Trauma Free Papers - aioseducation

ContentsContentsTRAUMAOcular Manifestations of Head Injury-A Clinical Study in Eastern India-------------- 1133Dr. Sucheta Parija, Dr. Bighnaraj PalBelt Buckling For Traumatic Vitreous Hemorrhage------------------------------------------- 1136Dr. Amarjeet KadamTo Study Visual Outcome and Prognostic Factors of Open Globe Injury in Paediatricage Group (

Trauma Free PapersTRAUMAChairman: Dr. B Shukla; Co-Chairman: Dr. Kaushal BhavsarConvenor: Dr. (Lt. Col.) T S Ahluwalia; Moderator: Dr. Sanjiv MohanDr. SUCHETA PARIJA: MBBS (1994), SCB Medical College, UtkalUniversity; MS (1999), VSS Medical College, Sambalpur University; Longterm fellowship in Pediatric Ophthalmology and Strabismus, Aravind EyeHospital and Post Graduate Institute of Ophthalmology, Madurai, Tamilnadu.Presently, Assistant Professor, SCB Medical College, Cuttack, Orissa.Contact: +919437044380; E-mail: suchetaparija@yahoo.comOcular Manifestations of Head Injury-A ClinicalStudy in Eastern IndiaDr. Sucheta Parija, Dr. Bighnaraj Palhead injury occurs every 15 second and a patient dies of head injuryA every 12 minute. Head injuries cause hospitalization of 200-300 personsper 1 lakh population per year and 25% of these are associated with ocularand visual defects. The role of ocular injuries secondary to head trauma inthe causation of blindness continues to be an immense public health problem.The immediate impact of head injury threatening other vital organs is socompelling that damage to the visual system is most likely to be ignored.Hence, working in an institute dealing with multiple trauma causalities everyday, the study was conducted to assess the clinical profile of ocular findingsin head injury and to attempt a correlation between the neurological signs,ocular signs, GCS and final outcome.MATERIALS AND METHODSThe study comprises a prospective analysis of 189 patients of head trauma tothe neurological department of a tertiary hospital from January 2009 to January2010. The Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS) wereapplied to grade the severity of head injury and to assess the prognosis in allcases. A specially designed protocol was used to record the information basedon the demographic data, nature and cause of injury, neurological and ocularexamination, along with any treatment received. A detailed ophthalmologicalexamination was carried out in each case. Radiological investigation like CTscan of brain and orbit or MRI of brain along with B-scan of eye was donewhere necessary. Apart from suturing of laceration, patients were managed bya multidisciplinary approach.RESULTSIn this study of 189 cases of head injury, 129 cases had ocular involvement. 1711133

69th AIOC Proceedings, Ahmedabad 2011cases (90.4%) were male and 18 cases (9.5%) were female. The age ranged from 3to 75 years. Young adult males (16-30 year) were most vulnerable to head injuryin 124 cases (65.6%) indicated in Table-1. Road traffic accident was the mostcommon cause of ocular disorders in 131 cases (69.3%) followed by assaultsin 32 cases (16.9%). Ophthalmic examinations were carried out in all cases ofhead injury within first few hours of admission. The ocular manifestationsobserved in 129 cases of closed head injury are shown in Table-2.They included soft tissue injuries to the globe and adnexa in 96 cases (50.8%),neuro-ophthalmic abnormalities in 27 cases (13.8%), fracture of orbit in7 cases (3.7%) and rupture of eye in 4 cases (2.1%). Most frequent soft tissueinjuries were periorbital ecchymosis in 44 cases (23.3%) and subconjunctivalhaemorrhage in 37 cases (19.6%). The most frequently encountered neuroophthalmicmanifestation was pupillary involvement in 10 cases (5.3%).The globe was ruptured in 4 cases and 3 cases needed immediate evisceration,while one patient had a traumatic optic nerve avulsion with auto-enucleationof the eye ball. 18 patients (9.5%) had orbital fracture along with soft tissuedamage. When the severity of ocular injury was related to Glasgow ComaScale (GCS) on admission, 142 cases of ocular injuries occurred in mildly headinjured patients with GCS of 13-15. Severe ocular injury was associated withsevere head injury whose GCS was less than or equal to 3 on admission, whichis shown in Table-3.Table 1: Age and Sex distribution of head injurymalefemaleAge group in years nos. % nos. %0-15 12 6.3 1 1.116-30 116 61.3 8 4.231-45 35 18.5 5 2.646-60 22 11.6 2 1.161-75 4 2.1 1 0.5Table 2: Ocular Manifestation of Closed Globe Injuries (n=129/189)Nos. %A. Soft tissue injuries to globe and adnexa (n=96/189) 50.81 Periorbital Ecchymosis 44 23.32 Eyelid laceration 6 3.23 Subconjunctival haemorrhage and chemosis 37 19.64 Corneoscleral laceration and Hyphema 4 2.15 Retinal haemorrhage 3 1.66 Vitreous haemorrhage 2 1.11134

Trauma Free PapersB. Neuro-ophthalmic complications (n=26/189) 13.61 Optic nerve trauma 2 1.12 Pupillary involvement 10 5.3i) Traumatic mydriasis 2 1.1ii) Hutchisons’ pupil 8 4.23 Papilloedema 8 4.24 Lateral rectus palsy 5 2.65 Ptosis 1 0.5C. Orbital Fracture( n=7/189) 3.71 Orbital margin 6 3.22 Blow out 1 0.5Table 3: Correlation of ocular signs with head injury scoreNo. of head injury ocularGCS RTS Expected Cases ocular finding of Finaloutcome n=189 % involve neurological outcome-ment cal significance3 0 very poor 2 1.1 129 2 2 death4-8 1 -2 poor to fair 18 9.5 2 10 4 death and 14survived9-12 3 fair to good 27 14.3 16 11 2 death and 25survived13-15 4 good 142 75.1 23 3 142 survivedDISCUSSIONHead injuries can be defined as those in which there is injury to the brainincluding concussion, loss of consciousness, neurological signs, and skullfractures. Most head injury cases are mild and can be treated as out-patients.Those that need neuro-observation are treated as in-patients for 24-48 hours.The eyes are often involved in head injury with neuro-ophthalmic deficits. Mostophthalmologists when faced with injured patients tend to focus on obviousocular manifestations like contusions and lacerations. Subtle manifestationsmay be often missed. Neuro-ophthalmic evaluation is challenging in headinjury patients with associated injuries and reduced consciousness.The following observations were made from the study:• Patients of 16-30 years were most commonly affected 124 cases (65.6%)• Road traffic accident was the most common cause of head injury (69.3%)• Closed globe injuries outnumbered the open head injury patients (129:60)• Injury to the soft tissues of globe and adnexa were seen in 90 cases (50.8%)and was the most prominent form of ocular injury1135

69th AIOC Proceedings, Ahmedabad 2011• Papilloedema was seen in 8 cases (4.2%) while traumatic optic neuropathywas seen in 2 cases (1.1%)• Patients with ocular signs and neuro deficit exhibited a progressivelyworse outcome as the GCS worsened.Hence, ophthalmological examination of a patient with head injury is essentialand needs integrating it as a part of routine assessment. This aids in the followup, prognosis and further management of neurological deficits, thus reducingthe late or missed diagnosis.REFERENCE1. Baker RS, Epstein AD., Ocular motor abnormalities from head trauma. SurvOphthalmol 1994;35(4):245-67.2. Chaudhuri Z, Pandey PK, Gupta R, Chauhan D.; Profile of ocular morbidityassociated with head injury; AIOC Proceedings: Miscellaneous 2002;P:6093. To Odeboda et al.; Ocular and visual complication of head injury. Eye 2005;19:561-6.4. AR Kulkarni et al.; Ocular manifestations of head injury: a clinical study, Eye2005;19:1257-63.5. Van stavern et al; Neuro-ophthalmic manifestation of head trauma; J Neuro-Ophthalmol 2001;21:112-7.6. Lepore F.; Disorder of Ocular Motility following head trauma. Arch Neurol 1995;52:924-6.7. Moster M, Volpe NJ, Kresloff MS.; Neuro-ophthalmic findings in head injury;Neurol 1999;52(suppl 2):A23.Dr. AMARJEET KADAM: MBBS (1998), Jawaharlal Nehru MedicalCollege, Belgaum, Karnataka University; MS (2002), Kasturba MedicalCollege/ Manipal Academy of Higher Education Karnataka; DNB (2003),National Board of Examinations, New Delhi; FRCS (Glasgow) 2007; FICO(UK) -2004. Presently, Medical Director, Swayam Eye Hospital and RetinaCentre. E-mail: Amarjeetkadam@Rediffmail.ComBelt Buckling For Traumatic Vitreous HemorrhageDr. Amarjeet KadamTo study the incidence of retinal detachment in cases of traumatic vitreoushemorrhage managed by vitreous surgery with or without belt buckling(240 band).MATERIALS AND METHODSA retrospective study of 28 cases of traumatic vitreous hemorrhage managedby Vitrectomy was done. The patients included in the study were cases wherethe vitreous hemorrhage failed to resolve for 2 weeks following trauma1136

