Malaysian Journal of Ophthalmology

Special issue on ophthalmic trauma

2024-06-22T01:44:45+00:00

Advocacy in action: preventing eye injuries in India

2024-06-22T01:47:07+00:00

Purpose: To summarise key areas of ophthalmic trauma in India and propose prevention measures.

Study design: Descriptive review and expert opinion.

Methods: Key data presented by members and office bearers of the Ocular Trauma Society of India (OTSI), All India Ophthalmological Society, and Asia-Pacific Ophthalmic Trauma Society (APOTS) at a meeting of the National Human Rights Commission India on September 21, 2022 are summarised in this review. To study the incidence of eye injuries in India, the International Globe and Adnexal Trauma Epidemiology Study (IGATES) registry (a global web-based database platform for ophthalmic trauma developed by APOTS in collaboration with OTSI) was employed. IGATES makes use of cloud computing to collect and store data regarding ocular trauma worldwide.

Results: Eye injuries remain the leading cause of preventable monocular vision loss in India. In this study, 2,528 Indian patients presented with ocular trauma, 1,980 of which (78.3%) were males and 548 were females (21.7%). The mean age of the patients was 31.1 ± 17.4 years. Of all the cases, 281 (11.2%) were due to road traffic accidents (RTA), 70 (2.77%) were chemical injuries, and 43 (1.70%) were fireworks-related. There is an association between the use of eye protection and final best corrected visual acuity (p = 0.04). In light of this, several strategies are suggested to prevent the incidence or reduce the severity of eye injuries.

Conclusion: Given the high prevalence of RTA-related cases and the wide use of fireworks in many festive celebrations such as Diwali, it is paramount to look into ways to reduce the incidence of such injuries.

Ten-year review of traumatic nasolacrimal duct obstruction: clinical profile, management, and outcomes

2024-06-22T01:45:48+00:00

Purpose: To evaluate the clinical profile, management, and outcome in cases of traumatic nasolacrimal duct obstruction (NLDO).

Methods: Retrospective analysis of 40 patients during a 10-year period in one of oculoplastic centre in Malaysia.

Results: Forty patients were included in this study, in which 31 patients were male (77.5%) and 9 were female (22.5%). Age ranged from 19 to 72 years, with a mean of 36.7 years of age. The most common aetiology was motor vehicle accident, accounting for 95%, while the remaining 5% was due to blunt trauma. A total of 32 patients underwent external dacryocystorhinostomy (DCR) with bicanaliculi intubation, 6 patients underwent DCR and another 2 were planned for external DCR but abandoned intraoperatively due to the presence of extensive scar tissue involving lacrimal sac and severe disruption of anatomical site. The surgical outcomes, anatomical success seen in 87% (n = 28) of cases. However anatomical success can be divided into anatomical and functional success seen in 82% (n = 26), while anatomical success with functional failure seen in 5% (n = 2) of cases.

Conclusion: The majority of traumatic NLDO occurred in males who were involved in motor vehicle accidents. External DCR with bicanalicular intubation provided anatomical and functional success of 82% in cases of traumatic NLDO.

Ophthalmic injuries in female victims of domestic abuse

2024-06-22T01:46:02+00:00

Purpose: Ophthalmic injuries in female victims of domestic abuse are not uncommon but are often underreported. The purpose of this study is to examine the occurrence of ophthalmic injuries in such battered women and note the pattern of injuries. We also aim to raise awareness among ophthalmologists that these injuries are more common than one might think and frequently go undetected.

Study design: Prospective cohort study.

Methods: A prospective cohort study of all ophthalmic injuries in female victims of domestic abuse was conducted in Geta Eye Hospital (Dhangadhi, Nepal) from April 2021 to September 2021 for a period of 6 months. Visual acuity, age, level of education, mechanism of trauma, ophthalmic findings, and Ocular Trauma Score were documented. Other physical injuries, past history of abuse, and denial of gender-based violence were also included. The data were collected via a questionnaire and exported to an Excel sheet. Analysis was performed using mean and standard deviation.

