RESUMEN
OBJECTIVE: To identify the epidemiological profile and prognostic factors of open globe injuries that require emergency surgical treatment. DESIGN: Retrospective cohort study. SUBJECTS: Patients with OGI who underwent publicly funded emergency surgical treatment in the Federal District from 2014 to 2018. METHODS: Data were collected by reviewing electronic medical records through a questionnaire and tabulated. The statistical analysis was performed in SPSS Statistics 26.0.0.0 (p ≤ 0.05). RESULTS: A total of 359 records were included, corresponding to 336 eyes of 334 patients (294 males and 40 females). The average age was 32.7 years. The affected eye was the right eye in 165 cases, the left eye in 166 cases, and both eyes in 3 cases. The average time between injury and hospitalization was 75.7 h, and the time between injury and surgery averaged 173.7 h. The injury types were as follows: 197 penetrating; 109 rupture; 19 IOFB; 11 perforating. The injuries were in the following zones: 181 zone I; 82 zone II; 70 zone III. The OTS grades were as follows: 57 were classified as grade 1; 101 were grade 2; 142 were grade 3; 28 were grade 4; and 8 were 5. The most commonly performed surgeries were corneal suture, corneoscleral suture, and evisceration. The most common clinical features were traumatic cataract, herniated iris and hyphema. The following were risk factors for poor prognosis: zone III, time between trauma and surgery > 72 h, rupture injury, retinal detachment, disorganization of the eyeball, endophthalmitis, uveal prolapse, OTS classification 1 or 2, and low initial visual acuity. The following factors predicted a good prognosis: initial VA > 1/200, penetrating injury, OTS 4 and zone II. CONCLUSIONS: The high frequency of many of these factors may explain the high rate of severe visual loss found. Injury localization in zone II was identified as a previously unrecognized protective factor against severe visual loss.
Asunto(s)
Lesiones Oculares Penetrantes , Lesiones Oculares , Adulto , Brasil/epidemiología , Lesiones Oculares/epidemiología , Lesiones Oculares/cirugía , Lesiones Oculares Penetrantes/diagnóstico , Lesiones Oculares Penetrantes/epidemiología , Lesiones Oculares Penetrantes/cirugía , Femenino , Humanos , Masculino , Pronóstico , Estudios Retrospectivos , Agudeza VisualRESUMEN
OBJECTIVES: To describe, evaluate, and identify the characteristics, prognostic factors, and visual outcomes in patients with intraocular foreign body (IOFB) in a Latin American population. METHODS: A retrospective, observational case-series of patients with a diagnosis of IOFB. Variables analyzed included age, gender, initial and final best correct visual acuity (BCVA), ocular trauma score, intraocular pressure, mechanism of injury, material and number of IOFB, zone of injury, timing of primary repair and IOFB removal, complications, and follow up. RESULTS: Sixty-one patients with IOFB were identified of which 97% were male with a mean age of 37.9 years (SD 2.16). The most common IOFB location was intravitreal (43%). IOFBs were metallic in 78%, vegetal in 3%, and other materials in 11%. Primary repair and secondary IOFB removal were performed at a mean timepoint of 3 days and 5 days, respectively. Systemic and topical antibiotics were administered to all patients. The initial BCVA was 1.62 logMAR and the final was 0.6 logMAR, which was statistically significant (Pearson's chi-squared test, p value 0.01). No cases of endophthalmitis were seen. CONCLUSION: IOFB removal can be delayed when there are no signs of infection or evidence of retinal detachment, without an increased risk of endophthalmitis and a negative impact on visual outcomes. Use of topical and systemic antibiotics appear sufficient to prevent endophthalmitis in these cases.
