Caihui Jiang

Endophthalmitis following open globe injury

Objective: To study the clinical characteristics of post-traumatic endophthalmitis following open-globe injury and identify factors affecting its frequency in order to gain further knowledge about possible risk factors for the development of endophthalmitis. Methods: All consecutive records of open globe injury cases (4968 eyes in 4865 inpatients) in 15 tertiary referral hospitals in China over 5 years (January 2001 to December 2005) were retrospectively reviewed. The information was collected from a standardised database of eye injuries from which a detailed analysis of factors influencing the incidence of endophthalmitis was performed. Results: 173 eyes (one bilateral rupture of a male) removed within 24 h after trauma were excluded. It was observed that 571 eyes (571 patients) out of a total of 4795 eyes (4693 patients) developed endophthalmitis, and the rate of incidence was 11.91%. Laceration was an independent risk factor for open globe injury. Primary repair within 24 h, intraocular tissue prolapse and self-sealing of wounds seemed to impart protective effects against the development of endophthalmitis. However, gender, age, lens breach and posterior zone of wounds were not significant. Intravitreal antibiotic and corticosteroid therapy was administered to 53 eyes (9.28%), and vitrectomy was performed on 305 eyes (53.42%). At discharge or follow-up, the proportion (16.81%) of enucleation/evisceration of eyes with endophthalmitis was higher than that (8.71%) without endophthalmitis. Conclusions: Laceration was associatied with a significantly higher risk of endophthalmitis for open globe injuries. Early primary repair, intraocular tissue prolapse and self-sealing of wounds were independent protective factors against the development of endophthalmitis.

Intraocular Foreign Bodies in China: Clinical Characteristics, Prognostic Factors, and Visual Outcomes in 1421 Eyes

PURPOSE To investigate epidemiologic and clinical characteristics, prognostic factors, and visual outcomes of posttraumatic intraocular foreign body (IOFB). DESIGN Retrospective, consecutive case series. METHODS Information from 1,421 eyes (1299 inpatients) with IOFB selected from all open-globe injury cases (4,968 eyes of 4,865 inpatients) in 15 tertiary hospitals in China over a 5-year period were collected from a standardized preformulated database of eye injuries. Factors affecting retinal lesions or detachment, development of endophthalmitis, and visual outcome were analyzed statistically. RESULTS IOFBs represented 28.60% of all open-globe injuries. Of the 1,421 eyes, endophthalmitis developed in 232 (16.76%), and independent protective factors included primary repair within 24 hours (odds ratio [OR], 0.59; P = .006) and self-sealing wounds (OR, 0.69; P = .013). At discharge or follow-up, the enucleation rate was 7.53%, best-corrected visual acuity (VA) improved in 54.33%, and 4.85% had no light perception. Wound length of at least 3 mm and IOFB located in the posterior segment increased the risk of retinal lesion or detachment, and both (OR, 1.66; P < .001; OR, 4.04; P < .001) were significant negative predictors for visual outcome, along with wound larger than IOFB in largest length (OR, 2.38; P = .002) and endophthalmitis (OR, 2.01; P = .0003). Better initial VA (OR, 0.76; P < .001) was a protective factor for final VA. CONCLUSIONS For IOFBs, primary wound closure by repair within 24 hours or self-sealing independently reduces the risk of endophthalmitis. Worse presenting VA, larger wounds, IOFB in posterior segment, wound larger than IOFB in largest length, and endophthalmitis predict worse visual outcome.

Pseudophakic monovision is an important surgical approach to being spectacle-free.

There are few studies on pseudophakic monovision even though it is widely applied. We reviewed the published literature on pseudophakic monovision. Surgeons select patients who not only have a strong desire to be free of glasses after surgery, but also fully understand monovision design and its drawbacks. However, other criteria adopted for pseudophakic monovision are very different. Both traditional monovision and cross monovision are used in pseudophakic monovision, and the target binocular anisometropia ranges from –1.0 D to –2.75 D. Postoperative results were acceptable in every study and most patients were satisfied, with vision being improved and presbyopia corrected. Complications were decreased stereopsis, contrast sensitivity, and visual fields, similar to other types of monovision. The term “pseudophakic monovision” should include more than just monocular intraocular lens implantation in two eyes, and further studies are required.

