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Open-globe injuries have poor visual outcomes and have increased in frequency. The current standard of care is inadequate, and a therapeutic is needed to stabilize the injury until an ophthalmic specialist is reached. Unfortunately, current models or test platforms for open-globe injuries are insufficient. Here, we develop and characterize an open-globe injury model using an anterior segment organ-culture platform that allows therapeutic assessment for up to 72 h post-injury. Anterior segments maintained in organ culture were kept at physiological intraocular pressure throughout, and puncture injuries were created using a novel pneumatic-powered system. This system can create high-speed, military-relevant injuries up to 4.5 mm in diameter through the cornea. From intraocular pressure readings, we confirmed a loss of pressure across the 72 h after open-globe injury. Proof-of-concept studies with a Dermabond tissue adhesive were performed to show how this model system could track therapeutic performance for 72 h. Overall, the organ-culture platform was found to be a suitable next step towards modeling open-globe injuries and assessing wound closure over the critical 72 h post-injury. With improved models such as this, novel biomaterial therapeutics development can be accelerated, improving care, and, thus, improving the prognosis for the patients.

The objectives of this retrospective study were to evaluate the histopathologic changes associated with porcupine ocular quill injuries in dogs, to discuss the various methods of quill detection when quills are not grossly visible, and to discuss the pathogenesis of delayed ocular quill injuries in dogs. Seventeen globes sustaining ocular quilling injuries from 17 dogs (1986-2018) were identified in the COPLOW archives and the gross and histologic changes tabulated and compared. All cases were dogs, with one whole globe submitted from each patient. Sixteen of 17 cases had known or suspected porcupine encounters in the weeks or years preceding enucleation. Histopathologic findings included retinal detachment, hyphema, cataract, granulomatous to pyogranulomatous inflammation (uveitis, endophthalmitis, panophthalmitis), lens capsule rupture, suppurative phakitis, scleral perforation, stromal keratitis, breaks in Descemet's membrane, preiridal fibrovascular membrane, anterior and posterior synechia, Schnabel's cavernous atrophy, and periorbital fibrosis. Quill-associated ocular trauma can have a significant deleterious effect on vision and result in enucleation. The time from initial quilling to the manifestation of ocular signs may be prolonged (weeks to years). Any dog presenting for ocular signs with a history of a previous porcupine encounter should be carefully checked for quill migration into the globe as the source of ocular disease. Quills may not be visible grossly, and ancillary imaging techniques can be utilized with various rates of success., (© 2020 American College of Veterinary Ophthalmologists.)

Darts are constantly gaining in popularity. However, their risk of injury is often underestimated. This report is about a juvenile who suffered from a severe eye injury including the opening of the eye bulb. The attending ophthalmologists ruled out the possibility that this kind of injury could be caused by a dart with a plastic point. However, by reconstructing the course of action and throwing darts at porcine eyes, the forensic medical advisory opinion was able to state that darts with damaged plastic points may cause the exact same form of injury. This casuistic illustrates the essential significance of forensic-traumatological knowledge and, especially in the case of rare injury patterns, case-related practical experiments.

