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MEDICAL AND SOCIAL FEATURES OF LASER EYE INJURIES IN MILITARY PERSONNEL OF THE DEFENSE FORCES OF UKRAINE
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Over 30 million people worldwide suffer from untreatable vision loss and blindness associated with childhood-onset and age-related eye diseases caused by photoreceptor (PR), retinal pigment epithelium (RPE), and choriocapillaris (CC) degeneration. Recent work suggests that RPE-based cell therapy may slow down vision loss in late stages of age-related macular degeneration (AMD), a polygenic disease induced by RPE atrophy. However, accelerated development of effective cell therapies is hampered by the lack of large-animal models that allow testing safety and efficacy of clinical doses covering the human macula (20 mm2). We developed a versatile pig model to mimic different types and stages of retinal degeneration. Using an adjustable power micropulse laser, we generated varying degrees of RPE, PR, and CC damage and confirmed the damage by longitudinal analysis of clinically relevant outcomes, including analyses by adaptive optics and optical coherence tomography/angiography, along with automated image analysis. By imparting a tunable yet targeted damage to the porcine CC and visual streak - with a structure similar to the human macula - this model is optimal for testing cell and gene therapies for outer retinal diseases including AMD, retinitis pigmentosa, Stargardt, and choroideremia. The amenability of this model to clinically relevant imaging outcomes will facilitate faster translation to patients.
Choroidal neovascularization (CNV) secondary to Nd:YAG laser macular injury consists of a rare condition without standardized treatment. Herein, we present the long-term outcomes of a case with a spontaneous closure of a laser-associated macular hole that was followed by late-onset CNV and was successfully treated with intravitreal ranibizumab. A 32-year-old man suffered a macula injury in his right eye after accidental exposure to an 800-nm wave length Nd:YAG laser pulse. Ophthalmological examination demonstrated deterioration in visual acuity along with parafoveal and post-hyaloid hemorrhage. After 1 month, fundoscopy indicated the formation of a full-thickness macular hole. A close observation revealed spontaneous closure of the hole and visual improvement within the next month. One and a half year later, the patient presented with sudden visual distortion, while optical coherence tomography and fluorescein angiography disclosed the development of CNV. The patient was successfully treated with a single intravitreal injection of ranibizumab. The patient's condition has remained stable during an 8-year follow-up period. In conclusion, laser-induced macular injury consists of an increasingly remarkable condition that may have a profound impact on visual outcomes. Our case provides insight into the potential mechanisms of Nd:YAG laser injury and its complications, indicating that CNV may occur even in the long term, while anti-vascular endothelial growth factor may help maintain stable anatomic and functional outcomes.
Objectives:
To examine the incidence and the etiology of corneal and corneoscleral injuries in the setting of combat ocular trauma, and to determine what effect these injuries have on overall visual impairment from combat ocular trauma.
Methods:
Retrospective, noncomparative, interventional case series, analyzing U.S. service members who were evacuated to the former Walter Reed Army Medical Center (WRAMC). Primary outcome measures were types of corneal injuries, length of follow-up at WRAMC, globe survival, and anatomical causes of blindness. Secondary outcome measures included surgical procedures performed, use of eye protection, source of injury, and visual outcomes.
Results:
Between 2001 and 2011, there were 184 eyes of 134 patients with corneal or corneoscleral injuries. The average age was 26 years (range, 18-50); 99.3% were male, 31.9% had documented use of eye protection. The average follow-up was 428.2 days (3-2,421). There were 98 right-eye and 86 left-eye injuries. There were 169 open-globe and 15 closed-globe injuries with corneal lacerations occurring in 73 eyes with injuries to Zone I. Most injuries were attributable to an intraocular foreign body (IOFB; 48%), followed by penetrating (19.6%) and perforating (16.3%) injuries. The most common presenting visual acuity was hand motion/light perception (45.7%), yet, at the end of the study, visual acuity improved to 20/40 or better (40.8%). The majority of injuries in eyes with visual acuity worse than 20/200 involved the cornea and retina (58%). Injuries solely to the cornea accounted for only 19% of all injuries sustained.
Conclusions:
Ocular injuries in military combat have led to significant damage to ocular structures with a wide range of visual outcomes. The authors describe corneal and corneoscleral injuries in combat ocular trauma by classifying injuries by the anatomical site involved and identifying the main source of decreased visual acuity. In combat ocular trauma, corneal or corneoscleral injuries are not the sole etiology for poor vision. A cohesive approach among multiple ophthalmic subspecialties is needed when treating combat ocular trauma.
