Objective: To evaluate the accuracy of the Classification and Regression Tree (CART) model in prognosticating visual outcomes of patients with open-globe injuries Methods: This was a retrospective, single-center, cohort study of patients with open-globe injuries seen over a two-year period. Purposive sampling of hospital medical records was done to collect data from both in- and out-patient cases. The CART algorithm was utilized to determine the predicted visual outcome for each case, and the accuracy of prognostication was measured by computing for sensitivity, specificity, positive predictive value, and negative predictive value. The area under the receiver operating characteristic curve was used to check its discriminatory capability. Results: A total of 65 eyes (65 patients) with the following diagnoses based on the Birmingham Eye Trauma Terminology (BETT) classification were included: penetrating eye injury (n=58), globe rupture (n=2), and intraocular foreign body (n=5). Majority were male patients (81.5%) in the 17-39 year age group (40%). The sensitivity and specificity of CART were 100% (95% CI 93.6 to 100%) and 77.8% (95% CI 40 to 97.2%), respectively, with an overall accuracy of 96.9% (95% CI 89.3 to 99.6%). Area under the curve (AUC) was statistically significant at 0.89 (95% CI 0.79 to 0.95), indicating that the CART model can discriminate vision survival versus no vision. Conclusion The CART model demonstrated high accuracy in prognosticating visual outcomes after an openglobe injury in the local setting. It may be used as a helpful tool to guide treatment decisions in open-globe injuries.
Eye Injuries, Penetrating

We reported an 8-year-old boy with panscleritis in left eye and right epididymitis after falling on the ground. Etiologic diagnosis played a key role in this case. Systemic examinations ruled out systemic autoimmune diseases, tumors, and infections as the cause of scleritis and suggested that the disease was caused by a local delayed-type hypersensitivity (DTH) induced by ocular trauma and was non-infectious. Still, the right epididymitis was infectious. Both conditions were treated successfully using steroids and antibiotics, respectively. Thus, early etiologic diagnosis and reasonable treatment are crucial to prevent visual loss.
Male ; Humans ; Child ; Epididymitis/complications* ; Eye Injuries/complications* ; Wounds, Nonpenetrating/complications* ; Scleritis/etiology* ; Face

Alkalies/therapeutic use* ; Burns, Chemical/drug therapy* ; Corneal Injuries/drug therapy* ; Eye Burns/drug therapy* ; Humans ; Taurine

OBJECTIVES: To study the quantitative and qualitative differences of visual evoked potential (VEP) in monocular visual impairment after different parts of visual pathway injury. METHODS: A total of 91 subjects with monocular visual impairment caused by trauma were selected and divided into intraocular refractive media-injury group (eyeball injury group for short), optic nerve injury group, central nervous system injury and intracranial combined injury group according to the injury cause and anatomical segment. Pattern Reversal visual evoked potential (PR-VEP) P100 peak time and amplitude, Flash visual evoked potential (F-VEP) P2 peak time and amplitude were recorded respectively. SPSS 26.0 software was used to analyze the differences of quantitative (peak time and amplitude) and qualitative indexes (spatial frequency sweep-VEP acuity threshold, and abnormal waveform category and frequency) of the four groups. RESULTS: Compared with healthy eyes, the PR-VEP P100 waveforms of the intraocular eyeball injury group and the F-VEP P2 waveforms of the optic nerve group showed significant differences in prolonged peak time and decreased amplitude in injured eyes (P<0.05). The PR-VEP amplitudes of healthy eyes were lower than those of injured eyes at multiple spatial frequencies in central nervous system injury group and intracranial combined injury group (P<0.05).The amplitude of PR-VEP in patients with visual impairment involving central injury was lower than that in patients with eye injury at multiple spatial frequencies. The frequency of VEP P waveforms reaching the threshold of the intraocular injury group and the optic nerve injury group were siginificantly different from the intracranial combined injury group, respectively(P<0.008 3), and the frequency of abnormal reduction of VEP amplitude of threshold were significantly different from the central nervous system injury group, respectively(P<0.008 3). CONCLUSIONS VEP can distinguish central injury from peripheral injury, eyeball injury from nerve injury in peripheral injury, but cannot distinguish simple intracranial injury from complex injury, which provides basic data and basis for further research on the location of visual impairment injury.
Evoked Potentials, Visual ; Eye ; Humans ; Optic Nerve ; Optic Nerve Injuries ; Vision Disorders/etiology*