Introduction: Childhood ocular trauma is a preventable cause of visual impairment and blindness worldwide. The purpose of our study was to determine demographic, etiologic, and clinical characteristics, visual outcome, and factors affecting visual prognosis in children with open globe injuries (OGI) and to analyze the predictive value of ocular trauma scoring systems for OGI in children., Methods: We conducted a retrospective study enrolling 120 pediatric patients hospitalized for OGI from January 2010 to March 2017. Age, gender, date of trauma, time between trauma and presentation, place and circumstances of injury, etiology, visual acuity (VA), wound location and type of injury based on the Birmingham Eye Trauma Terminology, and the clinical signs were recorded. We recorded the number of surgical procedures performed, complications and visual outcomes., Results: The mean age was 7.38 years. In all, 62.5% of the patients were male, and 37.5% were female. The gender ratio was observed to decrease with increasing age. The mean time interval between injury and consultation was 22.80±42.68hours. Injuries usually occurred at home (80%) followed by playgrounds and sports venues (8.3%), the street (6.7%) and school (5%). All of the OGI's were accidental, and the main context was play (70%). The most common traumas were penetrating injury (60.8%) and metal (30%) objects. Penetrating trauma accounted for 68.3% of cases, followed by rupture (27.5%) and intraocular foreign body (IOFB) (7.5%). Initial VA was<1/10 in 59.2% of cases, and the point of entry was the cornea in 65.8% of cases. Final VA was<1/10 in 39.69% of all cases. FVA was significantly correlated with BCVA prior to the surgery, mechanism of the trauma, wound location and size, and other associated lesions. The Ocular Trauma Score (OTS) and the Pediatric Ocular Trauma Score (POTS) were significantly correlated with final VA., Conclusion: OGI's in children occurs most frequently in school-age boys. Prognosis is determined by presenting visual acuity, trauma score, and wound severity and location., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Purpose: To investigate the clinical characteristics and visual outcomes of patients with work-related open globe injuries (OGIs) and compare them with patients with non-work-related OGIs., Design: Retrospective, observational, multicentre, case-control study., Methods: A total of 374 patients with work-related OGIs and 170 patients with non-work-related OGIs who presented to hospitals that belong to the Japan-Clinical Research of Study group from 2005 to 2015 were included in this study. Clinical data including age, sex, initial and final visual acuity, type of open globe injury, lens status, zone of injury, wound length, and presence of proliferative vitreoretinopathy, retinal detachment, expulsive haemorrhage, and endophthalmitis were recorded., Main Outcome Measures: Visual acuity. Results Work-related OGIs were associated with younger age, male sex, better initial and final visual acuity, more laceration, smaller wounds, presence of retinal detachment, and expulsive haemorrhage, compared with non-work-related OGIs. Multiple regression analysis revealed that final visual acuity is significantly associated with initial visual acuity, wound length, and the presence of proliferative vitreoretinopathy in work-related OGIs., Conclusions: Work-related OGIs showed better visual outcomes than other OGIs. Initial visual acuity, wound length, and the presence of proliferative vitreoretinopathy are predictors of visual outcomes in patients with work-related OGIs.

Penetrating ocular injuries from writing instruments that are thrown, especially by children, in the community can result in significant ocular morbidity. Often these cases present to the accident and emergency department. Accurate and prompt assessment is key in saving sight. We present a case of one such injury and how it was surgically managed., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

A rare case of Staphylococcus gallinarum endophthalmitis with intraocular foreign body (IOFB) was managed successfully by vitrectomy, IOFB removal and intravitreal antibiotics with steroids. Intraoperatively, the inferior retina was noted to be pale, possibly secondary to arteriolar occlusion/inflammation. This pale retina detached while peeling the vitreous, but spontaneously reattached postoperatively within a week. The case report describes the natural course of an iatrogenic detachment of pallid retina and the outcome of an uncommon ocular infection., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: While generally reducing morbidity and mortality, TASER® electrical weapons have risks associated with their usage, including burn injuries and head and cervical trauma associated with uncontrolled falls. The primary non-fatal complications appear to be significant eye injury but no analysis of the mechanisms or suggested treatments has been published., Methods: We used a biomechanical model to predict the risk of eye injury as a function of distance from the weapon muzzle to the eye. We compared our model results to recently published epidemiological findings. We also describe the typical presentation and suggest treatment options., Results: The globe rupture model predicted that a globe rupture can be expected (50% risk) when the eye is within 6 m of the muzzle and decreases rapidly beyond that. This critical distance is 9 m for lens and retinal damage which is approximately the range of the most common probe cartridges. Beyond 9 m, hyphema is expected along with a perforation by the dart portion of the probe. Our prediction of globe rupture out to 6 m (out of a typical range of 9 m) is consistent with the published risk of enucleation or unilateral blindness being 69 ± 18%, with an eye penetration., Conclusions: Significant eye injury is expected from a penetration by an electrical weapon probe at close range. The risk decreases rapidly at extended distances from the muzzle. Not all penetrating globe injuries from electrical weapon probes will result in blindness., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To describe the ocular findings and management of Hymenoptera insect stings., Methods: We treated and followed 8 patients with ocular Hymenoptera stings. All patients were admitted through emergencies and hospitalized at the Hedi Rays eye institute in Tunis., Results: The site of the sting was the cornea in 5 cases, limbus in one case, conjunctiva in one case and upper lid in the last case. Retained stingers were objectified in 4 cases. Immediate surgical extraction carried out in all cases. We also followed one case of post-sting Adie's syndrome and one case of retrobulbar optic neuritis. The sting was conjunctival in one case and palpebral in the other case. Corticosteroids were ineffective in these two cases., Conclusion: Ocular Hymenoptera stings are rare environmental accidents. They may cause various severe ocular complications. Early management, adapted to the clinical manifestations, is the key to a good outcome., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