Significance:
This case report demonstrates the use of novel imaging techniques and functional tests to longitudinally evaluate retinal structure and function following laser retinal injury. The structural and functional prognosis could be predicted with clinical findings, high-resolution retinal imaging, and functional testing.
Purpose:
We present a laser retinal injury case in which an adaptive optics scanning laser ophthalmoscope and adaptive-optics-based psychophysics were used to examine and monitor the retinal structure and function after accidental exposure to a 1-watt infrared laser beam.
Case report:
A 23-year-old patient was unwittingly exposed to a 1-watt, 852 nm continuous-wave laser at work as they noticed a small central blurry spot in the right eye. An initial eye examination was done one-day post exposure and the right eye's acuity was 20/25-2. Posterior segment evaluation revealed disrupted outer retina near right eye's fovea. Adaptive optics imaging 2 weeks after the exposure revealed a 0.50x0.75-degree elliptical area with irregular borders and abnormal cone reflectivity just below the fovea. Starting one-month follow-up, structural recovery was observed on optical coherence tomography (OCT). Subsequent adaptive optics imaging showed significant recovery of cone reflectivity. Importantly, adaptive optics microperimetry showed measurable detection thresholds at all affected retinal locations at 6 months, which restored normal sensitivity at 10 months.
Conclusions:
Retinal structure and function from laser injury can be visualized and measured with OCT, adaptive optics imaging and psychophysics. An intact Bruch's membrane on OCT and measurable retinal sensitivity by adaptive optics microperimetry may serve as good biomarkers for retinal recovery.
Background:
The study was to report the clinical features and post-operative outcomes in military personnel admitted to the Ocular Trauma Center of Gülhane Training and Research Hospital after sustaining combat injuries in urban warfare.
Methods:
This is a retrospective, non-comparative, interventional case series analyzing Turkish military personnel transferred to our tertiary ocular trauma center from the warfare zone and combat support hospitals. Ocular injuries were subdivided into zones and ocular trauma classification.
Results:
There were 103 combat ocular injuries in 74 military personnel. The average age was 27.31±4.64 years (range; 21-48 years), and all were men (100%). The average follow-up was 529.34±213.98 days (288-1464 days). There were 84 open-globe and 19 closed-globe injuries. Thirty-six (34.9%) had final vision of 20/40 or better. Pars plana vitrectomy was the most common surgery (79.6%). Five eyes underwent evisceration, and seven eyes developed phthisis bulbi. The globe survival rate was 88.3%. Zone III injuries (32.2%) were the most common cause of unfavorable visual outcomes, and most injuries were caused by improvised explosive devices (IEDs) (59.2%). These devices also had the worst impact on globe survival and visual improvement. These eyes had a higher likelihood ratio of requiring globe removal surgery or developing phthisis bulbi [odds ratio: 21.5 (95% CI: 1.23-373)]. Two eyes that underwent keratoprosthesis-assisted pars plana vitrectomy followed by penetrating keratoplasty (PKP) during the same session developed PKP failure while failure was not seen in any of the cases that underwent PKP in a later session.
Conclusion:
Ocular injuries related to IEDs had the most significant impact on both visual and anatomic prognoses, and globe survival was less likely in eyes with zone III trauma, in which intraocular foreign bodies penetrated the choroid. There is a higher pos-sibility of PKP failure if this procedure is performed during the same session as other ocular surgery.
Introduction
The ocular trauma score (OTS) is a widely used predictive tool in determining the visual prognosis of ocular injuries. Intraocular-foreign-body (IOFB)-type injuries comprise the leading type of open-globe injuries (OGI) in ocular combat injuries. However, there are scarce reports evaluating the efficacy of OTS in IOFB-type injuries. Only one study is available that explored the validity of OTS in combat-related IOFB injuries with a limited number of eyes. The aim of this study is to confirm the predictive value of OTS in lethal-weapon (LW)-related OGI with IOFB.
Material and Methods
The charts of 488 patients with IOFB-type-eye injuries between January 1998 and January 2018 were analyzed. Only the LW-related ocular injuries were included. Baseline details (patient demographics, surgeries, OTS categories, and visual acuity [VA]) were recorded. To test the validity of OTS, Fischer exact test was used to compare the likelihood of the final VAs for every OTS subgroups between OTS study group and this study.