Asunto(s)
Cuerpos Extraños en el Ojo , Lesiones Oculares Penetrantes , Cuerpos Extraños en el Ojo/diagnóstico , Cuerpos Extraños en el Ojo/cirugía , Lesiones Oculares Penetrantes/diagnóstico , Lesiones Oculares Penetrantes/cirugía , Humanos , Recién Nacido , Masculino , Estudios Retrospectivos , Centros Traumatológicos , Resultado del Tratamiento , VitrectomíaRESUMEN
INTRODUCCIÓN: En lo que a traumatismos se refiere, el ojo es el tercer órgano más afectado después de manos y pies [1]. El trauma ocular constituye una de las principales causas de pérdida de la visión unilateral y determina consecuencias graves en el ámbito psico-social del individuo; siendo la causa más común de ceguera unilateral en la edad pediátrica, principalmente en países en vías de desarrollo [2]. La epidemiología de las lesiones oculares depende de varios factores; como el estilo de vida, el estado socioeconómico y las actividades deportivas y recreativas [2]. Según la Organización Mun-dial de la Salud (OMS), la incidencia anual mundial de traumatismo ocular es de alrededor de 55 millones [1]. Alrededor del 38-52% de todos los casos de urgencias oftálmicas son traumas ocu-lares y el 0.9-1.8% de ellos deben ser ingresados debido a un traumatismo grave [2]. Las lesiones varían desde una pequeña abrasión epitelial de la córnea hasta penetración y ruptura del globo [3]. El desgarro de la córnea, el desgarro de la esclerótica y el daño de la lente son las morbilidades observadas con mayor frecuencia del traumatismo ocular, seguidas de laceración del párpado, prolapso uveal, anomalías de la cámara anterior, desprendimiento de retina y avulsión del nervio óptico [1]. Las lesiones oculares, incluso las de menor importancia, pueden generar importantes cargas económicas por la necesidad de cuidados especiales, la costosa hospitalización, tratamiento y rehabilitación visual [2]. Este artículo presenta un caso clínico de trauma ocular, con pronóstico desfavorable según OTS. Epidemiológicamente entre el 30-40% de las cegueras monoculares son producidas por traumas oculares [2]. Al existir un trauma ocular con herida penetrante, se debe intervenir de forma oportuna en las primeras 24 horas para prevenir complicaciones y mejorar el pronóstico [4].(au)
BACKGROUND: The eye is the third most common organ affected by trauma after hands and feet [1]. Eye trauma is one of the main causes of unilateral vision loss and imposes major social and psychological impact on patients; in fact it is the most common cause of unilateral blindness in pediatric age groups, especially in developing countries [2]. The epidemiology of eye injuries depends on several factors, such as lifestyle, socioeconomic sta-tus, and sports and recreational activities.[2] According to the World Health Organization (WHO), the global annual incidence of eye trauma is around 55 million [1]. About 38-52% of all cases in ophthal-mic emergency rooms are ocular traumas and 0.9-1.8% of them needs to be admitted due to severe trauma [2]. Corneal tear, scleral tear and lens damage are the most frequently observed morbidities of ocular trauma, followed by lid laceration, uveal prolapse, anterior chamber abnormality, retinal detachment and optic nerve avulsion. [1]. Eye injuries, even the minor ones, can result in significant economic burdens due to special care and family costs, the expensive hospital admission, treatment and visual rehabilitation. [2] We present a case report of ocular trauma, with poor prognosis according to OTS. Epidemiologically between 30-40% cases of monocular blindness are caused by eye trauma [2]. In cases of ocular trauma with penetrating injuries, patients should be treated in the first 24 hours to prevent complications and improve the prognosis [4].(au)
Asunto(s)
Humanos , Masculino , Preescolar , Lesiones Oculares Penetrantes/cirugía , Lesiones de la Cornea/terapia , Ceguera/complicacionesRESUMEN
PURPOSE: To report a case of a child with strabismus and delayed discovery of a metallic intraocular foreign body with good recovery of visual acuity and stereopsis with 36-month follow-up. METHODS: A 4-year-old girl was evaluated due to exotropia of right eye initiated 9 months before with progressive worsening. Visual acuity was 1.00 logMAR (20/200) in the right eye and 0.00 logMAR (20/20) in the left eye. Anterior segment evidenced a small paracentral corneal leukoma, posterior synechia and mild lens opacity in the temporal quadrant only in the right eye. Fundus examination in the right eye identified the presence of an intraocular foreign body, with appearance of metallic components surrounded by retinal pigmented endothelial cells atrophy. Full-field electroretinography (ERG) showed reduced amplitudes and delayed implicit times for both rods and cones in the affected eye. All tests were normal in the fellow eye. RESULTS: Pars plana vitrectomy was promptly performed in the right eye, followed by phacoemulsification with intraocular lens implantation 4 months later due to worsening of the lens opacification. The full-field ERG was repeated after the surgical procedures. The ERG showed mild worsening of all responses in the right eye. After 36 months of follow-up, visual acuity was 0.20 logMAR (20/32) with improvement of the ocular misalignment and with 60 s of arc stereopsis with ERG responses unchanged. CONCLUSION: In this young girl perforating ocular trauma with metallic material was lately diagnosed with strabismus as a sign of alert. Prompt surgical intervention and proper management were essential to provide reasonable visual function including some degree of stereopsis, even though retinal dysfunction characterized by ERG was persistent.