A 40-year-old drug addict, who was being treated with methadone and occupational therapy, committed suicide by striking a wooden pencil into his right eye socket. While still conscious, he hit his head hard against a table, jamming the pencil even deeper into his head. The autopsy showed that the pencil missed the globe and lodged in the inner part of the right eye socket. It pierced the orbital part of the right ethmoid bone, the right ethmoid cells, and the right superior nasal concha, then passed through the body of the sphenoid bone and the clivus of the occipital bone before stopping in the brain tissue. The basilar artery was transected at the pontomedullary junction, where the tip of the pencil had lodged. Also, at the pontomedullary junction, an approximately 3 mm deep laceration of the brainstem was evident together with flecks of green paint. Histological examination revealed that laceration at the pontomedullary junction was even deeper than the macroscopic appearance had suggested, with several small lateral cracks, focal deep hemorrhage, and disruption of both gray and white matter of the brainstem. Fragments of cellulose originating from the wooden pencil could also be clearly distinguished. Toxicological analysis was performed using liquid chromatography with mass spectrometry, and it showed traces of methadone in the blood and humor vitreous samples. The cause of death was damage to the vital structures in the brainstem, resulting from a penetrating injury to the head by a pencil. Herein, we present a self-inflicted trans-orbital penetrating injury by a non-missile, low-velocity object - a pencil, with a rather unusual, immediately incapacitating outcome.

Penetrating eye injuries are surgical emergencies with guarded visual prognosis. The purpose of the current study was to determine the force required to rupture the cornea with a penetrating object, and to study how this force is affected by the object geometry. Thirty-six human cadaveric eyes from donors of various ages were characterized for diameter, axial length, and pre-test intraocular pressure. In order to investigate the effects of specimen storage time on the tissue response, half of the specimens were tested within two weeks of donor expiration, and half of the specimens were stored at -4°C for 12-18 months. Indenters of three different diameters (1.0, 1.5, and 2.0mm) were lowered into the apex of the cornea until rupture. Resistance to displacement (stiffness), displacement at failure, and the force at failure were determined. Multi-variable regression analysis was used to determine associations of the input variables (indenter size, test speed, and tissue postmortem time) on the mechanics of the tissue response. Twenty-nine of the 36 specimens failed at the indenter location in the cornea, four failed at the limbus, and three failed in the sclera near sites of muscle attachment. The average force at failure caused by the 1.0mm, 1.5mm, and 2.0mm indenters increased from 30.5±5.5N to 40.5±8.3N to 58.2±14.5N, respectively (p<0.002). The force at failure was associated with the donor age (p<0.001), and globe diameter (p<0.041), but was not associated with pre-test intraocular pressure, tissue postmortem time, axial length, or speed of the indenter. This study has quantified the force-displacement and failure response of a large series of human cadaveric eyes subjected to penetrating indentation loads on the cornea. The results provide useful data for characterizing the relationship between corneal rupture and the geometry of a penetrating object., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Competing Interests: Competing interests: None declared.

Although bean bag guns are considered a "less-lethal" form of law enforcement, these blunt projectiles have risk. The purpose of this study was to perform a literature review of morbidity and mortality associated with less-lethal munitions and present a case report of a bean bag injury leading to a traumatic globe evisceration and skull base fracture. Patients presenting with bean bag gun associated injuries warrant a high clinical suspicion for injury to deeper structures.