Results: The study included a total of 15 women with ages ranging from 22 to 58 years. Ocular findings of subconjunctival haemorrhage and ecchymosis were present in all cases; 1 case had lens dislocation, lid laceration was present in 1 case, commotio retinae, and hyphaema were present in 2 cases each. The ocular trauma score was 100 in 66.7 % cases. Sixty percent of the victims had a lower level of education than their male partners. History of similar abuse was present in 4 cases (26.7%). The abuser was under the influence of alcohol in 6 cases (40%).

Conclusion: Domestic violence can lead to serious ocular injuries. Considering that ophthalmologists frequently encounter such cases as primary caregivers, it is imperative to uphold a heightened level of vigilance. Our research findings indicate the recurrence of an abusive past, suggesting that ophthalmologists cannot only
address eye injuries but also guide individuals toward a safer life.

A ten-year study of clinical presentation and predictive factors on final visual outcome in paediatric trauma patients

2024-06-22T01:46:53+00:00

Purpose: To present the demographic and clinical presentation, and to evaluate the predictive factors for final visual outcomes in paediatric ophthalmic trauma.

Methods: A retrospective observational study was conducted in Indonesia’s private tertiary eye hospital between 2012 and 2021.

Results: A total of 194 patients/201 eyes were included. Closed globe injuries (CGI) represented the most common injury (80/194, 41.2%), followed by adnexal injury (65/194, 33.5%), open globe injuries (OGI) (30/194, 15.5%), chemical injuries (13/194, 6.7%), orbital fracture (3/194, 1.5%), and fireworks injuries (3/194, 1.5%). The mean age was 8.60 ± 5.23 years, with children aged 11–18 years (69/194, 35.5%) comprising the majority of cases. The home (43/201, 21.4%) and blunt trauma (105/201, 52.2%) were identified as the most common setting and mechanism of injury, respectively. There were 78/201 (38.8%) eyes included in the visual acuity (VA) predictors analysis. The mean initial VA and final VA were 0.595 ± 0.775 logMAR and 0.461 ± 0.790 logMAR,
respectively. A strong correlation between initial VA, final VA, and type of injury was found (r = 0.761, P < 0.001), with 13/78 (16.7%) patients having severe visual impairment and blindness. In multivariate analysis, initial VA (P = 0.003), scleral injury (P = 0.013), and hyphaema (P = 0.013) were statistically significant as visual outcome predictors.

Conclusion: CGI and adnexal injury show high incidence in paediatric ophthalmic trauma. The home is the most common setting for paediatric ophthalmic trauma. OGI causes visual impairment to blindness. Initial VA, scleral injury, and hyphaema are identified as visual outcome prognostic factors.

Ten-year review of traumatic hyphaema cases in a tertiary hospital in the east coast of Malaysia

2024-06-22T01:46:27+00:00

Purpose: Traumatic hyphaema is a common sequela following blunt trauma. The aim of this study was to analyse the demographics, complications, and visual outcome of patients presenting with traumatic hyphaema at a tertiary hospital in the East Coast of Malaysia.

Methods: Retrospective study based on medical records from 2011 to 2021.

Results: A total of 41 eyes from 41 patients were included in the study. The mean age of patients was 22.2 years (± 15.1 SD), with 39.1% within 25–59-years of age. The incidence was higher among males (90.2%). Sports and recreational activities were the most common causes (61.0 %), followed by occupational (12.2%) and domestic causes (12.2%). More than half the patients sought treatment within 24 hours of injury (56.1%). The majority of patients presented with grade 1 hyphaema (68.3%), while 2.4% came with severe hyphaema (grade 4). Re-bleeding was noted in 2 patients, both were below 12 years old, on day three and day eleven respectively. Six patients (14.6%) had presenting intraocular pressure IOP > 30 mmHg. Mean presenting visual acuity was 6/36 (± 0.89 SD) and mean visual acuity post-treatment was 6/7.5 (± 0.15 SD). There was a significant difference between mean presenting visual acuity and visual outcome (p < 0.05).