Asunto(s)
Cuerpos Extraños en el Ojo/diagnóstico , Lesiones Oculares Penetrantes/diagnóstico , Metales , Retina/lesiones , Atrofia , Preescolar , Diagnóstico Tardío , Percepción de Profundidad/fisiología , Electrorretinografía , Exotropía/diagnóstico , Cuerpos Extraños en el Ojo/fisiopatología , Cuerpos Extraños en el Ojo/cirugía , Lesiones Oculares Penetrantes/fisiopatología , Lesiones Oculares Penetrantes/cirugía , Femenino , Humanos , Implantación de Lentes Intraoculares , Facoemulsificación , Refracción Ocular/fisiología , Retina/fisiopatología , Epitelio Pigmentado de la Retina/patología , Agudeza Visual/fisiología , VitrectomíaRESUMEN
Los traumatismos oculares representan la principal causa de pérdida de la agudeza visual en individuos jóvenes y se sitúa entre las causas de ceguera en el mundo. Pueden tener un efecto devastador sobre el globo ocular; es el tipo de traumatismo más severo en esta zona, con un pobre pronóstico visual para el paciente. Constituye un accidente grave, que en muchas ocasiones conlleva a la enucleación. Se presentan tres pacientes con rotura del globo ocular, con la conducta terapéutica, seguimiento y resultados visuales en cada caso, para mostrar a la comunidad médica, la complejidad y particularidades de este traumatismo(AU)
Ocular traumatisms represent the principal cause of loss of vision in young people and they are among the causes of blindness in the world. Trauma can result in a wide spectrum of tissue lesions of the globe and it can has devastating effect on the eyeball, since it is the most severe type of trauma in this area, with a poor visual prognosis for the patient. It is a serious accident, which often leads to nucleation as result of a bruised intense trauma. This is the report of three patients with rupture of the ocular globe with the therapeutic behavior, follow-up and visual results in each case, to show the medical community, the complexity and particularities of this traumatism(AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Anciano , Vitrectomía/métodos , Enucleación del Ojo/métodos , Lesiones Oculares Penetrantes/cirugía , Tomografía Computarizada Espiral/métodos , Vitreorretinopatía ProliferativaRESUMEN
Los traumatismos oculares representan la principal causa de pérdida de la agudeza visual en individuos jóvenes y se sitúa entre las causas de ceguera en el mundo. Pueden tener un efecto devastador sobre el globo ocular; es el tipo de traumatismo más severo en esta zona, con un pobre pronóstico visual para el paciente. Constituye un accidente grave, que en muchas ocasiones conlleva a la enucleación. Se presentan tres pacientes con rotura del globo ocular, con la conducta terapéutica, seguimiento y resultados visuales en cada caso, para mostrar a la comunidad médica, la complejidad y particularidades de este traumatismo(AU)
Ocular traumatisms represent the principal cause of loss of vision in young people and they are among the causes of blindness in the world. Trauma can result in a wide spectrum of tissue lesions of the globe and it can has devastating effect on the eyeball, since it is the most severe type of trauma in this area, with a poor visual prognosis for the patient. It is a serious accident, which often leads to nucleation as result of a bruised intense trauma. This is the report of three patients with rupture of the ocular globe with the therapeutic behavior, follow-up and visual results in each case, to show the medical community, the complexity and particularities of this traumatism(AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Anciano , Vitrectomía/métodos , Enucleación del Ojo/métodos , Lesiones Oculares Penetrantes/cirugía , Tomografía Computarizada Espiral/métodos , Vitreorretinopatía Proliferativa/tratamiento farmacológicoRESUMEN
Abstract This report aims to show an unusual case of "transorbitário" wooden foreign body causing visual loss due to optic nerve damage on the side contralateral penetration of foreign matter.