Role of Lutein Supplementation in the Management of Age-Related Macular Degeneration: Meta-Analysis of Randomized Controlled Trials

Objective: The conduct of this meta-analysis aimed at examining the individual role of lutein as a dietary supplement in improving conditions of age-related macular degeneration (AMD) from the data generated from randomized controlled trials (RCTs). Method: The literature search was made in multiple electronic databases. Eligibility criteria were RCTs that recruited AMD patients or individuals at risk and evaluated lutein supplementation efficacy against placebo. The quality of the trials was assessed by using the Jadad scale. The meta-analysis was conducted under the fixed effect model with RevMan software by calculating the mean differences of the changes from baseline of both lutein and placebo groups. Parameters of interest were macular pigment optical density (MPOD) and visual acuity (VA) in logMAR (minimum angle of resolution). Heterogeneity was determined by χ2 and I2 and publication bias was assessed by visual examination of funnel plots. Results: After following predetermined inclusion and exclusion criteria, five RCTs that recruited 445 participants were selected for the meta-analysis. It has been found that lutein treatment was associated with a significant improvement in MPOD, with mean differences between lutein and placebo groups in the changes from baseline of 0.09 (95% CI: 0.06, 0.12; p < 0.00001). VA also improved with a mean difference between lutein and placebo groups in the changes from baseline of −0.04 (95% CI−0.07, 0.00; p = 0.05). Statistical heterogeneity was not apparent. Conclusion: A statistically highly significant effect of lutein supplementation has been observed for improving the MPOD, whereas the improvement in VA was milder. A daily dose of 10 mg was found as effective as higher doses in this meta-analysis. However, the number of input studies is not adequate for conclusive evidence.

When case report became case series: 45 cases of late traumatic flap complications after laser-assisted in situ keratomileusis and review of Chinese literature

Objective To report 45 cases of late traumatic flap complications after laser-assisted in situ keratomileusis (LASIK) and discuss the continually increasing number of cases in China. Methods A multicentre retrospective survey of eye injuries was carried in 31 military hospitals from January 2006 to December 2011. Detailed information from the medical records of all 92 cases with a history of prior LASIK treatment were collected and summarised, with respect to visual acuity (VA), flap condition, treatment and final outcome. All Chinese publications relevant to late traumatic flap complications in Chinese patients were retrieved and summarised. Results 92 inpatients (92 eyes) underwent LASIK surgery; 45 of these had traumatic LASIK flap complications. Flap dislocation was the commonest and most needed surgical repair. VA after treatment was good and no statistically significant difference was observed when compared with the 47 cases without flap complications. 109 articles related to late traumatic flap complications after LASIK were retrieved from four Chinese document databases. There were 550 cases of late traumatic flap complications. From 2004, case reports became more common; 10 or more cases were reported in some case series. VA of most cases was good and there was no remarkable vision loss after treatment. Conclusions Late traumatic flap complications after LASIK have become more frequent in China, although the prognosis of most cases is good.

Appropriate time for assessing patient satisfaction with cataract surgery care

Appropriate time for assessing patient satisfaction with cataract surgery care In the article byColin et al., patient satisfactionwith cataract surgery care was assessed. The postoperative questionnaires were sent at 2 periods only, after the postoperative visit at 1 to 7 days and after the postoperative visit at 14 to 30 days. In our opinion, another questionnaire sent between 3 months and 4 months would make the design better. First, 30 days is not long enough for a postoperative eye to be quiet, especially with intraoperative or early postoperative complications (39 cases in this study), even though the incision was very small in most cases. Three months would be more appropriate. Second, patients needmore time to adapt to their new refractive status, which will be stable in 2 to 3 months or longer if the incision was large and sutured. In this period, they will ask a lot of questions about their postoperative eyes. In addition, later postoperative complications, such as posterior capsule opacification, retinal detachment, dislocation of the intraocular lens, and cystoid macular edema, will arise 4 to 8 weeks after surgery. Based on these factors, postoperative visits should be carried out at least 3 months after cataract surgery and so should postoperative questionnaires. Colin et al. have done a good study of patient satisfaction with cataract surgery care and could do even better.

Contents Vol. 52, 2014

175 SIRCOVA-OFTARED-RIG Joined Congress Abstracts Valencia (Spain), November 7–8, 2014 (online only) 239 Acknowledgement to Referees

The survey of the causes of eye injury of various services in China

The cause of eye injury in various services may be different. Preventing the injury according to the cause would be more effective. We investigated 502 (549 eyes) cases of ocular injury in 21 military hospitals in China. Sports-related injury was the first cause of ocular injury (181/502, 36.1%), and it was more often seen in navy and air force personnel. A total of 69.1% of sports-related ocular injuries were caused by playing basketball and 18.8% by playing football. Work-related injury was the second cause (140/502). The highest ratio of work-related injury was in the surface warship force (31/67, 46.3%). The ratios of military training-related injury in the army and armed police were 21.4% and 21.3%, respectively, but it is only 4.4% in the navy. The analysis of training subjects showed that about 49.2% of injuries occured during skill training, such as parachuting and operating firearms, and 29.5% occurred during physical exercise or counter-acting exercises. We also found that the ratio of sports-related injury increased and military training-related injury decreased with the level of education.