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العنوان
A Study on Patients with Gunshot Wounds to the Ocular Region /
المؤلف
Karas, Faris Ishak Faris.
هيئة الاعداد
باحث / Faris Ishak Faris Karas
مشرف / Ayman Abd El Moneim Gaafar
مشرف / Mouamen Mohamed Mostafa
مناقش / Mouamen Mohamed Mostafa
تاريخ النشر
2014.
عدد الصفحات
113 p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
طب العيون
تاريخ الإجازة
1/1/2014
مكان الإجازة
جامعة عين شمس - كلية الطب - Ophthalmology
الفهرس
Only 14 pages are availabe for public view

from 113

from 113

Abstract

Trauma to the eye is no longer a rare event. After the era of revolution, street protests and the uprising of the people against political regimes, ocular trauma cases became very common.
After the 25th of January revolution in Egypt, firearm ocular injuries have become very prevalent and by observation of the ocular trauma cases received since that date, firearm ocular injury takes the upper hand among all other causes of ocular trauma. This study was done on 120 eyes of 117 patients exposed to gunshots to the ocular region from non rifled weapons that attended the Ophthalmology Department of Ain Shams University Hospitals. All patients of the study were subjected to full medical and ophthalmic history and complete ophthalmic examination in addition to orbital CT scan, axial and coronal cuts with thin views. In this study 109 patients (93.2%) were males and 8 patients (6.8%) were females, peak incidence (81 patients, 69.2%) was in the age group 20-39 years old and the mean age was 28 years old. In this study we found that, 104 eyes (86.7%) were ruptured and 16 eyes (13.3%) were intact. Of the ruptured globes, 57 eyes (55%) had scleral inlets, 26 eyes (25%) had corneal inlets, 13 eyes (12.5%) had limbal inlets, 7 eyes (6.7%) had 2 inlets, one corneal and one scleral and 1 eye (0.9%) suffered multiple scleral & corneal inlets (more than 2 inlets). In this study also, orbital CT scans showed that 61 eyes (50.8%) had evidence intraorbital foreign body, 27 eyes (22.5%) had intraocular foreign body and 19 eyes (16 %) had both intraocular foreign body and intraorbital foreign body. Seven eyes (5.8%) had the shots impacted in the orbital apex. Three eyes (2.5%) had intra nasal shots in the CT scan and 2 eyes (1.7%) had the shots lying on the outer surface of the globe which were shown to be in the subconjunctival space during surgery and 1 eye (0.8%) in the eyelid. Presenting visual acuity ranged from 6/6 to no perception of light. Ninety eight eyes (81.6%) presented with visual acuity of hand motion or worse. Forty five eyes (37.5%) presented with visual acuity of hand motion. Thirty five eyes (29.2%) presented with visual acuity of light perception and 17 eyes (14.2%) with visual acuity of no perception of light. Six eyes (5%) presented with visual acuity of counting fingers 50cm and 3 eyes (2.5%) with VA of 3/60. Two eyes (1.6%) presented with visual acuity of 6/6, 2 eyes (1.6%) with 6/18, 2 eyes (1.6%) with 6/24, 2 eyes (1.6%) with 6/60 and 2 eyes (1.6%) with 2/60. One eye (0.83%) presented with visual acuity of 6/9, one eye (0.83%) with 6/12, one eye (0.83%) with 6/36 and one eye (0.83%) with 1/60. In eyes with corneal inlets (26 eyes), 11 eyes (42.3%) presented with visual acuity of hand motion, 8 eyes (30.7%) presented with visual acuity of light perception, 6 eyes (23.1%) presented with visual acuity of no perception of light and 1 eye (3.8%) presented with visual acuity of counting fingers 50cm. In eyes with scleral inlets (57 eyes), 24 eyes (42.1%) presented with visual acuity of hand motion, 21 eyes (36.8%) presented with visual acuity of light perception and 5 eyes (8.8%) presented with vision of 1/60 to 3/60. 5 eyes (8.8%) presented with visual acuity of counting fingers 50cm and 2 eyes (3.5%) with visual acuity of no perception of light. In this study, 9 eyes out of 79 eyes (11.4%) with single site of shot penetration presented with visual acuity of no perception of light, 4 eyes out of 7 eyes (57.1%) with double sites of shot penetration presented with visual acuity of no perception of light and 4 out of 4 eyes (100%) with multiple (3 or more) shot penetrations presented with visual acuity of no perception of light. In this study, 7 orbits had gunshots impacted at the orbital apex with no intraocular shots. Four eyes (57.1%) presented with no perception of light, 2 eyes (28.6%) with visual acuity of light perception and one eye (14.3%) with hand motion. In our study, 104 eyes (86.7%) had undergone primary repair, 8 eyes (6.7%) had undergone exploration and 8 eyes (6.7%) had not undergone any surgery because there was no evidence or suspicion of open globe injury. Fifty patients (50 eyes) continued to follow up with us. Of these 3 eyes (6 %) did not need surgery at the time of presentation, 24 eyes (48%) needed one surgery at presentation (primary repair / exploration) and 23 eyes (46%) needed more than one surgery. Sixteen patients had undergone cataract extraction and vitrectomy, 4 patients had undergone vitrectomy only, 1 patient cataract extraction only, 1 patient globe evisceration and 1 patient globe enucleation. Follow up of the visual acuity in the 6 intact globes for 6 months showed stable vision with no change. Follow up of the visual acuity in the 44 ruptured globes for the same time period showed no change in visual acuity in 21 eyes (47.7%), improvement in visual acuity in 16 eyes (36.4%) and deteriorated visual acuity in 7 eyes (15.9%). Among the 44 ruptured globes, 23 eyes had scleral wounds, 12 eyes had corneal wounds, 5 eyes had corneal and scleral wounds and 4 eyes had limbal wounds. Eleven eyes out of the 23 eyes (47.8%) with scleral wounds showed improvement in visual acuity during follow up, 4 eyes (17.4%) had deteriorated visual acuity and 8 eyes (34.8%) showed no change in vision. Three eyes out of the 12 eyes (25%) with corneal wounds showed improvement in visual acuity during follow up, 2 eyes (16.7%) had deteriorated VA and 7 eyes (58.3%) showed no change in vision. Two eyes out of the 4 eyes (50%) with limbal wounds showed improvement in visual acuity, 1 eye (25%) had deteriorated visual acuity and 1 eye (25%) showed no change in vision. All the 5 eyes with corneal and scleral inlets had deteriorated visual acuity in follow up.
Endophthalmitis had been observed in 3 patients (6.8% of the 44 open globe injuries). Panophthalmitis had been observed in 1 patient. One case ended with evisceration of the globe and another ended with enucleation of the globe. Atrophia Bulbi had been observed in 2 patients. Other complications seen were corneal scars, macular scars, aphakia and traumatic optic neuropathy.