Resumo O presente relato tem o objetivo de mostrar um caso incomum de corpo estranho de madeira "transorbitário" que causou perda visual por lesão do nervo óptico do lado contralateral a penetração do corpo estranho.
Asunto(s)
Humanos , Femenino , Adolescente , Cuerpos Extraños en el Ojo/cirugía , Cuerpos Extraños en el Ojo/diagnóstico por imagen , Traumatismos del Nervio Óptico/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Lesiones Oculares Penetrantes/cirugía , Lesiones Oculares Penetrantes/diagnóstico por imagen , Vehículos a Motor Todoterreno , Traumatismos del Nervio Óptico/cirugíaRESUMEN
We herein present a case with corneal overriding due to improper suturing of a full-thickness corneal laceration. There was a 2.5-mm difference between horizontal and vertical white-to-white measurements in the cornea. However, slit lamp examination failed to demonstrate the exact architecture of the laceration. Ultrasound biomicroscopy defined the wound edges thoroughly and confirmed the presence of corneal overriding. Six weeks after suture enhancement, the abnormal oval appearance of the cornea was absent and correct apposition of the corneal edges was seen on ultrasound biomicroscopy. Ultrasound biomicroscopy can be used in preoperative surgical planning of cases with complicated corneal lacerations. It can be used to adjust and enhance wound architecture in eyes with penetrating injury.
Apresentamos um caso com encavalamento corneano devido à sutura inadequada de uma laceração da córnea de espessura total. Houve uma diferença 2,5 mm entre as medidas do branco ao branco horizontais e verticais na córnea. No entanto, o exame da lâmpada de fenda não conseguiu demonstrar a arquitetura exata da laceração. A biomicroscopia ultrassônica definiu as bordas da ferida completamente e confirmou a presença de encavalamento da córnea. Seis semanas após a melhora da sutura, a aparência oval anormal da córnea havia desaparecido, e a correta aposição das bordas da córnea foi identificada na biomicroscopia ultrassônica. A biomicroscopia ultrassônica pode ser usada no planejamento cirúrgico pré-operatório de casos com lacerações corneanas complicadas. Ela pode ser utilizada para ajustar e melhorar a arquitetura da ferida em olhos com lesão penetrante.
Asunto(s)
Adulto , Humanos , Masculino , Lesiones de la Cornea/cirugía , Laceraciones/cirugía , Complicaciones Posoperatorias/cirugía , Técnicas de Sutura/efectos adversos , Lesiones de la Cornea , Lesiones Oculares Penetrantes/complicaciones , Lesiones Oculares Penetrantes/cirugía , Laceraciones , Microscopía Acústica/métodos , Complicaciones Posoperatorias , Resultado del TratamientoRESUMEN
We herein present a case with corneal overriding due to improper suturing of a full-thickness corneal laceration. There was a 2.5-mm difference between horizontal and vertical white-to-white measurements in the cornea. However, slit lamp examination failed to demonstrate the exact architecture of the laceration. Ultrasound biomicroscopy defined the wound edges thoroughly and confirmed the presence of corneal overriding. Six weeks after suture enhancement, the abnormal oval appearance of the cornea was absent and correct apposition of the corneal edges was seen on ultrasound biomicroscopy. Ultrasound biomicroscopy can be used in preoperative surgical planning of cases with complicated corneal lacerations. It can be used to adjust and enhance wound architecture in eyes with penetrating injury.
