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PURPOSE: Ocular missile injuries often involve the lens. Some have suggested that lens capsular violation by a foreign body is an indication for immediate lens removal. Sometimes, however, the resultant lens opacity may remain localized without visual compromise. The authors report a series of patients who had lens capsular disruption from an intraocular foreign body that resulted in visually insignificant lens opacities. METHODS: A series of five patients with lens capsular disruption as a result of an intraocular foreign body injury were reviewed retrospectively. RESULTS: All five patients had lens injury from a small foreign body in a peripheral lenticular location. In three patients the foreign body was intralenticular, whereas in the other two patients the foreign body transversed the lens and was located in the posterior segment. In two patients, the foreign body was not removed. Three of the patients required pars plana vitrectomy. In all patients, final visual acuity was at least 20/40, and the lenticular opacity remained localized to an eccentric location. CONCLUSIONS: A progressive, visually significant cataract is not the inevitable result of lens injury by an intraocular foreign body. When indicated, surgical removal of the foreign body may be attempted using a lens-sparing procedure.

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The authors examined a patient who had neovascular glaucoma (NVG) shortly after ipsilateral carotid endarterectomy and followed the patient's clinical course. The authors speculate that the sudden reperfusion after endarterectomy that occurs in patients with combined central retinal artery occlusion and carotid occlusive disease may enhance the circulation of preformed angiogenesis factors, leading to the development of neovascularization. The authors recommend frequent and careful surveillance of patients with central retinal artery occlusion associated with carotid occlusive disease if ipsilateral carotid endarterectomy is performed.

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Between February 1988 and May 1990, the authors treated 12 perforating ocular injuries caused by anesthetic injections around the eye. All 12 injections were performed by nonophthalmologists. Eleven were performed by anesthesiologists and one by a certified nurse anesthetist. Five were caused by blunt needles and seven by sharp needles. Two of the eyes had multiple posterior exit wounds. The five eyes that had sharp needle, single perforations (i.e., one entrance wound and one exit wound) were easily managed with cryopexy, laser, or observation. All five of these eyes have a visual acuity of 20/40 or better. Six vitrectomies were performed on the five patients with single perforations caused by blunt needles; three of these eyes have a visual acuity of counting fingers or worse. The two patients who had multiple posterior exit wounds required a total of four procedures. The visual acuity in these eyes is 20/400 and light perception. Anesthesia personnel should be well trained before attempting ocular anesthesia. The use of blunt needles does not prevent ocular penetration.

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A 30-year-old man had symptoms and signs consistent with bilateral classic central serous chorioretinopathy. Conventional single-session laser treatments to both eyes stabilized the condition for 9 years. The patient then developed atypical central serous chorioretinopathy consisting of tracts of fluid emanating from the posterior pole and bilateral inferior exudative retinal detachments. Diffuse retinal pigment epithelial disease with recurrent leakage in both maculas was treated with grid laser photocoagulation, which was effective in stabilizing the patient's condition.

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Krypton red (647 nm) laser photocoagulation may offer distinct advantages in the treatment of branch retinal vein occlusion (BRVO), particularly in eyes with extensive intraretinal hemorrhage or in the presence of media opacities such as vitreous hemorrhage or cataract. Twenty-three eyes were followed for a minimum of 6 months (range, 6-38). Of 19 eyes treated for macular edema, 17 (89%) had complete resolution of their edema, one (5%) had reduction of its edema, and one (5%) was unchanged. Of five eyes treated for retinal neovascularization of the disc or retina, all eyes had complete elimination of neovascularization. The authors were unable to demonstrate any statistical correlation between final visual acuity and the following factors: duration of symptoms, cystoid macular edema (CME), degree of paramacular nonperfusion, and contiguous intraretinal hemorrhage extending into the foveal avascular zone (FAZ).

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Two hundred forty-one eyes with a "limited retinal detachment" were treated between 1967 and 1983 by transconjunctival retinocryopexy without scleral buckling. Follow-up ranged from 6 months to 10 years (mean, of 34 months). Anatomic reattachment was accomplished with retinocryopexy alone in 95% (228 eyes) of cases. Thirteen eyes (5%) were anatomic failures, but 12 of these were subsequently reattached with additional surgery. Risk factors for anatomic failure included multiple breaks, vitreous hemorrhage, and breaks with a rolled posterior edge. Visual results indicated that 229 eyes (95%) had stable or improved vision, while 12 eyes (5%) lost two or more Snellen lines. Causes for visual deterioration included premacular fibroplasia, proliferative vitreoretinopathy, and preexisting ocular pathology. Single breaks occurred in 172 eyes (71.4%), and multiple breaks in 69 eyes (28.6%). Associated clinical findings included high myopia (17%), surgical aphakia (12%), and retinal detachment in the fellow eye (27%).

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