Analysis of clinical and functional results of microsurgical restoration of eyeball in remote terms after primary surgical processing for traumatic injury of eyes, using combined one-stage operative intervention on anterior and posterior segments, was presented. Satisfactory result was achieved in 56.4% injured persons, in 43.6% - functional outcome after the operation, concerning perspectives of further restoration of optic functions, have appeared unsatisfactory.

In the present study, we investigate and compare the efficacy of bone marrow- and adipose tissue-derived mesenchymal stem cell (MSCs) in corneal wound healing. A penetrating injury was created in the right corneas of Wistar rats (n = 40). Ten microliters of phosphate-buffered solution (PBS) containing 2 × 10(5) green fluorescent protein (GFP) labeled bone-marrow-derived MSCs to group 1 (n = 15), 10 μl of PBS containing 2 × 10(5) GFP-labeled adipose-tissue-derived MSCs to group 2 (n = 15), 10 μl PBS was injected into anterior chamber in group 3 (n = 10, control). Corneal opacity scoring, in vivo confocal microscopy, and histopathological evaluation were done at the end of 8 weeks. Immunofluorescence sections were evaluated to detect transplanted cells. Immune staining was performed to measure the expression levels of keratocan, aldehyde dehydrogenase (ALDH) and CD34. The gene expression levels of tumor necrosis factor (TNF-α), the interleukin 6 receptor (IL-6R), interleukin 12b (IL-12b), and transforming growth factor beta (TGF-β1) was measured on corneas. The establishment of stem cells in the corneas of the transplanted groups was confirmed by immunofluorescence staining. The expression of keratocan, ALDH, and CD34 increased in the transplanted groups (p < 0.05). The density of keratocytes increased significantly in both transplanted groups according to the in vivo confocal microscopy data (p < 0.05). The expression of TNF-α, IL-6R, and IL-12b decreased significantly in the transplanted groups (p < 0.05). Based on our findings, we consider that allogeneic stem cells facilitate the regeneration of corneal stroma and can be a cell source for stromal repopulation in diseased cornea., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

It is sometimes difficult to detect a plant intraocular foreign body, mostly in cases where the history of ocular trauma is unclear, or in patients who consult several months after the trauma. We report a rare case of a 7 year old child with self inflicted trauma of the the left eye by a cactus thorn 3 months before admission, which resulted in a temporal conjunctival granuloma with higher inflammatory reaction of the anterior segment. Surgical exploration was performed allowing the extraction of the thorn with total excision of the granuloma. A slight clinical improvement in visual acuity was observed, but the eyeball secondarily atrophied few months after extraction., Competing Interests: Conflits d’intérêts Les auteurs ne déclarent aucun conflit d'intérêts.

Objectives: To report the clinical features of ocular injuries associated with explosive military ammunition in insurgent attacks in Turkey., Methods: The medical records of 48 casualties who were treated for ocular injuries sustained in insurgent attacks at the Combat Region Hospitals in Turkey were retrospectively reviewed. The reviewed data included initial visual acuity, type of explosive military ammunition (ie, improvised explosive device, mine, hand grenade and rocket-propelled grenade), type of globe injury (open-globe vs closed-globe injury), traumatised globe zones, the presence/absence of an intraocular foreign body, medical interventions, status during the explosion and injuries to other parts of the body. The visual acuity differences between different explosive materials and between 'on-foot' and 'inside-vehicle' casualties were investigated., Results: A total of 83 injured eyes were analysed. The mean patient age was 24.5±6.6 years. The mean initial logarithm of the minimum angle of resolution visual acuity was 0.60±0.63. The injuries were due to improvised explosive devices in 28 cases (58.3%), land mines in 16 cases (33.3%), and hand grenades and rocket-propelled grenades in 2 cases each (4.2%). Forty-seven eyes (56.6%) had open-globe injuries. The most frequently involved zones were zone 1 (50.0%) in closed-globe injuries and all zones (31.9%) in open-globe injuries. Intraocular foreign bodies were present in 45/47 (95.7%) eyes with open-globe injuries. Twelve (14.4%) eyes with no light perception were enucleated, and two (2.4%) eviscerated. The difference in the visual acuities between the on-foot and inside-vehicle casualties and between the injuries that were caused by the different types of explosive ammunitions was also insignificant (p=0.271 and 0.394, respectively)., Conclusions: The clinical results for eye injuries caused by explosive military ammunition sustained during insurgent attacks in Turkey are disappointing irrespective of the explosive material. The use of protective eyeglasses might improve the outcomes and should be encouraged., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