Asunto(s)
Lesiones de la Cornea/cirugía , Laceraciones/cirugía , Complicaciones Posoperatorias/cirugía , Técnicas de Sutura/efectos adversos , Adulto , Lesiones de la Cornea/diagnóstico por imagen , Lesiones Oculares Penetrantes/complicaciones , Lesiones Oculares Penetrantes/cirugía , Humanos , Laceraciones/diagnóstico por imagen , Masculino , Microscopía Acústica/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Resultado del TratamientoRESUMEN
Se describe el caso clínico de un paciente de 47 años de edad, de procedencia rural, que asistió al cuerpo de guardia del Centro Oftalmológico del Hospital General Docente Juan Bruno Zayas Alfonso de Santiago de Cuba por haber sufrido traumatismo contuso en su ojo derecho al caerse de un árbol de 5 o 6 metros de altura aproximadamente. Se le diagnosticó trauma ocular a globo abierto en zona II, herida penetrante escleral e hifema grado IV. Luego de 4 días, al disminuir el hiposfagma, se observó subluxación del cristalino en la conjuntiva inferonasal. Después de un proceso prolongado de exploración y seguimiento preoperatorio y posoperatorio logró una recuperación visual satisfactoria(AU)
The case report of a 47 year-old patient of rural origin is described, who was attended in the emergency room of the Ophthalmological Center in Juan Bruno Zayas Alfonso Teaching General Hospital from Santiago de Cuba due to a traumatic contusion in his right eye when falling from an approximately 5 or 6 meters high tree. He was diagnosed an ocular trauma in opened globe in area II, penetrating scleral wound and IV degree hyphema. After 4 days, when decreasing the hyposphagma, subluxation of the lens was observed in the inferonasal conjunctiva. After a prolonged process of exploration and preoperative and postoperative follow-up, he achieved a satisfactory visual recovery(AU)
Asunto(s)
Humanos , Masculino , Adulto , Lesiones Oculares Penetrantes/cirugía , Cristalino/lesiones , Subluxación del Cristalino/diagnóstico , Subluxación del Cristalino/cirugíaRESUMEN
We report a case of penetrating eye globe injury due to a metallic nail. This is the first case evaluated by our service that presented with an intact 2.5-centimeter nail penetrating the right eye with a significant intraocular component that the patient did not remove. We describe the initial presentation and the multi-step surgery that this complicated injury required. The early postoperative visual acuity remained unchanged when compared to the presenting. In addition, the patient had no retinal pathology or optic nerve damage after the procedure.
Asunto(s)
Lesiones Oculares Penetrantes/etiología , Lesiones Oculares Penetrantes/diagnóstico , Lesiones Oculares Penetrantes/cirugía , Humanos , Masculino , Uñas , Adulto JovenRESUMEN
We described the clinical, surgical details and results (motor and sensory) of the retrieving procedure of traumatically avulsed muscles in three patients with no previous history of strabismus or diplopia seen in the Department of Ophthalmology, State University of Campinas, Brazil. The slipped muscle portion was reinserted at the original insertion and under the remaining stump, which was sutured over the reinserted muscle. For all three cases there was recovery of single binocular vision and stereopsis.
Asunto(s)
Lesiones Oculares Penetrantes/cirugía , Músculos Oculomotores/lesiones , Adolescente , Diplopía/diagnóstico , Lesiones Oculares Penetrantes/complicaciones , Femenino , Humanos , Persona de Mediana Edad , Músculos Oculomotores/cirugía , Procedimientos Quirúrgicos Oftalmológicos , Reimplantación/métodos , Estrabismo/diagnóstico , Estrabismo/etiología , Agudeza VisualRESUMEN
We described the clinical, surgical details and results (motor and sensory) of the retrieving procedure of traumatically avulsed muscles in three patients with no previous history of strabismus or diplopia seen in the Department of Ophthalmology, State University of Campinas, Brazil. The slipped muscle portion was reinserted at the original insertion and under the remaining stump, which was sutured over the reinserted muscle. For all three cases there was recovery of single binocular vision and stereopsis.
Foram descritos os quadros clínicos, detalhes cirúrgicos e resultados (motores e sensoriais) da reinserção de músculos traumaticamente avulsionados, em três pacientes sem estória prévia de estrabismo ou diplopia, atendidos no Departamento de Oftalmologia da Universidade Estadual de Campinas. A porção muscular deslizada foi reinserida na linha da inserção original e sob o coto remanescente, o qual foi acomodado e suturado sobre o músculo reinserido. Para os três casos houve recuperação da visão binocular única e da estereopsia.