Conclusion: Despite serving mainly a rural population, sports and recreational activities remained the most common cause of traumatic hyphaema in this centre. Raising public awareness for protective eyewear should be advocated in this population.

Time interval for emergency ophthalmic surgery in Hospital Kuala Lumpur during the peak of the COVID-19 pandemic

2024-06-22T01:44:57+00:00

Purpose: The coronavirus disease 2019 (COVID-19) pandemic led to staff shortages and repurposing of health facilities, thus affecting the workflow of emergency ophthalmic surgery in Hospital Kuala Lumpur (HKL). The objective of this audit was to ensure that there was no time delay for emergency ophthalmic surgery in HKL during the peak of the COVID-19 pandemic.

Study design: Retrospective clinical audit.

Methods: Data of patients who underwent emergency ophthalmic surgery for a period of 8 months in HKL were collected from the operation theatre records and patient medical records of HKL.

Results: A total of 49 patients underwent emergency ophthalmic surgery from May 2020 to December 2020. There was male 34 male patients (69%) and the majority of patients belonged to the age group of 21–30 years. Most of the cases were sight-threatening (80%), which included ocular trauma, vitreoretinal cases, and evisceration. Meanwhile, non-sight threatening cases comprised eyelid/conjunctival laceration, iris repositioning, and glaucoma surgery. Most of the surgeries (36%) were performed within 6 hours of admission/decision for surgery. Only 4% of surgeries were delayed more than 24 hours. A vitreoretinal case was delayed for 26 hours due to presence of electrocardiogram changes and hypokalaemia. The second case was a case of planned for evisceration for panophthalmitis and was delayed due to syndrome of inappropriate antidiuretic hormone. Both patients were referred to the medical team for stabilisation prior to surgery.

Conclusion: The cause of the delay in both patients were not due to the COVID-19 pandemic but due to medical co-morbidities. Despite the limitation of staff and resources during the COVID-19 pandemic, ophthalmic emergency surgeries were carried out on appropriate timing without delay.

Establishing a safe, medical officer-led intravitreal injection clinic: minimizing inadvertent crystalline lens injury

2024-06-22T01:45:10+00:00

Purpose: To study the incidence of iatrogenic crystalline lens injury in a medical officer-led intravitreal (IVT) injection clinic and to evaluate the effect of a structured training programme designed to teach medical officers how to safely administer IVT injections.

Study design: Clinical audit.

Methods: The first phase of the clinical audit comprised a retrospective analysis of the consecutive numbers of IVT injections between January and December 2020. Outcome measures included incidence and risk factors of lens injury. Target incidence rate of iatrogenic crystalline lens injury was set at < 0.06%. Intervention was implemented in the form of a structured training programme over the course of 4 months. The programme encompassed a lecture and video on proper administration techniques, as well as a handout detailing the key points. Medical officers were guided, directly supervised, and assessed by a single ophthalmologist and were required to complete a logbook before being sanctioned to perform IVT independently. Re-audit was done on the consecutive numbers of IVT injections in the following year, between May 2021 and April 2022.

Results: Out of 1,952 IVT injections performed by medical officers pre-intervention, 3 cases of iatrogenic lens injuries were reported, corresponding to an incidence rate of 0.15%. One patient was uncooperative. No other risk factors were identified. Post-intervention, our target was achieved with zero injection-related lens injury out of 2,118 consecutive IVT injections.

Conclusion: A structured training programme results in highly skilled medical officers delivering a well-rounded service that improves the quality of care and reduces the rate of adverse events in a large overburdened tertiary centre. Training must be conducted on a regular basis due to the entry of new medical officers periodically.