Trauma Free Papers(No view of fundus after 2 weeks following trauma). 15 patients underwentVitrectomy with belt buckling and 13 patients underwent Vitrectomy withoutbelt buckling. A complete detailed evaluation (Anterior and Posterior segmentwith B scan) was done and patients with pre existing (prior to surgery) retinaldetachment were excluded.RESULTS28 cases of trauma with vitreous hemorrhage presented to our hospital overthe past 2 years. The age of the patients ranged from 8 to 74 years. The preopvisual acuity ranged from hand movements to light perception with accurateprojection. 19 patients had blunt trauma whereas 9 patients had penetratingtrauma. 16 patients had developed coexisting cataract which was managedsimultaneously with either Phacoemulsification with IOL implantation inbag or sulcus (12 cases) or lensectomy with scleral fixation of IOL (4 cases).1 patient had extruded IOL with vitreous hemorrhage and she underwentVitrectomy + Belt Buckling + Scleral fixation of IOL. The post op visual acuityranged from 6/6 to 6/60. The mean duration of follow up was 13 months.Out of the 15 patients managed by Vitrectomy with belt buckling, 1(6.66%)patient developed retinal detachment post operatively whereas out of the 13patients managed by Vitrectomy alone 4 (30.76%) patients developed retinaldetachment. 4 patients developed post operative epiretinal membrane.Belt buckling significantly reduced the incidence of Retinal detachmentfollowing Vitrectomy for traumatic vitreous hemorrhage.DISCUSSIONOcular trauma is a very complex situation as every case is different andmanagement of each surgeon can vary. I usually prefer early surgicalintervention in cases of traumatic vitreous hemorrhage. With the advancesin new Vitreo-retinal surgical techniques we have become more comfortablewith early intervention in such cases. I believe traumatic vitreous hemorrhageshould be managed surgically if the vitreous hemorrhage fails to clear within2 weeks. The logic behind this early surgical intervention is that in traumaticvitreous hemorrhage retinal breaks form at the vitreous base and they caneasily precipitate retinal detachment if we wait for too long. Once retinaldetachment occurs the prognosis is extremely poor.In this study I have highlighted the importance of Belt Buckling in such cases.Belt buckling reduces the incidence of retinal detachment by supporting theperipheral retinal breaks which form at the vitreous base in cases of trauma.When vitreous surgery is performed without belt buckling these breaks arenot supported because they cannot be detected due to the opaque vitreousskirt. In this study clearly the incidence of post op retinal detachment was1137

Trauma Free PapersGrading was done based on initial visual acuity as follows:5=NO PL, 4=PL/ HM, 3=1/200-19/200, 2=20/200-20/50, 1=>20/40, 6=UNASSESIBLE. Final visual acuity was graded according to World HealthOrganization (WHO) visual impairment categories:≥ 20/70, (good visual outcome),

69th AIOC Proceedings, Ahmedabad 2011RESULTSOur study included 80 patients till the age of 18 years.The age, sex distribution, length of wound, zone and grade of injury are shownas follows:Complications noted on presentation were: IOFB–8 patients (10%),Endophthalmitis 7 patients (8.8%), hyphema 22 patients (27.5%), Cataract 35patients (43.8%), Iris Prolapse 59 patients(73.8%), Retinal detachment 8 patients(10%), Vitreous hemorrhage 16 patients(20%). 1 eye went into phthisis.Additional procedures done were cataract surgery in 22 patients(27.5%), TPPVin 6 patients (7.5%), IOFB removal in 5 patients (6.2%), Intravitreal antibioticinjection in 9 patients (11.2%) and Evisceration in 1 patient (1.2%).Table 1: Impact of additional procedures done on final visual acuityGood Moderate Poor UnassessibleCataract Surgery 50 %(11) 27.3%(6) 4.5%(1) 18.2%(4)Intravit 44.4%(4) 22.2%(2) 33.3%(3) 0%Iofb Removal 80%(4) 20%(1) 0% 0%Tppv 50%(3) 0% 33.3%(2) 16.7%(1)Initial visual acuity could be assessed only in 64 patients and for them OTSwas applied. Results are shown in the table. None of the patients were in group4 and 5.Table 2OTS Score Frequency Percent (%)1 16 25.02 32 50.03 16 25.0Table 3: Comparison of Our Score and OTS Score:Sum of OTS No Light Light Preception/ 1/200- 20/200 >=20/40raw Perception Hand Movement 19/200 -20/50 Ourpoints Our Score Our Score Our Score Our Score Score{OTS Score} {OTS Score} {OTS Score} {OTS Score} {OTS Score}%/% %/% %/% %/% %/%0-44 1 50.0{74} 43.8 { 15} 6.2{7} 0{3} 0{1}45-65 2 0{27} 68.2{26} 25.0{18} 6.2{15} 0{15}66-80 3 0{2} 0{11} 0{15} 50{31} 50{41}81-91 4 0{1} 0{2} 0{3} 0{22} 0{73}92-100 5 0{0} 0{1} 0{1} 0{5} 0{94}1140

Trauma Free PapersAt 6 month follow up vision of 71 patientscould be assessed. The distribution was asfollows:Who CategoryFrequencyPercentGood 40 56.3Moderate 13 18.3Poor 18 25.4Total 71 100.0Figure 6Applying Univariate analysis for these 71 cases, significant factors predictingfinal visual outcome were:Age (p=0.012), Vision at presentation (p=0.00), Zone of injury (p=0.007),Length of injury (p=0.00), OTS score (p=0.00). Amongst the complicationsnoted Retinal detachment with a p value of 0.00 came as a significant factorpredicting the visual outcome. Amongst additional procedure done Cataractsurgery was found to be a significant predictor (p=0.028).1 case underwent evisceration (Ocular survival 98.75%).DISCUSSIONIn our study mean age of presentation was 10.05 yrs like in the study done byNan-Kai Wang et al 4 while in other studies 1,2,3 it was 7 yrs. Statistical analysisshowed age as a significant factor (p=0.012).In our study 76% were males and 24% females, this distribution correspondsto many other studies 2-4 , however gender was not found to be a statisticallysignificant factor in our study. Using univariate analysis vision at presentation,length of wound, zone of injury were found to be a significant factor in ourstudy however there aren’t any similar studies to compare with our results.Retinal detachment was found to be a significant factor which corresponds tothe study done by Nan-Kai Wang et al. 4Our study showed a statistically significant correlation with OTS scoringsystem unlike the study result of Y B Unver et al1 where OTS score was foundto have a limited role in predicting final visual outcome.In our study cataract surgery was found to be a significant predictor for finalvisual outcome like in study done by Peter K. Rabiah. 5We conclude by saying that in our study 11.2% patients had good vision atpresentation but at the end of 6 months 50% had good vision. Age, Visionat presentation, Zone and Length of injury, OTS score, Retinal Detachment,Cataract surgery were significant predictors of visual outcome. Ocularsurvival was 98.75%.1141

Trauma Free PapersMATERIALS AND METHODSA prospective study was carried out in 112 patients of mechanical ocularinjuries who presented to the department of ophthalmology, Shyam ShahMedical College, Rewa, Madhya Pradesh, since October 2007 to December2009. All patients thoroughly underwent ophthalmic and systemic evaluation.Data pertaining to age, sex, socio-economic status, mode of injury, duration ofinjury, laterality, type and extent of defect, tissue loss, involvement of lacrimaldrainage system, type of surgery used, complication, revision surgery and it’soutcome, the functional and cosmetic outcomes were noted.Pre and post operative photography was done in every case for futurecomparison.Inclusion criterion(1) Patients admitted and operated in ophthalmology department for eyelidand periocular injuries, (2) Age between 0 years to 80 years, (3) Patients willingfor pre- and post operative photography and participation in studyExclusion criterion(1) Patients having eyeball and neuro-ophthalmic injuries, (2) Orbital andfacial bone fractures, (3) Minor abrasions, (4) History of prior lid/ lacrimalsurgery, (5) Lid dysfunction prior to ocular trauma like facial palsy, leprosy,lagophthalmos, or acquired ptosis due to any cause, (6) Patients not willing forlong term follow up, (7) Patients having coexisting serious systemic injuries, (8)Patients who had undergone an eyelid laceration repair elsewhere and camefor further management, (9) Congenital lid malformation e.g eyelid coloboma,congenital ptosis and others, (10) Patients having pre-existing oculo-facialcosmetic deformities.After careful detail clinical evaluation and investigations to rule out eyeballinjuries and other life threatening injuries, the eyelid/ periocular reconstructionwas undertaken under microscope in general/ local anesthesia. The selectionof technique for eyelid and adnexal reconstruction was depending on the typeand extent of the defect, age of patient, and availability of surrounding tissue.Routine post operative care was given to all patients. Mini Monoka canalicularstent was used in canalicular laceration repair. The stent was removed after 3months post operatively.Patients were followed up post operatively to evaluate the complications,functional and the cosmetic outcome. For the functional outcome, patientswere assessed independently by other ophthalmologist who was not aware ofthe preoperative status of the patients. “Good functional outcome” was definedas absence of: lid lag/lagophthalmos/ lid margin deformity/significant lossof eyelashes/ trichiasis/ptosis/ entropion/ ectropion in reconstructed area1143

