve. Deposition of the effective crystallins within the vitreous body was also associated with an influx of circulating macrophages and an activation of retinal astrocytes, Müller cells, and resident microglia. Furthermore beta-crystallin induced CNTF expression in retinal astrocytes and activation of CNTF's major downstream signaling pathway (JAK/STAT3) when intravitreally injected or added to the culture medium ex vivo. Consistently, in culture the addition of beta- and gamma-crystallins to the medium also increased axon regeneration from retinal explants. These results demonstrate that crystallins of the beta/gamma-superfamily are the lens-derived activators of cascades, which lead to axonal regeneration and suggest that their effects might be mediated by astrocyte-derived CNTF.

Myelopid and MP-1 myelopeptide increase the count of antibody-producing cells, reduced under the effect of injury and standard therapy, and do not modify the suppression of delayed hypersensitivity. Injections of myelopid and MP-3 together with standard drugs optimized the traumatic inflammation processes.

Objective: To systematically evaluate the effects of laser beam size, power, and pulse duration of 1 to 100 milliseconds on the characteristics of ophthalmoscopically visible retinal coagulation lesions., Methods: A 532-nm Nd:YAG laser was used to irradiate 36 retinas in Dutch Belt rabbits with retinal beam sizes of 66, 132, and 330 mum. Lesions were clinically graded 1 minute after placement, their size measured by digital imaging, and their depth assessed histologically at different time points., Results: Retinal lesion size increased linearly with laser power and logarithmically with pulse duration. The width of the therapeutic window, defined by the ratio of the threshold power for producing a rupture to that of a mild coagulation, decreased with decreasing pulse durations. For 132- and 330-mum retinal beam sizes, the therapeutic window declined from 3.9 to 3.0 and 5.4 to 3.7, respectively, as pulse duration decreased from 100 to 20 ms. At pulse durations of 1 millisecond, the therapeutic window decreased to unity, at which point rupture and a mild lesion were equally likely to occur., Conclusions: At shorter pulse durations, the width and axial extent of the retinal lesions are smaller and less dependent on variations in laser power than at longer durations. The width of the therapeutic window, a measure of relative safety, increases with the beam size., Clinical Relevance: Pulse durations of approximately 20 milliseconds represent an optimal compromise between the favorable impact of speed, higher spatial localization, and reduced collateral damage on one hand, and sufficient width of the therapeutic window (> 3) on the other.

Purpose: To explore connexin43 (Cx43) knockdown as an efficient treatment for corneal endothelial injury in an in vivo rat corneal scrape injury model., Methods: Scrape injury was induced in the corneal endothelium, and immunolabeling (ZO-1, alpha-SMA, Cx43) was performed to analyze changes in Cx43 expression during wound healing. Single injection of Cx43 antisense oligodeoxynucleotide (AS-ODN), small interfering RNA (siRNA), or adenovirus (CMV-Cx43-mRFP1) was applied into the anterior chamber simultaneously with the injury, and wound closure was examined by immunolabeling (ZO-1, Cx43) and propidium iodide staining. Corneal endothelium proliferation on day 1 after injury was studied by Ki67-immunolabeling. Cx43-knockdown treatment was performed also without injury, and its effect on Cx43 expression and Ki67 immunolabeling was examined. The postinjury appearance of myofibroblasts in Cx43 AS-ODN- and sense-ODN-treated corneas was compared by alpha-SMA-immunolabeling., Results: Complete wound closures were observed in five of six corneas on day 3 after injury with either Cx43 AS-ODN or siRNA treatment, whereas no complete closure was observed on day 3 in the control corneas (S-ODN, zero of six; or nonsense siRNA, zero of six). Consistently, Cx43 overexpression using adenovirus delayed wound closure. Cx43 knockdown increased the number of Ki67-positive proliferating cells on day 1, whereas it decreased the number of alpha-SMA-positive myofibroblasts on day 5. Cx43 knockdown without injury decreased Cx43 expression and induced endothelial proliferation in vivo., Conclusions: These results show that Cx43 knockdown induces corneal endothelium proliferation but inhibits endothelial-mesenchymal transition/transformation after injury, suggesting that Cx43 knockdown is a new therapeutic approach for acceleration of wound closure and for prevention of retrocorneal fibrous membrane formation.

Background: To evaluate the factors affecting visual acuity in cases subjected to surgical repair due to open globe injury., Methods: The records of the patients who have been subjected to emergency surgical repair due to open globe injury were examined retrospectively. From a total of 195 cases, 119 eyes of 119 cases who fulfilled the inclusion criteria were included into the study. Cases were examined in terms of age, gender, trauma type, localization, preoperative examination findings, the presence of additional surgical interventions and the findings in the last examination. Chi-square test and logistic regression analysis were used in statistical analysis., Results: Original visual acuity (p=0.042), zone (p=0.001), trauma type (p=0.003), preoperative anterior chamber loss (p=0.005), existence of hyphema (p=0.001), vitreous prolapse (p=0.000) and posterior segment pathology development (p=0.000) influenced the visual outcome. In cases with grade 4 or grade 5 resulting visual acuity, statistically significant factors were determined as "existence of pathology in the posterior segment" (p=0.000, Odds ratio=12.397) and "total anterior chamber loss" (p=0.015, Odds ratio=4.661)., Conclusion: Changes occurring at the posterior segment pathology and anterior chamber loss are determinant in terms of resulting visual acuity. For this reason, ophthalmoscopy and ultrasonography that should not be omitted in the follow-up period for cases with a transparent media and with media opacity, respectively.