Traumatic angle-recession glaucoma: a literature review

2024-06-22T01:46:14+00:00

Ocular trauma is a main cause of ocular comorbidity worldwide. Cornea or lens injury, secondary glaucoma, vitreous haemorrhage, retinal or choroidal detachment, and endophthalmitis are the sequelae of ocular injury causing vision loss. Many articles have been published identifying the common sequelae of closed-globe injuries, including the risk of developing secondary glaucoma from angle recession. This review article aims to cover the sequelae of closed globe ocular trauma, the definition of traumatic angle-recession glaucoma (TARG), and the natural course, detection, management, and prophylactic treatment of TARG.

Clinical features of ocular trauma requiring vitreoretinal surgery: a case series

2024-06-22T01:46:41+00:00

Background: Ocular trauma is a significant cause of monocular blindness and visual impairment worldwide. This report describes the clinical characteristics of ocular trauma requiring vitreoretinal surgery presented to the vitreoretinal unit of Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia.

Case presentation: A retrospective case series study of all traceable records of ocular trauma from the surgical logbook of a single vitreoretinal surgeon from January 1, 2008 to December 31, 2019 was performed. Demographics, causes of injury, types of ocular trauma, presenting visual acuity (VA), and postoperative VA were recorded and analysed. All patient data were collected from the medical records system. Of all the ocular trauma cases requiring vitreoretinal surgery, 63.6% were contusions. The most common cause of injury in our group of patients was sports injury (28%). Patients with open-globe injury had poorer preoperative and postoperative VA (logMAR) when compared to those with closed-globe injury (preoperative VA: 1.55 versus 1.39; postoperative VA: 0.93 versus. 0.67, in open- and closed-globe injury respectively, p = 0.467).

Conclusion: Specific injury prevention strategies, which include the use of protective eyewear, must be advocated in the workplace and during sports to reduce the incidence and severity of ocular trauma.

Intraorbital foreign bodies: a case series of unfortunate events

2024-06-22T01:45:36+00:00

Background: Intraorbital foreign bodies (IOrbFB) are a common result of trauma and can cause significant ocular morbidity. When left in the orbit, they can remain asymptomatic or cause serious complications such as the loss of an eye.

Case presentation: We report 6 cases of IOrbFB treated in Hospital Serdang and their surgical outcomes. Two cases involved organic foreign bodies (wood) and 4 involved inorganic foreign bodies (3 cases of metal and 1 of glass). Both cases with organic foreign bodies had surgical removal in a delayed setting, while the inorganic foreign bodies were removed within 3 days of initial presentation. Five patients had a good visual outcome and only 1 patient had resultant blind eye due to involvement of the globe.

Conclusion: Loss of vision due to IOrbFB is usually a result of globe involvement. Early surgical exploration and foreign body removal affects the visual prognosis and outcome. Organic IOrbFBs pose a great challenge due to their diverse manifestations, thus tends to be missed during the initial visit. Delayed diagnosis can cause higher risk of orbital infections.

Spectrum of firecracker eye trauma in Batu Pahat

2024-06-22T01:45:24+00:00

Background: Fireworks are small explosive devices used primarily to create a large amount of noise, usually for celebration or entertainment, especially during the holidays. Fireworks can cause chemical trauma as well as explosive trauma to the ocular tissue and orbit.

Case series: We report the spectrum of eye injuries in a district hospital on the Hari Raya Festival in 2022. In just 4 days during the Hari Raya Festival, a total of 6 patients were referred to us. We observed a variety of ocular injuries, such as hyphaema, angle recession, traumatic cataract, corneal abrasion, commotio retinae, and even
traumatic optic neuropathy. Some patients were admitted for closer monitoring and intravenous administration of methylprednisolone, as is the case with patients with traumatic optic neuropathy. Some of them are treated only as outpatients.

Conclusion: Fireworks are dangerous and can cause severe blast injuries to the eyes. Early and prompt treatment is critical. However, primary prevention is also of utmost importance.