69th AIOC Proceedings, Ahmedabad 2011or persistent epiphora after surgery. Presence of above mentioned one ormore criteria were considered as a poor functional outcome. Patients “selfassessment” technique was used to assess the final cosmetic outcome. Allpatients were asked to rate the cosmetic outcome on two point scale. To whatextent you are satisfied from oculo-facial appearance altered by the eyelidand adnexal injury and reconstruction? (End points: not satisfied, satisfied)Comparative statistical analysis was not performed because randomizationwas not done and the numbers of covariates were too large for the sample size.RESULTSAge ranged from 0 to 80 years (mean age 28years+/- 4 years). Out of 112 cases,72(64.28%) were males and 40(35.71%) were females. Unilateral injuries werein 108(96.42%) cases while only 12(10.71%) cases had both eyelid involvement.Upper eyelid involvement seen in 56 (60.48%) and lower eyelid involvementin 40 (43.20%) in unilateral injuries. 106(94.64%) patients received treatmentwithin 24 hours. An isolated full thickness eyelid lacerations with eyelidmargin involvement were the commonest type of eyelid injury seen in40(35.71%) cases followed by superficial eyelid laceration without eyelidmargin involvement 13(11.60%), eye brow lacerations 12(10.71%), lacrimalsystem injuries 8(7.14%), medial canthal laceration 5(4.46%), medial canthalavulsion 4(3.75%), lateral canthal avulsion 2(1.78%), and lateral canthal injuries2(1.78%). 14(12.50%) patients had sustained mixed injuries. 5(4.46%) patientshad tissue loss between 25-50%. Direct closure is the most common proceduredone on 96(85.71%) cases followed by canalicular repair 12(10.71%). Patientswith tissue loss of 25-50% required, canthotomy and cantholysis with directclosure (1 case), lateral forehead flap (1 case), Cutler-Beard procedure (1 case),Tenzel flap (1 case), and the Hughes procedure (1 case).11 out of 12 canalicular stent retained for 3 months. One patient experiencedpost operative epiphora during driving without helmet. Only 14 patientsunderwent secondary/ revision surgery: ectropion correction 3(21.42%),3(21.42%) scar revision, DCR with bicanalicular silastic intubation 2(14.28%),ptosis correction 2(14.28%), entropion correction 1(7.14%), full thickness skingrafting 1(7.14%), telecanthus correction 2(14.28%). DCR was successful in allthree cases. Out of 14 patients who underwent revision surgery: 5 patientswere presented after 72 hours of injury and 5 patients had tissue loss (25-50%). 106(94.64%) patients were satisfied with their final oculo-facial cosmeticappearance after revision surgery. 98(87.50%) patients had good functionaloutcome after primary repair.DISCUSSIONThe goal of eyelid and adenexal reconstruction is to restore the anatomy,1144

69th AIOC Proceedings, Ahmedabad 2011In conclusion the results of the study provide useful clinical informationrelating to the functional and the cosmetic outcome following post traumaticeyelid and adnexal reconstruction, and this will be of benefit in counselling ofpatients before surgery.REFERENCES1. Burroughs JR, Soparker CN, Patrinely JR. The buried vertical mattress: a simplifiedtechnique for eyelid margin repair. Ophthal Plast Reconstr Surg. 2003;19:323-4.2. Cutler ML, Beard C. A method for partial and total upper lid reconstruction. Am JOphthalmol. 1955;39:1-7.3. Irvine F, McNab AA. A technique for reconstruction of upper lid marginal defects.Br J Ophthalmol. 2003;87:279-81.4. Mustarde JC. Major reconstruction of the eyelids: functional and aestheticconsiderations. Clin Plast Surg. 1981;8:227-31.Pediatric Traumatic Cataract: Analysis ofEpidemiology, Development of PCO and FinalVisual OutcomesDr. Suma Ganesh, Dr. Priyanka Arora, Dr. Varshini Shanker, Dr. ManishSharmaOcular trauma is one of the leading causes of acquired monocular visualloss in children and young adults. 1 Traumatic cataract can result fromboth penetrating and blunt ocular trauma. Injuries of the eye occur mostlyduring play or in sport-related activities. Injuries are often caused by a knife,toys, glass, stone, wire, stick, pencil, or firecracker. 2 The present study wasundertaken to review the mechanisms of ocular injury, type of surgicalinterventions required, development of posterior capsule opacification (PCO)and visual outcomes in pediatric traumatic cataract.MATERIALS AND METHODSAfter approval of institutional review board, a retrospective review of patientcase sheets was carried out to identify the children less than 16 years of agewho underwent cataract extraction following ocular trauma, during theperiod between February 2007 to January 2009. 28 eyes of 28 children withfollow up of more than 6 months were included in the study and analyzed.The data was retrieved from patient admission charts and surgical recordsin the form of age, sex, description of injuring object, preoperative visualacuity, associated ocular injuries, status of lens, type and detail of surgicalintervention, postoperative complications, duration of follow up and bestcorrected visual acuity.1146

Trauma Free PapersDepending upon the type of injury, injuries were classified as either bluntor penetrating. In children ≤7 years and older children in whom posteriorcapsule was breached by trauma or was thick and fibrous, a primary posteriorcapsulorrhexis with anterior vitrectomy was performed. In children withopen globe injury, lens extraction was performed as a second and separateprocedure after the primary repair of globe. Visual acuity was recorded at eachfollow up visit, glasses prescribed 1 month postoperatively and amblyopiatherapy initiated as and when required.PCO was considered significant when vision dropped by 2 lines from the bestcorrected postoperative vision or when the retinoscopy or fundus examinationwas not possible. Nd:YAG capsulotomy was done for cooperative children andmembranectomy for younger children in cases with significant PCO.SPSS 17 was used to compare means using independent t test, and chi squareor Fischer extract test were used wherever appropriate. P values less than 0.05were considered significant.RESULTSAge of the patients ranged between 3-16 years (Mean ± SD = 8.57±3.5 years)with 14 children (50%) ≤ 7 years and 14 (50%) > 7 years. Peak age at the timeof injury was 4-6 years. Males represented 75% of the study population andleft eye was the injured eye in 64% children. Mean length of follow up was16.25±8.5 months (range: 6-33 months).Mechanism of injury: Bow and arrow injuries were the most common (21.4%)mode of injury, followed by stone (14%), wooden stick (10%) and fire crackerinjury (6%). 14 ( 50%) of children developed cataract after a blunt trauma and14 (50% ) following penetrating trauma.Surgical procedure: In 13 (46%) children, the primary surgery performedwas corneal tear repair followed later by secondary cataract extraction andintraocular lens (IOL) implantation, with a mean gap of 1.2 months betweenthe two procedures. 14 (50%) children had cataract extraction with IOLimplantation as the primary procedure. 1 child presented with traumaticendophthalmitis and intraocular foreign body (IOFB) and underwentvitreoretinal surgery as the primary procedure.Visual acuity: Mean preoperative visual acuity was 2.4±0.7 logMAR units,which improved to 0.3±o.4 logMAR units post operatively. Mean logMARvision was 0.44±0.4 in children below 7 years and 0.2±0.3 in older children(p=o.o37). Final visual outcome was found to be linearly related to the age attime of trauma. Final visual acuity was poor in 29% of children who sustainedopen globe injuries and 12% of patients who sustained closed globe injuries,though this difference failed to achieve significance (p=0.434).1147

69th AIOC Proceedings, Ahmedabad 2011The most common long term postoperative complication in our series wasposterior capsule opacification (PCO). PCO developed in 14 children (50%) (6children ≤7 years and 8 children >7 years), of whom 3 had acrylic and 11 hadPMMA lenses. PCO developed in 9 out of 11 (82%) children with intact posteriorcapsule and in 5 out of 17 (29%) children with primary posterior capsulorrhexis.PCO was treated by Yag capsulotomy in 8 and membranectomy in 6 patients.DISCUSSIONIn this study, we retrospectively analyzed the findings in 28 children whounderwent surgery for traumatic cataract following blunt or penetrating oculartrauma. Boys outnumbered girls by a ratio of 3:1, similar to that reported inprevious studies on traumatic cataract in children. 3 75% of our study patientsachieved visual acuity better than 6/18 and all except one achieved visualacuity better than 6/60. This one was the patient who presented with traumaticendophthalmitis and IOFB. Older age at the time of cataract surgery has beencorrelated with better visual outcome in children with traumatic cataract. 4This trend also was observed in our series of patients with traumatic cataract.Bow and arrow injuries were the most common (21.4%) mode of injury,followed by stone (14%), wooden stick (10%) and fire cracker injury (6%).Similar previous Indian studies report trauma with wooden stick (33%) to bethe commonest cause followed by stone injury (21%).Visual acuity outcome and PCO rates are compared with various studies onpediatric traumatic cataract and tabulated in Table 1.1148Table 1Authors and Type of follow upyear trauma N Age group VA>6/18 PCO% (months)Bienfait 1990 5 Blunt + penetrating 23 1-13 years 70% 83% 78Eckstein 1998 6 Blunt + penetrating 52 2-10 years 75% 92% 33Segev 2007 7 Penetrating 8 2-10 years 62% 37% 18Brar 20018 Blunt + Penetrating 40 4-12 years 65% 91% 18Kumar 20089 Penetrating 114 3-10 years 50% 21% 12-36Present study Blunt + Penetrating 28 3-16 years 73% 50% 182010The most common long term postoperative complication in our series wasposterior capsule opacification (PCO). In our series, 50% patients developedvisually significant PCO requiring treatment. PCO is reported to occur in17% to 100% of pediatric patients undergoing cataract extraction with IOLplacement. 10,11 Some authors have suggested that the incidence of PCO maybe greater in patients with traumatic cataracts. 10 9 out of 11 (82%) eyes withan intact capsule and 5 out of 17 (29%) eyes that had primary posteriorcapsulorrhexis with anterior vitrectomy developed PCO. These findings