Asunto(s)
Adolescente , Femenino , Humanos , Persona de Mediana Edad , Lesiones Oculares Penetrantes/cirugía , Músculos Oculomotores/lesiones , Diplopía/diagnóstico , Lesiones Oculares Penetrantes/complicaciones , Procedimientos Quirúrgicos Oftalmológicos , Músculos Oculomotores/cirugía , Reimplantación/métodos , Estrabismo/diagnóstico , Estrabismo/etiología , Agudeza VisualRESUMEN
INTRODUCTION: Open-globe ocular trauma causes visual deficiency; calculating the magnitude of the latter often misses the estimation in patients without follow-up. AIM: to identify the modification of the postoperative proportion of visual deficiency in open-globe ocular trauma, which would introduce considering the proportion estimated in patients without follow-up. METHODS: Non-interventional, retrospective, longitudinal, analytical study. Visual outcome in eyes with open-globe trauma, with and without follow-up, was calculated using the Ocular Trauma Score. The observed postoperative proportion of visual deficiency was identified in eyes with follow-up; in eyes without follow-up, the postoperative proportion of visual deficiency was estimated using an analysis of scenarios: best (Ocular Trauma Score), mean (that of eyes with follow-up) and worst (last observation/no visual improvement). The estimated proportion of visual deficiency was added to that observed in eyes with follow-up, and the resulting proportion was compared with that expected in the sample, using the Ocular Trauma Score (χ(2)). RESULTS: 104 eyes, 70 without follow-up and 34 without it. In eyes with follow-up the expected proportion of visual deficiency was 58.6%, and the observed one was 71.4% (p = 0.1); the estimated proportion of visual deficiency in eyes without follow-up was 76.5%. The resulting postoperative proportion of visual deficiency in the sample would be 73.1%, which would overcome that expected by the Ocular Trauma Score (59.6%, p = 0.04). CONCLUSIONS: In open-globe ocular trauma, the efficacy of surgery to reduce the proportion of visual deficiency would decrease with regard to the standard expected by the Ocular Trauma Score, if the deficiency estimated in eyes without follow-up were considered.
Asunto(s)
Lesiones Oculares Penetrantes/epidemiología , Pacientes Desistentes del Tratamiento , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Endoftalmitis/epidemiología , Endoftalmitis/etiología , Cuerpos Extraños en el Ojo/complicaciones , Cuerpos Extraños en el Ojo/epidemiología , Cuerpos Extraños en el Ojo/cirugía , Lesiones Oculares Penetrantes/complicaciones , Lesiones Oculares Penetrantes/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Trastornos de la Pupila/epidemiología , Trastornos de la Pupila/etiología , Recuperación de la Función , Desprendimiento de Retina/epidemiología , Desprendimiento de Retina/etiología , Estudios Retrospectivos , Rotura/epidemiología , Rotura/cirugía , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Índices de Gravedad del Trauma , Resultado del Tratamiento , Trastornos de la Visión/epidemiología , Trastornos de la Visión/etiología , Agudeza Visual , Infección de Heridas/epidemiología , Infección de Heridas/etiología , Adulto JovenRESUMEN
A case of a perfluoro-n-octane leakage into the orbital cavity after corneoscleral suture, scleral buckling and pars plana vitrectomy in an eye with perforating injury after trauma is reported for the first time. A previously healthy 39-year-old man was sent for ophthalmic evaluation one day after suffering a penetrating ocular trauma in his right eye while hammering a nail. On the initial evaluation, the patient presented sudden reduction of visual acuity on his right eye with a perforating corneoscleral injury, intraocular foreign body and retinal detachment. The patient was submitted to corneoscleral suture, pars plana vitrectomy with perfluoro-n-octane administration to flatten the retina and scleral buckling, when it was found transfixation of the globe by the intraocular foreign body. Postoperatively, computed tomography scans of the orbit were ordered due to proptosis, which showed the presence of hyperdense images, suggesting leakage of perfluoro-n-octane into the orbital cavity. Thus, in cases of perforating eye injury, one should be suspicious about the possibility of intraocular foreign body, as well as possible occurrence of transfixation of the globe when scheduling the surgery.