We describe herein a case of an impending corneal perforation with a large descemetocele in a patient with previous penetrating keratoplasty (PKP) that subsequently was treated with an emergent lamellar keratoplasty using frozen preserved cornea. A 76-year-old male patient, who had a PKP, presented with a completely whitish and edematous graft accompanied by large epithelial defects. Although antibiotics and antiviral agents were tried for three days, the corneal stroma abruptly melted, except for the Descemet's membrane and endothelium. Cryopreserved corneal tissue that was kept at -80°C was thawed and sutured on top of the remaining Descemet's membrane and endothelium. Pathological and microbiological tests were conducted using the remaining donor and recipient corneal tissues. After tectonic corneal transplantation on top of a large descemetocele, a healthy graft and relatively clear interfaces between graft-host junctions were maintained without serious adverse reactions throughout 6 month follow-up period. Microbiological evaluations of donor tissue at the time of thawing and tissue preparation were done, and the results were all negative. Tissue that was taken intraoperatively from the recipient cornea also showed negative microbiological results. In conclusion, tectonic lamellar keratoplasty, using cryopreserved corneal tissue, only onto the remaining Descemet's membrane and endothelium in an emergent condition, was a safe and effective treatment.

Objective: To report the histopathologic findings of 3 corneal buttons incised from 2 patients during penetrating keratoplasty (PKP) because of corneal perforation due to corneal siderosis., Methods: Three eyes of 2 patients had accidental trauma to the corneas caused by iron fragments; the injuries were initially treated conservatively with antibiotics and therapeutic soft contact lenses. However, the corneal stroma melted and perforated, necessitating corneal transplantation. The corneal buttons removed during PKP were examined histopathologically, and the findings were compared with the slit-lamp biomicroscopic and anterior segment optical coherence tomographic (AS-OCT) findings., Results: Slit-lamp examinations showed that the corneal epithelium was hyperplasic around the area of perforation in 2 eyes 1 month after the injury. Wide areas of the stroma had melted, and the corneas were perforated. The corneal epithelium was atrophic in the perforated corneas 4 months after injury. Histopathologically, the corneal stroma and Descemet's membrane were stained by Prussian blue, suggesting that the ferric ions had penetrated deeper than expected by the slit-lamp examinations. The areas of Prussian blue staining corresponded well with the areas altered in the AS-OCT images., Conclusions: Ferric ions penetrate much deeper into the cornea than estimated by slit-lamp biomicroscopy. The ferric ions can induce stromal melting that can lead to corneal perforation. We conclude that (i) the ferric ion-infiltrated areas can be estimated in the AS-OCT images and (ii) extensive corneal abrasion should be performed to prevent corneal melting and perforation., (Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the characteristics and outcomes of drunken patients treated for ocular rupture, and to compare these results to patients injured without alcohol consumption., Design and Methods: The medical records of 182 patients with or without alcohol consumption before injury who were treated and followed up because of ocular rupture at the Affiliated Hospital of Weifang Medical University from October 2007 to October 2011 were evaluated retrospectively. The characteristics and outcomes of 45 alcohol-related injury patients were compared with the rest in the cohort. The clinical data included in this study were: anatomic sites and length of the wound, involvement of ocular adnexa injuries, evisceration rate, and final mean visual acuity., Results: Wound locations were significantly different between the alcohol-related group and the non-alcohol-related one. Compared with the non-alcohol-related ocular rupture population, the anatomic sites of the drunken patients were more likely to be located at zone I and zone II (60.0 vs 40.1 %; χ2 = 5.39,P < 0.05). The difference of wound length between the alcohol-related group and the non-alcohol-related one was significant. The alcohol-related patients had a longer wound length (Z = -8.590,P < 0.05). Compared with the non-alcohol population, the alcohol-consuming patients were more likely to suffer adnexa injuries (84.4 vs 59.8 %; χ2 = 5.86,P < 0.05), and had worse final visual acuities (Z = -7.195,P < 0.05). The evisceration rate of the alcohol-related patients was significantly higher than the non-alcohol patients (24.4 vs 9.4 %; χ2 = 6.62,P < 0.05)., Conclusions: Drinking more easily leads to injury of the front part of eyes. Moreover, the drunken patients had a worse visual acuity outcome, longer wound length, higher evisceration rate, and were more prone to endure adnexa injuries. The importance of prevention and education to recognize the hazards of drinking cannot be overemphasized.