69th AIOC Proceedings, Ahmedabad 2011Evaluation of Visual Outcome in ChemicalInjuries in Tertiary Care HospitalDr. Dinesh Patil, Dr. Arjun Ahuja, Dr. Sujata Tank, Dr. Madhura Satoskar,Dr. Riddhima DeshpandeChemical injuries to the eye constitute a markedly heterogenous collectionof accidents, varying in severity from complete and sudden loss of vision,to trivial and transient irritation of little significance. Chemical traumaconstitutes 7 to 9.9 percent of the reported cases of ocular trauma. 1-3 Frequencyof bilateral involvement is 23 to 42 percent. 4-5 Most victims are young males andexposure to chemicals occurs in industrial accidents, at home or in associationwith criminal assaults. 6 Most of these injuries are caused by alkalis and acids.Alkali injuries are more commonly encountered as they are extensively usedin industries and as household cleaning agents. 4 Patients in cases of suchinjuries need to be attended and given prompt treatment, in order to improvetheir final visual prognosis.MATERIAL AND METHODSWe conducted prospective analysis of 64 eyes of 50 patients, comprising of allages who presented with history of chemical injury to eyes during Oct 2007to September 2009(period of two years) who attended outpatient departmentand emergencies in KEM Hospital. The parameters which were evaluated inthis study were age group, sex distribution, bilaterality, causative chemicalagents and their nature, cause and place of the incident, time between injuryand presentation to the hospital (duration of exposure), ,severity of damageto ocular tissue, nature of management required, requirement of surgicalintervention and final visual outcome. To assess all these parameters, detailedhistory and complete eye examination were performed and followed uppatients for average period of 8 months (range from 3 months to 2 years) .Necessary investigations were done.Once the patient was received at the hospital, immediate copious irrigationof conjunctival sac with sterile irrigating solution was started even beforetaking a detailed history. All particulate matter which was mostly lodgedin the conjunctival sacs and sulci was removed meticulously and upper lidswere double everted to achieve a satisfactory approach to particulate matterin superior fornix. Topical steroids, cycloplegics and antibiotics with tearsubstitutes were administered along with justified use of ascorbic acid. Oralantibiotics and oral prednisolone were started if required.RESULTSAge of the patients ranged from 5-55 years. 60% of patients were between 21-1150

Trauma Free Papers40 years of age. 42(84%) of the injured were males and 8(16%) of them werefemales. Both eyes were affected in 14 patients (28%) and 36(72%)cases wereunilaterally affected. 25 (50%) patients suffered chemical injuries in domesticenvironment such as while cooking food, cleaning the bathroom floors orwhile children were playing with objects, followed by injuries occurring inchemical factories 10 patients (20%). 3 patients were involved in assault cases.21(42%) cases were due to miscellaneous agents such as adhesives, kerosene,turpentine oil, anaesthetic gas while 19(38%) due to alkali and 10(20%) weredue to acids.30(60%) patients presented within first six hours of the injury. 11(22%) presentedwithin 24 hours and 6(12%) presented within 72 hours. 36 out 64 eyes(56.25%)had no limbal ischemia while 10(15.62%) less than 1/3 rd limbal ischemia, 7 eyes(10.93%) between 1/3rd to ½ limbal ischemia and 11 eyes(17.18%) had more than½ limbal ischemia. The visual acuity at presentation was between 6/6 to 6/18in 32 (50%)eyes. There were 7 eyes (10.93%) each in group of hand movementsand perception of light. Out of the 50 patients (60%) required admission inthe ward and 40% were treated on OPD basis. Out of the 64 eyes studiedby us 33 eyes (51.57%) had no complications and 31 eyes (48.43%) had somecomplications. Commonest complication seen was corneal opacity (30.61%)followed by symblebharon (19.60%) and corneal vascularisation (10.93%).Out of the 19 eyes that suffered from alkali burns 17 eyes(89.47 %)developedcomplications while 2 eyes did not had complications. In our study majority ofeyes 40(62.50%) had final visual acuity between 6/6 and 6/18,while countingfingers were 12(18.75%)and below hand movements were 8(12.50%). Out ofthe 12 eyes that underwent amniotic membrane grafting, vision improved in8 eyes, while the vision in 3 eyes remained static and 1 eye deteriorated invision.DISCUSSIONChemical burns of the eye are among the most urgent of ocular emergencies.The clinical outcome of the injury is directly related to the how early treatmentis begun. Copious irrigation is the most important emergency treatment of thechemically injured eye. 3 This irrigation should begin immediately at the sceneof the accident with normal saline. 7 Removal of any particulate matter must bedone to prevent further ocular damage. The subsequent therapy is directed atthe treatment of secondary sequelae. 8 In our study most common age groupaffected is between 21-40 years (60%) as this age group is more physicallyactive and form the working population of the society. Males are affected morecommonly because of the same reason.50% patients suffered chemical injuries in domestic environment becauseall of them were exposed to chemical agent at home, 20% developed while1151

Trauma Free PapersStudies have shown greater extent of damage to cases resulting from assaultand hence resulting in poor visual outcomes. Amniotic membrane graftingwas done to facilitate healing of an epithelial defect, to prevent ocular surfaceadhesions and for conjuntival surface reconstruction following excision ofsymblepharon. Amniotic membrane grafting resulted in improved visualoutcome in 8 of 12 eyes. It was helpful in minor grades of ocular burns suchas grades I, grades II, grade III and not much useful in grade IV. Mumbai beinga metropolitan industrialised city and our hospital being a tertiary centre amajority of our patients suffered chemical injuries due to domestic, industrial,and assault related injuries.Chemical injuries of the eyes are a cause of significant ocular morbidity. In ourstudy all ocular chemical injuries resulted from accidents; at work or at homeand few resulted from assault. Patients with alkali injuries were associatedwith more complications with poor visual outcome with Lime was found to bethe single major culprit and was found to be used extensively as chuna spilledaccidentally into the eyes of children while playing and for painting purposes.Visual outcome correlated with severity of injury at initial presentation.Amniotic membrane grafting was helpful in lesser grade of injuries.As concluded in our study corneal opacity formed the main cause of decreasedfinal visual acuity. Full-thickness/lamellar optical keratoplasty can be a goodsurgical option done at a later date (after 1 year). But in eyes with unstableocular surface should undergo conjunctival or limbal autograft 6 months priorto keratoplasty. 6Kerotoprosthesis is done as last resort for visual rehabilitation in bilaterallyaffected patients. The only indication is repeated graft failure after keratoplasty. 9In the end we conclude that, if the chemical injury is very severe then any amountof treatment is unsuccessful in bringing about useful visual outcome. HENCEPREVENTION IS BETTER THAN CURE. Spread of information is necessaryfor adequate emergency care in case of eye burns as well as for employmentof protective glasses. And people should be careful while handling harmfulchemicals and should keep them away from reach of children.REFERENCES1. Jones NP, Hayward JM, Khaw PT et al. Funtion of an opthalmic’accident andemergency’department:Results of six month survey. Br Med J 1986;92:18-90.2. Vermon SA.Analysis of all new cases seen in busy regional centre ophthalmiccasualty department during a 24 week period. J R Soc Med 1989;76:279-82.3. Pfister RR.Chemical injuries of the eye. Opthalmology 1983;90:1246-53.4. Morgan SJ.Chemical burns of the eye: Causes and management. Br J Opthalmology1987;71:854-7.1153

69th AIOC Proceedings, Ahmedabad 20115. Sainai JS, Sharma A Ocular Chemical burns: Clinical and demographic profile.Burns 1993;19:67-9.6. Dutta LC ,Dutta NK .Modern ophthalmology, third edition, volume one, Chapterthirty-one, ocular chemical burns.7. Brodovsky SC, McCarty CA, Snibson G, et al. Management of alkali burns. An 11year retrospective review. Ophthalmology 2000;107:1829–35.8. Coster DJ, Aggarwal RK, Williams KA. Surgical management of ocular surfacedisorders using conjunctiva and stem cell allograft. Br J Ophthalmol 1995;79:977-82.9. Claes H Dohlmann.When Corneal grafts fail,Kertoprosthesis is an option. Reviewof Refractive surgery 2003;4:31-2.Dr. B N R SUBUDHI: MBBS (1976) and MS (1984) both from MKCG MedicalCollege and Hospital, Berhampur University; DOMS (1982), Pune University.Recipient of Best Graduate of Berhampur University-1976. Presently,Associate Prof. Dept. of Ophthalmology, MKCG Medical College and Hospital.E-mail:bnrsubudhi@hotmail.comOcular Trauma in Relation To Road TrafficAccidentsDr. B N R Subudhi, Dr. Arun Kumar Panigrahi, Dr. Sarita Panda,Dr. Praveen Subudhi, Dr. Prangya PandaOcular injuries are one of the leading causes of blindness and visualimpairment. The incidence and nature changes with the changinglifestyle, leisure, work etc. Due to increase in industrialisation and urbanizationthe number of motor vehicles on the road are increasing day by day. Theenormous growth in the number of transport vehicles has led to an increasein road traffic accidents (RTA). Now RTA has become a major cause of ocularinjuries in urban India. Most of these injuries are due to the following reasons1) High speed 2) Bad roads 3) Driving under the influence of alcohol 4)Use of mobile phone while driving 5) Not using proper safety measures 6)Animals on the road. Hence many of them are preventableMATERIALS AND METHODSA 1 year retrospective study (March ’09 to February ’10) was carried out.All the patients who had RTA and sustained ocular injuries attending thecasualty/emergency department were included in the study. Each case sheetwas reviewed to collect the following data11541. Age and gender2. Type of vehicle