Asunto(s)
Extravasación de Materiales Terapéuticos y Diagnósticos/complicaciones , Cuerpos Extraños en el Ojo/cirugía , Lesiones Oculares Penetrantes/cirugía , Fluorocarburos/efectos adversos , Desprendimiento de Retina/etiología , Vitrectomía/efectos adversos , Adulto , Cuerpos Extraños en el Ojo/complicaciones , Lesiones Oculares Penetrantes/complicaciones , Fluorocarburos/uso terapéutico , Estudios de Seguimiento , Humanos , Masculino , Agudeza VisualRESUMEN
O objetivo é relatar, pela primeira vez, o caso de um paciente submetido à vitrectomia posterior e sutura de perfurante ocular que evoluiu com extravasamento de perfluoroctano para cavidade orbitária. Paciente do sexo masculino, 39 anos, hígido, encaminhado para avaliação oftalmológica após ter sofrido trauma no olho direito com pedaço de metal há um dia. Ao exame, apresentava redução súbita da acuidade visual à direita com ferimento perfurante ocular córneo-escleral, corpo estranho intraocular e descolamento de retina. O paciente foi submetido à sutura de perfurante, introflexão escleral e vitrectomia posterior com utilização de perfluoroctano, quando foi constatada transfixação do globo ocular. No pós-operatório, evoluiu com proptose e presença de imagens hiperdensas à tomografia computadorizada de órbitas, sugerindo tratar-se de extravasamento de perfluoroctano para a cavidade orbitária. Dessa forma, diante de ferimento perfurante ocular, deve--se sempre atentar para a possibilidade de existência de corpo estranho intraocular, bem como para possível ocorrência de transfixação do globo ocular, no momento de se realizar a programação cirúrgica destes casos.
A case of a perfluoro-n-octane leakage into the orbital cavity after corneoscleral suture, scleral buckling and pars plana vitrectomy in an eye with perforating injury after trauma is reported for the first time. A previously healthy 39-year-old man was sent for ophthalmic evaluation one day after suffering a penetrating ocular trauma in his right eye while hammering a nail. On the initial evaluation, the patient presented sudden reduction of visual acuity on his right eye with a perforating corneoscleral injury, intraocular foreign body and retinal detachment. The patient was submitted to corneoscleral suture, pars plana vitrectomy with perfluoro-n-octane administration to flatten the retina and scleral buckling, when it was found transfixation of the globe by the intraocular foreign body. Postoperatively, computed tomography scans of the orbit were ordered due to proptosis, which showed the presence of hyperdense images, suggesting leakage of perfluoro-n-octane into the orbital cavity. Thus, in cases of perforating eye injury, one should be suspicious about the possibility of intraocular foreign body, as well as possible occurrence of transfixation of the globe when scheduling the surgery.
Asunto(s)
Adulto , Humanos , Masculino , Extravasación de Materiales Terapéuticos y Diagnósticos/complicaciones , Cuerpos Extraños en el Ojo/cirugía , Lesiones Oculares Penetrantes/cirugía , Fluorocarburos/efectos adversos , Desprendimiento de Retina/etiología , Vitrectomía/efectos adversos , Cuerpos Extraños en el Ojo/complicaciones , Lesiones Oculares Penetrantes/complicaciones , Estudios de Seguimiento , Fluorocarburos/uso terapéutico , Agudeza VisualRESUMEN
Facial injuries with the retention of foreign bodies inside the tissues, both in soft and hard ones, can cause major functional and aesthetic damage. Among the different etiological agents, cutting tools, fragments of a firearm, the splinter of wood, steel, or iron, launched by misuse, or even caused by defects in equipment, are the main cause of these injuries. The aim of this study was to discuss the peculiarity of the multidisciplinary approach in caring of a 33-year-old man, victim of an accident at work, by the rupture of an emery disc and consequent penetration of the fragments in violation of the tissues in the orbital and zygomatic region of the left side, with perforation of the eyeball and orbital-zygomatic fracture. Urgent treatment consisted of debridement of wounds, bleeding control, removal of foreign bodies, fracture reduction with rigid internal fixation, and suture, performed by the oral and maxillofacial surgical team. Reconstruction of orbital tissues by the ophthalmology team consisted of suture of the injuries. About 1 month after the trauma, phthisis bulbi was noted, and the patient underwent a new procedure under general anesthesia for eye evisceration and installation of an alloplastic prosthesis associated with the homogenous sclera. Facial harmony was restored, especially in aesthetics and function of the zygomatic-orbital complex.