Autopsy ; Eye Injuries ; Forensic Medicine ; Humans

eye treatment with a novel mechanism of action. It is a purinergic P2Y2 receptor agonist that promotes the secretion of tears and healing of corneal epithelial wounds. However, its inhibitory effect on hyperosmotic stress-induced inflammation in human corneal epithelial cells (HCECs) remains unclear.METHODS: A hyperosmotic stress model was established by transferring HCECs from isosmotic (312 mOsm/kg to hyperosmotic medium (500 mOsm/kg). HCECs were incubated with 500 mOsm/kg hyperosmotic medium for 30 minutes, and then treated with diquafosol (0.6–6 mg/mL) for 4 or 24 hours. Cells were then harvested and analyzed by western blot, immunocytochemistry, and real-time polymerase chain reaction to evaluate the expression of interleukin-6, tumor necrosis factor-alpha, and the phosphorylation status of nuclear factor-kappa B.RESULTS: Diquafosol significantly decreased the mRNA and protein expression of hyperosmotic stress-induced tumor necrosis factor-alpha and interleukin-6. These results were supported by immunofluorescence staining and quantitative real-time polymerase chain reaction analysis. Furthermore, diquafosol inhibits nuclear factor-kappa B activation by suppressing the phosphorylation and degradation of the inhibitor of кB.CONCLUSIONS: This study shows that diquafosol inhibits nuclear factor-kappa B signaling and inflammatory factors induced by hyperosmotic stress in HCECs. This suggests that using diquafosol for the improvement of dry eye syndrome could be effective in the treatment of inflammation-related corneal and conjunctival diseases.]]>
Blotting, Western ; Conjunctival Diseases ; Dry Eye Syndromes ; Epithelial Cells ; Fluorescent Antibody Technique ; Humans ; Immunohistochemistry ; Inflammation ; Interleukin-6 ; Necrosis ; Phosphorylation ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Tears ; Tumor Necrosis Factor-alpha ; Wounds and Injuries

PURPOSE: To report a case of corneal collagen cross-linking for corneal ulcer caused by the Moraxella group.CASE SUMMARY: A 77-year-old male had decreased visual acuity for several days in his right eye. The patient showed severe stromal ring infiltrates with a corneal epithelial defect measuring (5.0 × 7.0 mm), a corneal endothelial plaque, and a hypopyon measuring less than 1.0 mm in height in the anterior chamber of the right eye. There was no abnormal finding in the right eye using B-scan ultrasonography. Before starting treatment, a corneal culture was conducted. The culture tests showed the presence of the Moraxella group. Because the patient was diagnosed with a corneal ulcer caused by the Moraxella group, corneal collagen cross-linking (CXL) was performed. The antimicrobial susceptibility test confirmed that this Moraxella group was sensitive to ceftazidime, so the patient was treated with 5% ceftazidime eye drops and 0.5% moxifloxacin eye drops every 2 hours for 9 months after corneal collagen CXL. The uncorrected visual acuity was 0.1 in the right eye, and there was almost no corneal stromal melting on anterior segment optical coherence tomography.CONCLUSIONS: This is the first known case of a corneal ulcer, in the Republic of Korea, caused by the Moraxella group and treated with corneal collagen CXL. Corneal collagen CXL should be considered as a surgical treatment for patients who have an impending corneal perforation due to a corneal ulcer because it is a simple procedure and causes fewer serious complications than other treatments.
Aged ; Anterior Chamber ; Ceftazidime ; Collagen ; Cornea ; Corneal Perforation ; Corneal Ulcer ; Freezing ; Humans ; Male ; Moraxella ; Ophthalmic Solutions ; Republic of Korea ; Tomography, Optical Coherence ; Ultrasonography ; Visual Acuity