69th AIOC Proceedings, Ahmedabad 2011VII. Different Types of Ocular TraumaNo %Eyelid oedema and ecchymoses 191 72Subconjunctival hemorrhage 82 31Lid and adnexal laceration 77 29Blunt injury 127 48Perforating injury 67 25.3Intraocular and intraorbital foreign body 16 6• Blunt injury was reported in 48% of eyes (127 eyes). Among these22/127(17.3%) had hyphema and 16/127(12.6%) had commotion retinae.• 77 patients who had lid and adnexal lacerations were surgically repairedin the emergency ward• 67 eyes had penetrating injuries ,of which 47 eyes(17.7%) had rupturedglobe• 35 eyes required some sort of surgical treatment for repair of globe and 12eyes were enucleated.• 50 patients (24%) had consumed alcohol during driving.• 34 patients (16%) were using mobile phone during driving.• 109/176 (62%) of bike riders did not wear helmet.DISCUSSIONMajority of the patients were young (

Trauma Free Papers2. Ensuring speed limit and other safety measures3. Prohibiting mobile phone use during driving4. Public awareness campaigns regarding various safety measures5. Stringent laws to punish offenders6. Strict driving test before issuing a driving licenseIncreasing traffic congestion due to rapid urbanization has resulted inspiralling growth in the number of ocular injuries due to RTA in the recentpast. A vast majority of affected people belong to economically productive agegroup. Hence it produces greater morbidity and mortality as well as economicburden on society.Many of these ocular injuries are preventable and in most cases the severitycan be reduced by following simple traffic safety measures.Responsibility lies with both the individual as well as the authorities inimplementing safe and stringent safety measures during driving.Considering the magnitude of the problem and morbidity associated with it,public awareness is very essential.Traumatic Macular Hole: Observation VersusSurgical Management, A Comparitive StudyDr. Praveen Muraly, Dr. Dhananjay Shukia, Dr. Poonam LimbadIn 1869, Herman Knapp first described traumatic macular hole(TMH). 1 It isa well-recognized complication of ocular trauma, but limited informationis available ont its natural history and pathogenesis. 2–4 Direct injury 5 to theeyeball was initially thought to cause TMH. Later, retinal cystic breakdown inthe fovea. 6,7 was thought as the cause TMH. Today, not only direct concussionbut other causative factors like vitreous traction 8,9 also plays a role in theformation of TMH. Even though vitreous surgery have shown good resultsfor TMH 10-14 and idiopathic macular hole 15-17 yet, there is no consensus on theoperative treatment, as some cases demonstrate spontaneous closure andimproved visual acuity. 18-22 We evaluate the outcome of surgical managementversus observation in the management of TMH.MATERIALS AND METHODSWe reviewed clinical records of a consecutive series of 25 eyes of 25 patientswith TMH who were referred to us between 2008 and 2010. They were firstexamined on the following day or within 2 weeks after trauma. Routineexamination included history taking for causes of injury and onset of visual1157

69th AIOC Proceedings, Ahmedabad 2011symptoms, recording of best corrected visual acuity, refraction, contactlens biomicroscopy, indirect ophthalmoscopy, fundus photography, opticalcoherence tomography (OCT) and ultrasonography. Patients who underwentsurgery were compared against observation. Association between visualoutcome and various preoperative, operative, and postoperative variables wasstatistically analyzed.RESULTSIn this consecutive series of 25 eyes of 25 patients with TMH, 23(92%) weremale and 2(8%) were female. Mean age was 20.6 years with a maximum of 36years and minimum of 5 years. 15(60%) patients had right eye was involvedand 10(40%) left eye. BCVA ranged from 1/60 to 6/12. Cause of TMH wassports related injury in 9(36%) patients, fall from height in 3(12%), blast injuryin 3(12%), road traffic accident 2(8%), stone injury in 2(8%) and others 6(24%).Mean macular hole size on OCT was 933 microns with a maximum of 3450microns and a minimum of 322 microns. 16 patients underwent observationand 9 patients underwent surgical correction (23g pars plana vitrectomy withILM peeling and gas tamponade with 16% C 3F 8). Out of the 9 patients, 7(77.8%)patients had closure of macular hole on follow up and two (22.2%) patients hadpersisting of macular hole on follow-up.The visual acuity was the same pre-operatively and post operatively in five,two patients had 2 line improvement and two patient had drop in visual acuityOut of the 16 eyes under observation 7(43.5%) eyes had spontaneous closureand five of them had 2 line visual improvement. There was no loss of vision inany of the patients.DISCUSSIONTraumatic macular holes have been noted to occur after blunt ocular injury.Vitrectomy has been shown to effectively close traumatic macular holes andimprove vision. 23 However, spontaneous closure of traumatic macular hole hasalso been reported. 20,22 Our study also confirms the above results. Althoughwe do not know whether surgical intervention would have altered the visualoutcome for our patient, our case illustrates that traumatic macular hole mayspontaneously close; therefore, surgical intervention may not be necessary.Thus patients with traumatic macular hole may benefit from a period of closeobservation immediately after their injuries.To conclude surgical treatment appears to lead to a higher rate of hole closure,but there is noticeably no significant difference in the proportion of final visualacuity between the observation group (gp) and the surgical closure gp. Fewpatients in the observation gp also had spontaneous closure of the macularhole. Thus, observation for a period of several months is a management of1158

Trauma Free PapersAttention was also paid to Ciliary Body flattening, Lens-Ciliary Body distanceand Iris-Lens contact. All eyes were subjected to Small Incision CataractSurgery (SICS) by superior approach sclerocorneal tunnel incision (ManualPhaco). Operations were performed by different surgeons. The UBM findingswere correlated with intra-operative findings.RESULTSThere were 18 males and 7 females. Average age was 42.52 yrs (Range – 19 to 66yrs). There were 7 eyes with Penetrating ocular injury and 18 eyes with blunttrauma. The findings were –Findings On Ubm On Slit LampCorneal scar 7 eyes 7 eyesAdherent Leucoma 5 eyes 5 eyesAvg. AC depth 2.84mm (Range- 0.5 - 4.2mm) -Posterior synechiae 5 eyes 5 eyesPeripheral Anterior Synechiae 3 eyes 3 eyesIridodialysis 1 eye 1 eyeIris bombe 1 eye 1 eyeIridal rotation 1 eye -Pupillary block3 eyesSubluxation of cataract 11 eyes 7 eyesMembranous cataract 3 eyes 3 eyesFocal rupture of anterior capsule 3 eyes 3 eyesPCR 2 eyes -Obvious zonular defect (Dialysis) 10 eyes 7 eyesOccult zonular defect 2 eyes -Zonular elongation 3 eyes -Cyclodialysis 3 eyes -Anterior vitreous herniation 3 eyes 2 eyesFourteen cases had intact posterior capsule and intact zonular apparatus.Zonular abnormality was as follows:Upto 3 clock hours6 eyes3 to 6 clock hours 3 eyesMore than 6 clock hours2 eyesBased on above pre-operative findings, the pre-op recommendation was asfollows:1. ECCE with PCIOL (without CTR) in 14 eyes – (12 in bag and 2 in sulcus).2. ECCE with PCIOL (with CTR) in 6 eyes – (less than 3 clock hourssubluxation)1161