Purpose: To determine whether penetrating scleral or corneal injury can enhance intraocular penetration of systemic moxifloxacin, vancomycin, and ceftazidime., Methods: Thirty rabbits were divided into 3 groups for each antibiotic and then further subdivided to receive either scleral or corneal injury to the right eye. The left eye served as a control. Intravenous antibiotics were given following injury, and eyes were subsequently enucleated. Vitreous antibiotic concentration was determined by high-performance liquid chromatography analysis. Plasma concentration was measured for comparison., Results: Intravitreal moxifloxacin concentration was unchanged by injury. Minimum inhibitory concentration (MIC90) was achieved in the vitreous against the most common gram-positive endophthalmitis-causing organisms. Intravitreal vancomycin levels were not enhanced by injury and did not reach the MIC90 for gram-positive organisms commonly causing intraocular infection. Intravitreal ceftazidime was increased in the injured eyes, 67% and 73% higher in scleral and corneal injury eyes. It reached MIC90 of many gram-negative bacteria., Conclusions: Intravitreal antibiotic penetration of systemic antibiotics with or without penetrating ocular injury varies depending on the antibiotic. For prevention or treatment of gram-positive-bacteria-causing endophthalmitis, intravitreal vancomycin is necessary and provides the most reliable coverage. Systemic ceftazidime can be used for many gram-negative bacteria, but intravitreal injection is recommended for better coverage, especially for more-potent organisms. Systemic moxifloxacin can be considered for most gram-positive and -negative infections due to its excellent intraocular penetration and broad coverage, but the patient's previous history of its topical use and increasing resistance patterns must be considered.

The authors present a case of sympathetic ophthalmia with Dalen-Fuchs nodules visualized with spectral-domain optical coherence tomography (SD-OCT). An 84-year-old man presented with floaters and decreased vision 25 years after penetrating trauma to the fellow eye. Examination revealed vitritis and subretinal lesions consistent with Dalen-Fuchs nodules. He was diagnosed with sympathetic ophthalmia after a negative systemic work-up. SD-OCT revealed hyper-reflective lesions at the level of the retinal pigment epithelium with disruption of the inner segment/outer segment (IS/OS) junction. Treatment resulted in clinical improvement and disappearance of Dalen-Fuchs nodules on SD-OCT; however, photoreceptor and retinal pigment epithelial disruptions persisted 5 months after treatment was initiated., (Copyright 2014, SLACK Incorporated.)

Purpose: To describe a surgical technique and intraoperative modifications to create a secondary capsulotomy using the femtosecond cataract laser in an eye with traumatic aphakia and aniridia., Methods: The expanded use of the femtosecond cataract laser (Catalys Precision Laser System; Optimedica, Sunnyvale, CA) for creation of a well-centered and circular secondary capsulotomy in the capsular remnants of an eye with traumatic aphakia and aniridia., Results: Using software modifications based on intraoperative anterior segment spectral-domain optical coherence tomography imaging, and customizing the capsulotomy settings, the femtosecond cataract laser was able to penetrate through most of the fused anterior and posterior capsular leaflets and a circular capsulotomy was achieved. The latter permitted optic capture and excellent centration of a three-piece intraocular lens placed in the sulcus with good postoperative visual rehabilitation., Conclusion: The femtosecond cataract laser can be customized to create a well-centered and circular secondary capsulotomy in aniridic and aphakic eyes where optic capture is critical for long-term intraocular lens stability., (Copyright 2014, SLACK Incorporated.)