Results
The complete data of 206 eyes of 142 patients including two civilians were analyzed in the study. No subjects had ocular protection at the time of the injury. OTS study and this current study did not show an exact validation in first three OTS categories in various final VA subgroups (no light perception (NLP) subgroup (P: 0.001), light perception/hand movements subgroup (P: 0.033), 20/200 to 20/50 subgroup (P: 0.047) in OTS category 1; NLP subgroup (P: 0.000), 20/200 to 20/50 subgroup (P: 0.036), 20/40 subgroup (P: 0.018) in OTS 2; and 20/200 to 20/50 subgroup (P: 0.01), 20/40 subgroup (P: 0.003) in OTS 3, respectively). The above results indicate that in first three OTS categories, OTS study was not useful in visual prognosis prediction in the mentioned VA subgroups. The results predicted the final VA only in OTS categories 4 and 5 in which all P values were greater than 0.05.
Conclusions
Visual outcome of this type of ocular injury may be unpredictable due to more frequent discouraging results. OTS failed to predict visual outcome in first three OTS categories in this study. Therefore, OTS appears to be verified only in better (OTS categories 4 and 5) categories.
The time course of the ophthalmoscopic and functional consequences of eight human laser accident cases from military laser systems is described. All patients reported subjective vision loss with ophthalmoscopic evidence of retinal alteration ranging from vitreous hemorrhage to retinal burn. Five of the cases involved single or multiple exposures to Q-switched neodymium radiation at close range whereas the other three incidents occur over large ranges. Most exposures were within 5 degrees of the foveola, yet none directly in the foveola. High contrast visual activity improved with time except in the cases with progressive retinal fibrosis between lesion sites or retinal hole formation encroaching the fovea. In one patient the visual acuity recovered from 20/60 at one week to 20/25 in four months with minimal central visual field loss. Most cases showed suppression of high and low spatial frequency contrast sensitivity. Visual field measurements were enlarged relative to ophthalmoscopic lesion size observations. Deep retinal scar formation and retinal traction were evident in two of the three cases with vitreous hemorrhage. In one patient, nerve fiber layer damage to the papillo-macular bundle was clearly evident. Visual performance measured with a pursuit tracking task revealed significant performance loss relative to normal tracking observers even in cases where acuity returned to near normal levels. These functional and performance deficits may reflect secondary effects of parafoveal laser injury.
Retinal injuries from industrial or military lasers are uncommon, but laser accidents can injure the retina and destroy central vision, permanently. Key principles of retinal anatomy and psychophysics provide a basis for understanding laser-retinal interactions, retinal trauma, and treatment options. Immediate vision loss after a laser accident depends primarily on the location and extent of retinal damage and vitreoretinal hemorrhage. Prompt ophthalmic evaluation of accident victims is indicated to determine the nature and severity of injuries to the cornea, iris, crystalline lens, and retina. There are no clinically proven therapies for minimizing the acute effects of retinal laser injuries, but vitreoretinal surgery is useful for managing complications such as persistent vitreous hemorrhages, macular holes, and epiretinal membranes. The best way to manage laser trauma is to prevent it.
Morfofunktsionalnyy stan hemomikrotsyrkulyatornoho rusla sytkivky pislya odnorazovoho vvedennya kriokonservovanoyi platsenty na tli hostroho eksperymentalnoho aseptychnoho retynitu u shchuriv
- O Stetsuk
- К Shepitko
Stetsuk O, Shepitko К. Morfofunktsionalnyy stan hemomikrotsyrkulyatornoho rusla sytkivky pislya odnorazovoho vvedennya
kriokonservovanoyi platsenty na tli hostroho eksperymentalnoho aseptychnoho retynitu u shchuriv. Svit medytsyny ta biolohiyi.
Perspektyvy prohnozuvannya viddalennykh rezulʹtativ likuvannya u patsiyentiv z boyovoyu travmoyu orhanu zoru
- B Zhupan
- I Lurin
- N Medvedovsʹka
- I Khramov
Zhupan B, Lurin I, Medvedovsʹka N, Khramov I. Perspektyvy prohnozuvannya viddalennykh rezulʹtativ likuvannya u
patsiyentiv z boyovoyu travmoyu orhanu zoru. J.ophthalmol. (Ukraine) [internet]. 30, Chervenʹ 2023 [tsyt. za 14, Serpenʹ 2023];
(3): 34-7. dostupnyy u: https://ua.ozhurnal.com/index.php/files/article/view/18.[in Ukrainian].