Trauma Free Papersthe ocular details were obscured by corneal opacity, hyphema, etc. Theyconcluded that UBM was a safe and effective adjunctive tool for diagnosis inocular trauma cases. Pavlin et al 2 conducted a UBM study on 18 eyes - withPXF, congenital spherophakia, trauma, Marfan’s syndrome to evaluate its usein detecting ciliary zonular defects and describe UBM signs of such defects.They found – 11 missing zonules, 11 zonular stretch, 4 both missing zonulesand zonular stretch.As per their observation, increased lenticular sphericity and Ciliary Bodyflattening are signs of zonular defects. In a retrospective case series, McWhaeet al 3 found zonular defects in 21 of 49 eyes with anterior segment traumaand concluded that UBM information was useful in surgical planning andanticipating complications. UBM is a very useful modality of imaging inanterior segment trauma with multiple ocular injuries. Ozdal et al 4 foundzonular dialysis in 64.2% of eyes with closed globe injuries (67 eyes) and in54.8% of eyes with open globe injuries (42 eyes).Our study correlates with above studies in so far as UBM is an effective toolin picking up multiple ocular injuries in cases of anterior segment trauma. Itis particularly useful in imaging zonules and quantifying extent of zonulardefects. However, The differences are.. - Other studies have been done using 50MHz transducer. Most of them have used 2% HPMC bath instead of NormalSaline used in this study. Their purpose was general assessment of effects ofocular trauma. However, our study is more concerned with bringing out thatdata which would directly aid the cataract surgeon to plan his surgery.Conclusions: UBM of the anterior segment using 35 MHz transducer is veryhelpful to find out details of ocular anatomy altered due to the effect of traumain traumatic cataracts. Using this, the operating surgeon can anticipate thelikely complications in the surgery. Accordingly he can modify the surgicaltechnique or use aids like CTR to improve the surgical outcome. Also, it helpsto tell the patient about the prognosis of his condition so that even they arementally prepared for likely complications and consequent diminished visualoutcome.REFERENCES1. Berinstein DM et al Ultrasound biomicroscopy in anterior ocular trauma.Ophthalmic Surg Lasers. 1997;28:201-7.2. Pavlin CJ, Buys YM, Pathmanathan T. Imaging zonular abnormalities usingultrasound biomicroscopy. Arch Ophthalmol. 1998;116:854-7.3. McWhae JA, Crichton AC, Rinke M Ultrasound biomicroscopy for the assessmentof zonules after ocular trauma. Ophthalmology 2003;110:1340-3.4. Ozdal MP, Mansour M, Deschênes J. Ultrasound biomicroscopic evaluation of thetraumatized eyes. Eye. 2003;17:467-72.1163

69th AIOC Proceedings, Ahmedabad 2011Outcome in Penetrating Ocular Injuries— RiskFactors and Predictive IndicatorsDr. Bhavana Sharma, Dr. Ananda R, Dr. Shrivastava S, Dr. Jharna SinghOpen globe injuries are one of common emergencies in ophthalmicpractice. In recent past, development of comprehensive surgery andreconstructive procedure can now restore the potential physiological functionin many eyes which would have been lost otherwise . However, it is alsoimportant to properly evaluate the patient before surgery with reference todetermining factors, which can effect final visual outcome. Just repairing theopen globe injury may not be helpful l in every case. Hence, it is necessary toprognosticate a case of open globe injury before repair.This study has been done with an objective to assess various variables whichcan have an impact on final visual outcome. It was conducted on 240 patientsof open globe injury in a period of 3 years at RIO, Gandhi Medical College,Bhopal. Assessment was done with careful and detailed history underfollowing variables: Age and sex; Occupation ;Cause of trauma; Object oftrauma ;Presenting visual acuity; Time lag between trauma and interventionAll the cases were examined in accordance with eye trauma terminologysystem and ocular trauma classification group, with reference to - zone ofinjury, grade of injury, extent of injury globe rupture, Iris prolapse, hyphema,vitreous loss, vitreous hemorrhage, presence of RAPD, endophthalmitis,Retinal Detachment. OTS was assigned to all the patient.Adequate surgical intervention was done in all cases, after informed consentand under guarded prognosis. Follow up of patient was done for 6 months .Final anatomical status of the eye with reference to corneal opacity ,traumaticcataract, posterior segment complication, secondary glaucoma, pthisis bulbiwere evaluated. Surgery at a later date (secondry intervention) was done inselected subjects.Data was analysed with appropriate statistical variables like Odd’s ratio [Relativerisk] and p value. Regression analysis was done to evaluate the final data.Maximum number of patients were seen in age group of 6– 10 years withsignificant RR -1.7 and significant p

Trauma Free PapersFigure 1: Extent of injuryFigure 1: Presenting Visual Acuity And Final Visual OutcomeFigure 3: Ocular Trauma Score With Final Visual Outcome1165

69th AIOC Proceedings, Ahmedabad 2011They reported 33.5% of cases below 14 years of age and also that incidenceof penetrating injury decreases with age. Narang S Gupta MS et al PGI,Chandigarh (2004),reported 79.19% cases under age 13 and only 21% after 13years.In our study 63% cases were in Zone 1, followed by 19% and 18% in zone 2 andzone 3. Zone 1 is most exposed part and hence more prone for injury. NarangS et al (PGI ,Chandigarh ) and Yograj Sharma et al (AIIMS ) reported similarfindings in their studies. Thakkar and Ray, Washington (2006) reported 48.8%cases in zone 1 and 51.2% in zone 2 and 3.Extent of injury69% cases had presenting visual acuity between PL to 2/60 and had significantRR 6.27 and p < 0.01. From univariate logistic regression analysis it wasconcluded that PVA6/60 i.e When PVA was 6/12.Thus PVA is a decisive variable in final visual outcome. These findings areconsistent with Rehman MS et al U.K (2005), they reported that in their study59% cases had presenting VA 6/60 was associated withfinal visual acuity > 6/12 in 90% cases. If PVA was < 6/60 only 26% cases couldachieve final visual acuity > 6/12.OTS was assigned to all cases and we found that maximum number of cases53% had OTS of 2, followed by 26%, 15%,4%, 1% in 1,3,4,5 respectively. In OTS1 group 100% cases had VA6/60.In OTS 4 and 5 100% achieved VA >6/60. OTS6/60.Multivariate logistic regression analysis revealed that presence of infection,hyphaema, vitreous loss, retinal detachment, RAPD, carry significant riskfor poor visual outcome. (ODDS RATIO >3). Thus significant factors affectingfinal visual outcome were—Extent of wound and involvement of visual axis.Presenting visual acuity; I nterval between injury and intervention; Ocular1166

Trauma Free Paperstrauma score; Ant segment complications (iris prolapse; hyphaema; cataractand capsular integrity); Post segment complications(endophthalmitis; vitreoushaemmorhage; vitreous prolapse, RD.Hence management of ocular trauma includes careful history, systemic andmeticulous ocular examination followed by appropriate investigation andproper treatment, and by identifying the underlying factors ,in etiology ofthese injuries, it may be possible to design effective methods for reducing theirincidence.Outcomes of Unilateral Traumatic Cataract (TC)in preschool children: A five-year Analysis at aTertiary Care CenterDr. Jatin Ashar, Dr. Muralidhar R, Dr. Debojit Roy, Dr. Sunita Chaurasia,Dr. Virender Sangwan SCataract formation is a serious visually challenging squeal after trauma.Children are in general prone to trauma, especially during early years oflife. Development of cataract during the early years of life leads not only tovisual impairment due to the cataract per se, but also to amblyopia. Althoughtraumatic cataract is usually unilateral, the visual impact cannot be underserved. Any significant stimulus deprivation during the amblyopenic agecan profoundly affect the further visual development. Unilateral cataractaffects the development of binocularity. Blindness in children is considered apriority area for VISION 2020, as visually impaired children have a lifetime ofblindness ahead of them. 1 Cataract is the leading treatable cause of blindness inchildren. Although lenticular injury is thought to comprise only 7% of ocularinjuries, cataract formation is the most common cause of vision loss secondaryto penetrating ocular injury. On a larger perspective it would impact thechild’s overall development and increase the economic burden.The mode of injury and presentation of the traumatic cataract in childrenlargely varies from that in adults. The mode of injury in young children ismainly related to the domestic injury while playing at home or school.Management of traumatic cataract depends on the integrity of the posteriorcapsule and zonular apparatus and the associated injury to the cornea, uvealtissue, angle structures, and posterior segment. Most of the patients withtraumatic cataract require surgical intervention. 3Despite the various advances in surgical techniques and expertise inmanagement of pediatric traumatic cataract, the visual prognosis in childrenwith traumatic cataract is poor due to associated inflammation, amblyopia1167

69th AIOC Proceedings, Ahmedabad 2011and injury to other ocular structures. Herein we present our experience in themanagement of traumatic cataract.To report the outcomes of unilateral post traumatic cataract under 6 years ofage (amblyogenic age group).1168Study design: Retrospective, non consecutive, interventional case series.MATERIALS AND METHODSThe study was approved by the institutional review board. This retrospectivechart review included 143 eyes of 143 children, aged less than 6 years whopresented to the outpatient services or emergency services of L V Prasad EyeInstitute, Hyderabad from Jan 2002 to Dec 2007 with a traumatic cataract wereevaluated.The exclusion criteria were: All the patients with posterior segment injurywere excluded from the analysis.Surgical details: All the surgeries were performed by experienced pediatricophthalmologists. The surgeries were performed under appropriateanesthesia. According to the surgeon’s discretion either scleral tunnel or clearcorneal incision were constructed. Lens aspiration and primary intraocularlens implantation in the bag was done in all the cases. Primary posteriorcapsulotomy and anterior vitrectomywas done in children. All thepatients were implanted with singlepiece, acrylic foldable intraocularlenses with 6.0 mm optic size and13.5 mm overall diameter. All thethree incisions (paracentesis andmain port) were sutured with 10-0monofilament nylon nonabsorbablesuture (Aurolab, Madurai, India).Single radial suture was applied tothe all the ports.Post operative care: Examinationunder anesthesia was done at oneweek, one month, three months andat six months. In all the patientsFigure 1sutures were removed within 3months of the surgery. Retinoscopy was done at each of the follow up visitsby an experienced optometrist. Glasses were prescribed at 4 weeks from thedate of surgery.Parameters studied included demographics, mode of injury, time since the