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 cm(3). 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., (Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

A five-year-old entire male Tibetan Terrier was referred for left-sided periorbital swelling and blepharospasm 4 days following ipsilateral maxillary tooth extraction. Examination of the left eye revealed mild exophthalmos, pain on retropulsion, and absent menace response and pupillary light reflexes. Examination of the posterior segment was not possible owing to the anterior segment pathology. Differential diagnoses considered were iatrogenic globe penetration and peribulbar abscess/cellulitis. Ocular ultrasound was consistent with a penetrating wound to the globe. Treatment with systemic prednisolone and marbofloxacin, and topical atropine sulfate 1%, prednisolone acetate, and brinzolamide was started. Marked clinical improvement allowed visual confirmation of the perforation. Oral prednisolone was tapered over the following 10 weeks. At final re-examination (10 months), the patient was visual, and fundic examination revealed an additional chorioretinal scar, most likely an exit wound that was obscured by vitreal debris on initial examinations. Neither scar was associated with retinal detachment. To the authors' knowledge, this is the first reported case of successful medical management of iatrogenic globe penetration following exodontic procedures., (© 2013 American College of Veterinary Ophthalmologists.)

Purpose: Thrombospondin-1 (THBS1) has been suggested as a corneal wound-healing modulator. Therefore, we compromised the integrity of the cornea to elucidate the role of THBS1., Methods: Full-thickness penetrating corneal incisions (1.5 mm) were created in wild type (WT, 129S2/SvPas) and THBS1-deficient mice (Thbs1⁻/⁻), 129S2/SvPas-Thbs1(tm1Hyn)/Thbs1(tm1Hyn)), and allowed to heal up to 1 month, while being monitored by slit-lamp and intravital corneal examinations. Corneas also were examined by transmission electron microscopy and indirect immunofluorescence. To determine how THBS1 was involved in the healing process, we examined THBS1 and α-smooth muscle actin (SMA), a marker of myofibroblasts and myoepithelial cells., Results: In WT mice by 1 month, corneas appeared transparent with a thin scar, and endothelium and Descemet's membrane (DM) were restored. In contrast, Thbs1⁻/⁻ corneas exhibited chronic edema and persistent opacity after wounding. The DM and endothelium were not restored, and wound contraction was impaired. The THBS1 was localized in epithelial cells at early stages of the healing process, and in the stroma and endothelial cells during later stages. The SMA-positive epithelial cells and myofibroblasts were observed within the healing area at day 4, peaked at day 14, and disappeared at day 30. The SMA-positive cells were reduced greatly in Thbs1⁻/⁻ mice., Conclusions: In the current study, we demonstrated that corneal restoration is strikingly compromised by a penetrating incision in Thbs1⁻/⁻ mice. The wound results in persistent edema and wound gaping. This appears to be the result of the lack of endothelial migration and DM restoration. In addition, myofibroblast formation is compromised, resulting in the lack of wound contraction.

Objective: To summarize the clinical and pathologic findings in a group of dogs and cats with progressive clinical ocular disease, which were diagnosed with suppurative endophthalmitis and lens capsule rupture., Animals Studied: Twenty cats and forty-six dogs that underwent unilateral enucleation or evisceration for intractable uveitis and/or glaucoma., Procedure: Biopsy submission requests and microscopic case material were evaluated for clinical and histological features, including history of ocular trauma, duration of ocular disease, pattern of inflammation, and the presence of intralenticular microorganisms., Results: The median duration for cats and dogs was 6 and 5 weeks, respectively. A history of trauma was reported for four (20%) cats and 18 (39%) dogs. All confirmed cases of trauma-three in cats and 14 in dogs-were caused by a cat scratch. Microscopically, all cases had suppurative endophthalmitis centered on the lens, lens capsule rupture, cataract, and lenticular abscess. Infectious organisms were identified by Gram stain within the lens of 14 (70%) cats and 30 (65%) dogs. Gram-positive cocci were seen most commonly. Male cats were overrepresented as compared to females. There were no apparent gender, age or breed predilections in dogs., Conclusions: A unique pattern of slowly progressive or delayed-onset endophthalmitis with lens capsule rupture, lenticular abscess, and frequently intralenticular microorganisms is associated with traumatic penetration of the globe and lens capsule. The term Septic Implantation Syndrome (SIS) is favored in lieu of 'phacoclastic uveitis' to avoid confusion with phacolytic uveitis and to clearly implicate the role of intralenticular microorganisms in the pathogenesis., (© 2012 American College of Veterinary Ophthalmologists.)