Purpose: To determine the health-related quality of life of patients sustaining ocular injuries prognosticated to be visually disabling and to correlate baseline characteristics with quality of life indices. Methods: A prospective, questionnaire-based health-related quality of life study was conducted in a tertiary hospital in the Philippines among 33 patients prognosticated to have visually-disabling ocular injuries using the ocular trauma score (OTS). Clinical and demographic data were collected and quality of life indices were measured using the EuroQoL five-dimension five-level (EQ-5D-5L) questionnaire at baseline and on three subsequent follow-up visits. Data was analyzed by OTS and type of injury. Baseline characteristics were described and correlated with quality of life indices. Results: Of the 33 participants recruited at baseline, 26 were able to return to at least 1 of the 3 recommended follow-up visits. The median age of study participants upon admission was 35 years old with 31 (94%) being males. The patients were admitted at a median of 4 days from injury. Thirty-one (31) or 94% of the participants sustained open globe injuries, with 14 (42%) being penetrating lacerations and 10 (30%) classified as having intraocular foreign bodies. Most patients reported pain and discomfort (82%), problems in usual activities (70%), and anxiety and depression (70%) at baseline. Those with an OTS of 1 had lower median EQ index score (0.447) and EQ visual analog scale (VAS) score (56). A diagnosis of globe rupture was associated with lower median EQ index scores (0.448) and EQ VAS scores (56). EQ index and VAS scores were lowest at baseline. A statistically significantly increase in EQ VAS was seen from baseline to the first month of follow-up (p=0.01). Using univariate regression analysis, no statistically significant correlation between baseline characteristics and baseline quality of life indices was identified. Conclusion Health-related quality of life was lowest shortly after admission for management of ocular trauma and significantly improved at 1 month. Most patients reported pain and discomfort, problems in usual activities, and anxiety and depression. None of the clinical characteristics were shown to be significantly associated with quality of life indices, including visual acuity.
Eye Injuries ; Quality of Life

PURPOSE: To evaluate and compare the efficacy and sensation of instillation between 0.05% cyclosporine nanoemulsion group and microemulsion group. METHODS: This is a double-blind, prospective randomized clinical trial. Patients had 2 weeks of wash-out period before the study. They were randomly assigned to either nanoemulsion group or microemulsion group and treated with each group's cyclosporine eye drop. Artificial eye drop and topical steroid were used together according to severity of dryness of cornea. We checked every patient's Break-up time (BUT), Schirmer test, Staining Score and Ocular surface disease index (OSDI) on baseline, 1 month and 3 months after. Patients also self-checked frequency of use of artificial eye drop and topical steroid. Sensation of instillation was also checked. RESULTS: Both nanoemulsion eye-drop and microemulsion eye-drop improved BUT, Schirmer test, Staining Score and OSDI throughout 12 weeks. The nanoemulsion type reduced OSDI significantly compared to the microemulsion type. The mean frequency of use of artificial tear and topical steroid was similar in both groups. Foreign body sense score was higher in microemulsion group. CONCLUSIONS: 0.05% cyclosporine nanoemulsion type has simillar efficacy and subjectively less foreign body sensation.
Cornea ; Cyclosporine ; Dry Eye Syndromes ; Eye, Artificial ; Foreign Bodies ; Humans ; Prospective Studies ; Sensation ; Tears

PURPOSE: To report a case of chemical injury of the cornea caused by high-dose ethanol during orbital wall fracture repair. CASE SUMMARY: A 56-year-old male presented with pain after blowout fracture repair surgery. During the surgery, 2% hexethanol solution (2% chlorhexidine and 72% ethanol mixture), which was used for disinfection of the face, flowed into the left eye. Conjunctival injection in the left limbus, a large corneal epithelial defect, and severe stromal edema were subsequently observed. The patient was treated with topical antibiotics, steroids, and autologous serum eye drops. After 1 week, the corneal epithelial defect was improved, but at the second month of therapy, recurrent corneal erosion with deterioration of the endothelial cell function occurred. Anterior stromal puncture and laser keratectomy were performed. The corneal epithelial defect and erosion improved, but the endothelial cell density was severely decreased. CONCLUSIONS: The 2% hexethanol solution is usually used for preoperative skin disinfection, but it contains a high concentration of ethanol. The surgeon should be aware that high concentrations of ethanol may result in severe corneal damage, including corneal endothelial dysfunction and limbal cell deficiency.
Anti-Bacterial Agents ; Chlorhexidine ; Cornea ; Corneal Injuries ; Corneal Surgery, Laser ; Disinfection ; Edema ; Endothelial Cells ; Ethanol ; Humans ; Male ; Middle Aged ; Ophthalmic Solutions ; Orbit ; Punctures ; Skin ; Steroids