Trauma Free Paperssurgery, associated anterior segment injuries, type of cataract, capsular status,timing of the surgery with respect to initial injury, type of surgery, site ofincision, concomitant or any prior surgery, post operative visual outcomes,post operative complications, amblyopia status.RESULTSOne hundred and forty three eyes of 143 children were included in the analysis.The mean age at presentation was 4.21 ±1.42 yrs. All injuries were more commonin boys (M: F, 103:40).Most common mode of injury was with stick (43.35%). Thedistribution of various modes of injury is summarized in figure 1.Table 1: Agewise Distribution of Type of CataractAge in years Total Cortical Partial PSC Absorbed

69th AIOC Proceedings, Ahmedabad 2011posterior capsular rupture, 7(4.89%) had both anterior and posterior capsularrupture, and 1 patient had a partially absorbed cataract with fusion of theanterior and posterior capsule. Cases with capsule rupture (43.35%) neededearly surgery (lens aspiration) (63.56+ 83.85 vs 89.87+138.32 days).16 patientshad a prior corneal tear repair done elsewhere. Surgery for traumatic cataractwas done at a median 45(1-720) days after the trauma.A sclera incision was made in 102 patients, clear corneal in 27, limbal in 12 casesand a pars plana approach in 2 cases. 92.30% had PCIOL. Primary PosteriorCapsulorrhexis (PPC) and Anterior Vitrectomy (AV) were performed in 67.13%.Post operatively all the children needed a high dose of topical corticosteroidswhich was tapered gradually over one month. Posterior capsular opacification(PCO) was most common complication. PPC and AV reduced PCO rate (7.29%vs 46.80%).All the patients had improvement in the visual acuity. The final visual acuityranged from fixing and following light to 20/20.24.47% developed amblyopia.Comparative analysis of children with pure traumatic cataract vs the ones withother anterior segment involvement with respect to the final visual outcomeand complication showed no difference between the two groups.Table 2: Correlation of pre and post operative visual acuitypost op/ Less than FC 3mts- 20/200 20/100 20/50-pre op FC 3 mts 20/200 -20/100 -20/50 20/2017 29 27 28 38FC 3mts-20/200 1 120/200-20/100 120/100-20/5020/50-20/20 1Traumatic cataract in children is more problematic than adults due to thedeveloping ocular system and the increased ocular inflammatory response.Amblyopia is a pediment to attainment of good final visual outcome. Mostcommon mode of injury was with stick. It is paramount to avoid exposure ofchildren to such dangerous sources of injury.Lens aspiration with IOL is the standard of care. A PPC+AV decrease the PCOrates. Children with visually significant traumatic cataracts can have goodoutcomes if they are managed aggressively and appropriately.DISCUSSIONTraumatic cataracts can interfere with visual development and result inamblyopia in young children. An early surgery can help in decreasing thechances of amblyopia. Anterior approach with implantation of the intraocular1170

Trauma Free Paperslens at the time of surgery helps achieving good visual outcomes. Posteriorcapsular opacification is a common complication and may again lead to a poorvisual outcome. A primary posterior capsulotomy and anterior vitrectomycan decrease the chances of this complication. A timely surgical intervention,aggressive control of postoperative inflammation, strict adherence to theamblyopia management can all lead to good outcomes in most of cases. Aboveall, patient and family education can help avoid such injuries.REFERENCES1. Rahi JS, Gilbert CE, Foster A, Minassian D. Measuring the burden of childhoodblindness. Br J Ophthalmol 1999;83: 387–388.2. Thakker MM, Ray S. Vision-limiting complications in open-globe injuries. Can JOphthalmol 2006;41:86-92.3. Jones WL. Traumatic injury to the lens. Optom Clin 1991;1:125-42.Dr. SUMEET KUMAR MALHOTRA: MBBS (1992) and MS (1997), Pt. B.D.Sharma Postgraguate Institute of Medical Sciences, Maharishi DayanandUniversity, Rohtak, Haryana; Fellowship with National Board of Examinationsin Vitreoretinal Diseases, 2004; Fellowship in Vitreoretinal diseases (2004),LVPEI, Hyderabad. Presently, Associate Ophthalmologist in Vitreo-retinalservices, MGM Eye Institute, Raipur. E-mail: sumeet_25@yahoo.comPrognostic Factors, Visual Outcomes andInterventions in Intraocular Foreign Body InjuriesDr. Sumeet Kumar Malhotra, Dr. Deepshikha AgrawalOcular trauma remains a major cause of blindness and ocular morbidityparticularily in working age population. 1 Intraocular foreign bodies arefrequently accompanied by penetrating open globe injuries and can leadto increased ocular morbidity. 2,3 The advancements in microsurgical andvitreoretinal surgical techniques have facilitated in better management ofcomplicated injury cases. 4-7 Ocular trauma with IOFB is an important causeof ocular morbidity and blindness in central India and often under reported.This study addresses the management strategies, prognostics factors andvisual outcomes after IOFB injuries in Indian scenario.MATERIALS AND METHODSIn a retrospective interventional case series, fifty consecutive patientsexamined at MGM Eye institute with open globe injuries with intraocularforeign bodies from January 2005 through December 2009 were identifiedthrough a review of clinical charts and operating room logs. Clinicalcharacteristics including age, gender, presenting visual acuity,mechanism of1171

69th AIOC Proceedings, Ahmedabad 2011injury, initial ocular examination findings and medical treatment, primaryand secondary surgical interventions performed, complications, final BCVAand IOFBs characteristics were evaluated. The clinical diagnosis of an IOFBwas confirmed by clinical examination, standardized ocular echography,plain X ray orbit or computed tomography (CT).The patients underwentremoval of IOFBs by 3 port para plana vitrectomy with intraocular magnet/foreign body forceps or anterior limbal route. A comprehensive ocularexamination findings comprising of BCVA by Log Mar visual acuity chart,applanation tonometry ,slit lamp biomicroscopy with 90D lens and fundusexamination by indirect ophthalmoscope and 20D lens were recorded atadmission, after intervention, 1st, 2nd, 4th , 6th, 12th,24th and 48th and 54thweek. The patients with minimum 12 months of follow-up were included inthe study for statistical analysis.The patients were divided into two groups based on final BCVA , Group 1with poor visual outcome (Final BCVA ≤20/400), Group 2 with good visualoutcome (final BCVA >20/400). For statistical purposes laceration length wasdivided into less than or equal to 5mm or greater than 5mm and size of foreignbody into ≤3mm or >3mmand mass into ≤20mg or 20mg. The time of injuryto initial surgical intervention was recorded. Characteristics of IOFB recordedincluded the location, composition, mass, size and shape. The main outcomevariable was final best corrected visual acuity after IOFB removal.Statistical Analysis: Univariate and multivariate statistical analysis wasperformed using Microsoft Excel and graph pad software and SPSS version16 soft ware packages using fisher’s exact test,and logistic regression analysisto identify prognostic variables for poor and good visual outcome after IOFBremoval. The prognostic factors evaluated were age of patient, presentingVA, primary repair, 20/400 in 70% and ≥20/40 in 34% patients.Good visual outcome (>20/400) was associated with

Trauma Free PapersTable 1: Demographic and Clinical Overview of Patients with OpenGlobe injuries with Intraocular Foreign BodiesTotal no patients with intraocular Foreign Bodies (n=50)Age (yrs) Mean±SD (range) 28.2±9.8( 8- 46)GenderMale (%) 48(96)Female (%) 2(4)EyeRight(%) 26 (52)Left (%) 24 (48)Mechanism of InjuryHammering 33 (66)Bomb Blast 8 (16)Playing 6 (12)Wooden Stick 2 (4)Tyre burst 1 (2)Presenting VA≤20/400 35 (70)>20/400 15 (30)Median time of IOFB removal (days) 12.5Follow-up (days) Mean±SD( Range) 396±4.9 (180-1500)Table 2: Wound and Ocular Examination Findings of Eyes withIntraocular foreign Bodies at PresentationOcular Examination Features No of Eyes (%)Anatomy of wound (n=50)Cornea Involved (%) 37 (74)Central (%) 14 (38)Peripherial (%) 18(49)Both (%) 5 (13)Corneoscleral (%) 2 (4)Scleral Involved % 11 (22)Superotemporal(%) 2Inferotemporal (%) 3Superonasal (%) 2Inferonasal (%) 6Mean length mm (range) 4.04 mm (1-14)Ocular FindingsHyphaema 11 (22)Hypopyon 10 (20)RAPD 14 (28)Uveal prolapse 13 (26)Damage to Lens/Cataract 34(68)Vitreous Haemorrhage 14 (28)Retinal Detachment 9(18)1173