Objective: To establish rabbit eyeball rupture model by air gun in order to observe and analyze the early injury condition and reasons of retinal cell after eyeball rupture., Methods: Forty eight healthy rabbits were randomly divided into control group and 1, 3, 6, 12 and 24 h after injury groups. After anesthesia, the rabbit eyeball rupture model was established by air gun. Then the early pathological changes of rabbit retina were observed, and apoptotic index (AI), oncosis index (OI), the relationship between the expression amounts of apoptosis-related genes and AI were analyzed., Results: Obvious pathological lesion appeared in retina 6 h after injury. Irreversible damage occurred 12-24 h after injury. The results of AI and OI indicated that the OI peak appeared 6 h after injury and then gradually declined, while the AI increased with the prolongation of time, and the AI was higher than OI in 12 h after injury. Immunohistochemical results indicated that there was no obvious bcl-2 protein expression change. Compared with the control group and the 3, 6, 12 and 24 h after the injury groups, the expressions of p53 and Caspase-3 were significantly improved and peaked at 12 h (P<0.01). Positive correlation existed among p53, Caspase-3 expression amount and cell apoptosis amount., Conclusions: Apoptosis and oncosis of visual cells are the main reasons of retinal cell injury. p53 and Caspase-3 are the important factors in promoting the retinal cell apoptosis after eyeball rupture., (Copyright © 2013 Hainan Medical College. Published by Elsevier B.V. All rights reserved.)

Penetrating head injury by foreign body is relatively uncommon and has been scattered reported in the literature. In this case, a transorbital impalement wound inflicted by bamboo objects was discussed. A 61-year-old alcoholized man died from a transorbital intracranial wound due to penetration of the left orbit after falling from a slope beside the road. Although the facial impalement injury was small and unobtrusive, the penetrating trauma itself could induce lethal consequences, special attention should be paid to such kind of cases. The autopsy and pathological examination revealed subarachnoid hemorrhage, brain contusion and intraparenchymal hematoma. Some pieces of bamboo were also detected in the left anterior cranial fossa. Based on all of the evidence and information, we can draw a conclusion that the bamboo was the instrument causing the injuries and the case was considered as accident., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

The recent clinical observation of two unintentional penetrating ocular and cerebral injuries due to 90-mm construction nails gave occasion to an experimental study to check the alleged trauma mechanism for plausibility. Both casualties reported that they had attached a mason's lacing cord to the masonry using a nail as anchoring when suddenly the nail was yanked from its moorings and propelled like a missile by the overstretched lacing cord. As to the best of the authors' knowledge, this mechanism of injury has not yet been reported in any of the literature; it was the aim to find an experimental approach to review the plausibility of the alleged sequence of events leading to the accidents. The tensile strength at break and strain at break of different mason's lacing cords (diameter of 1 and 2 mm) were measured according to DIN EN ISO 2062 by using a tensile testing machine. Based on the maximum spring energy of the lacing cords, which was determined 174.9 J for the 1-mm cord (length 10 m) and 747.4 J for the 2-mm cord (length 10 m), the maximum possible velocity of the nails as projectiles was calculated to be 243.5 m/s for the 1-mm cord and 503.4 m/s for the 2-mm cord. The critical elongation a cord of a certain length has to be stretched to deliver enough kinetic energy to a 90-mm nail to surpass the threshold velocity for skin penetration, which was investigated by Sellier (1977) to be approximately 18 m/s, was also calculated. To conclude, the energy delivered by the cords is high enough to surpass the rather low threshold velocity of nails. The details of how these accidents occurred, which seemed questionable at first, can be reasonably explained by trauma biomechanics.

We present a case of a 40-year-old soldier who was in close proximity to the detonation of an improvised explosive device (IED). Bubbles of gas were visible within the anterior chamber of his left eye. The authors propose that intraocular gas, present acutely after trauma, is diagnostic of open globe injury and is of particular importance in remote military environments.