69th AIOC Proceedings, Ahmedabad 2011Table 3: Surgical Intervention in Patients with Intraocular ForeignBodiesSurgical Interventions for Removal of IOFB No of Eyes (%)Initial interventionsPars plana Vitrectomy 47 (94)With Silicone oil 15 (30)Without Silicone oil 32 (64)With Belt Buckling 35(70)Without Belt buckling 15(30)With Intraocular antibiotics 16(32)Pars plana Lensectomy 33(66)Anterior Cataract Extraction +PCIOL 3(6)Subsequent InterventionsIndications No of Eyes Procedures No of EyesRetained IOFB 1 (2) Para plana Vitrectomy 12 (24)Retinal Detachment 7 (14) Pars plana Lensectomy 2 (4)Vitreous haemorrhage 3 (6)Glaucoma 1 (2) Trabeculectomy with mitomycin-C 1 (2)Cataract 5 (10) Phacoemulsification +PCIOL 5 (10)Table 4: Prognostic Factors for Visual Outcome in Patients withIntraocular Foreign body Injuries Univariate Analysis of factorsAssociated With Good Visual Outcome (VA> 20/400)Prognostic Factors No: patients No:of patients P valuewith Final with FinalVisual Acuity Visual Acuity>20/400 ≤20/400Presenting VA>20/400 14/35 (40%) 1/15 (6.6%) 0.02Older Mean Age 17/35 (48.5%) 2/15 (13%) 0.02Removal of IOFB 20/400 ≤20/400Hyphaema 9/15 (60%) 2/35 (5.7%) .001Prolapse of Intraocular Contents 8/15 ( 53%) 5/35 (14.2%) 0.02RAPD 10/15 (66.6) 4/35 (11%) .01Large Size of Entry wound ≥5mm 6/15 (40%) 3/35( 8.5%) 0.021174

Trauma Free PapersMultivariate Analysis of Factors Associated With Good and Poor Visual OutcomeGood Visual Outcome> 20/400 Poor Visual Outcome ≤20/400Size of IOFB ≤3mm (P=0.004),RAPD (P=0.03)IOFB (P=0.001) Large Size of Entry wound≥5mm (P=0.05).Removal of IOFB 20/400 15 (30) 35 (70)≥20/40 7 (14) 17 (34)DISCUSSIONOpen globe injuries with intraocular foreign bodies are important cause ofblindness in the developing world and United States. In this retrospectiveinterventional case series comprising of 50 consecutive patients with openglobe injuries and intraocular foreign bodies a detailed descriptive analysisof prognosic factors ,management and visual outcomes is done.Comparison of demographic features, Clinical Overview and Foreignbody characteristics with other studies:As mentioned in the literature by Camacho and Mejia, 7 the majority of patientsin our series with intraocular foreign bodies were also young males, 96%hadocular injuries while hammering metal on metal (66%). Metal on metal activitypaticularily with various tools are often associated with metallic intraocularforeign bodies as reported by Coleman 3 and Woodcock et al 6 in there series ofpatients. The involvement of cornea was commonly seen as the entry site in 37of 50(74%) of cases in our series which is similar as reported in other studies, 3,7traumatic cataract or dehiscence of anterior capsule was seen in 34 of 50 (68%)of patients in our study. 9(18%) patients presented with retinal detachmentand 7(14%) patients developed retinal detachment during follow-up whichis similar in figures from Woodstock et al 6 however the presentation withendophthalmitis was the commonest with 16(32%) patients presenting asendophthalmitis which is certainly higher as compared to other studies. 8,9Majority of foreign bodies retrieved from patients in our series were blade- shaped (60%),80% were metallic (Iron) with posterior segment (inferiorretina) as the preferred site in 94% cases, our results are also similar to reportfrom Greven et al. 10 The median time of removal of intraocular foreign bodywas 12.5 days, this delay intervention was result of improper referral of thepatients to our institute and increase in incidence of endophthalmitis in ourseries.1175

69th AIOC Proceedings, Ahmedabad 2011Comparison of Management and Visual Outcomes with other studies inLiterature.There is marked improvement in surgical techniques over the years as far asremoval of intraocular foreign bodies is concerned, before the vitrectomyera giant or hand held electromagnets were the instruments for extractionof magnetic and forceps for removal of nonmagnetic foreign bodies. 3 portparsplana vitrectomy with intraocular magnet/foreign body removing forcepswas the commonest method for removing IOFBs in 94% of patients, only 6%of the intraocular foreign bodies were extracted from anterior limbal route.Pars plana vitrectomy for removing posterior segment IOFBs is preferredtechnique advocated by most of the previous reports as vitrectomy offersbetter anatomic and functional outcomes. 2,3,5Pars plana lensectomy was perfomed in 66% and silicone oil injection in 30%of the patients in our series when there was damage to lens, retinal detachmentwith endophthalmitis and PVR. Visual acuity at 1 year follow-up after IOFBremoval was >20/400 in 70% and ≥20/40 in 34% patients.The results of visual outcomes in our studies are similar to reports fromBriton et al and Greven et al. 2,10 70% patients achieved functional visual acuityof >20/400 or better. The causes of poor visual ≤20/400 outcome were retinaldetachment (32%), endophthalmitis (32%) and macular scar in our series.Comparison of prognosic factors with other studies in Literature.Multiple variables have been identified as prognostic factors for final visualacuity such as age of patient, type of injury and inflicting agent, presentingVA, primary repair, 20/400) was associated with

Trauma Free Papersvariables have been found to bear no prognostic significance. In the absenceof prospective, standardized studies, and with much depending on howthe individual eyes are treated one cannot provide accurate prognosticinformation. An important fact which needs to be highlighted is none of thepatients wore protective safety glasses while performing their occupationalwork which is evidence of safety that glasses provide from ocular injuries.Drawbacks and Limitations of Study were retrospective nature of the study.Small sample size comprising of 50 patients were analyzed. Non standardizeddocumentation, variable interventions and therapeutic approaches andfollow due to retrospective design of study, although the posterior segmentinterventions were performed by one surgeon only, multiple biases cannot beruled out which would have influenced the study.To conclude anatomical and visual outcomes after IOFB injuries are not dismal.Appropriate and timely intervention is vision salvaging after IOFB injuries.Pars plana vitrectomy with intraocular foreign body magnet/forceps is thepreferred modality of treatment of ensuring better anatomical and functionaloutcome.REFERENCES1. Negrel AD, Thylefors B. The global impact of eye injuries. Ophthamic Epidemol1998;5:143-69.2. Briton GS, AabergTM, Reeser FH, Topping Tm. Abrams GW. Surgical results inocular trauma involving the posterior segment. Am J Ophthalmol 1982;93:271-8.3. ColemanDJ, Lucas BC, Rondeau MJ, Chang S, management of intraocular foreoignbodies. Ophthalmology 1987;94:1647-53.4. Benson WE, Machemer R. Severe perforating injuries treated with pars planavitrectomy. Am J Ophthalmol 1976;81:728-32.5. Michels RG. Surgical management of nonmagnetic intraocular foreign bodies.Arch Ophthalmol 1975;93:1003-6.6. Woodstock MG, Scott RA, Huntbach J, Kirkby GR. Mass and shape as factors inintraocular foreign body injuries. Ophthalmology 2006;113:2262-9.7. Camacho H, Mejia LF,Extraction of intraocular foreign body by pars planavitrectomy. A retrospective study. Ophthalmologica 1991;202:173-9.8. Jonas JB, Knorr LJ,Budde WM. Prognostic factors in ocular injuries caused byintraocular and retrobulbar foreign bodies. Ophthalmology 2000;107:823-8.9. Ehlers JP,Kunimoto DY, Ittoop S Joseph I, Maguire, HO AC, Regillo CD.MetallicIntraocular foreign bodies.Characteristics, Interventions, prognostic factors forvisual outcome and Globe survival. Am J Ophthalmol 2008;146:427-33.10. GrevenCM, Engelbrecht NE, Slusher MM, Nagy SS. Management, PrognosticFactors and Visual Outcomes. Ophthalmology 2000;107:608-12.1177

69th AIOC Proceedings, Ahmedabad 2011Retrospective Study of Orbital Trauma in Patientsat Tertiary Care Hospital During April 09 to May 10Dr. Puja Deshmukh, Dr. Khushbu Bhattad, Dr. Madan Ashok HukumchandThe orbit is designed to protect and nurture eyeball. Seven bones of orbitencloses a pear shaped cavity. The bones of superior&lateral orbit arestronger than inferior and medial bones. The strength and weakness inherentto orbital bones produce unique pressure safety valve, designed to protecteyeball. During the last 2500 yrs humanhave attempted to protect the orbitwith helmets, gladiator and safety googles. Inspite of long history of orbitalsafety advances, orbital trauma is a single most important cause of monoocularblindness worldwide.To study incidence, presentation&visual outcome in association with site oforbital fracture.MATERIALS AND METHODSWe examined 790 patients who presented with ocular injury in our tertiarycentre from April 09 to May 10.Inclusion CriteriaPatient with single wall orbital fracture and apex fracture with no other causeof decrease vision given in exclusion criteria and had previously normal V/A.Exclusion Criteria1) Patient in which assessment is difficult due to severe head injury, reducedlevel of cooperation in obtunded patient 2) Patient with no orbital wallfracture 3) Patient with fracture&associated with other cause of decreasedvision like corneal and sclera perforation, hyphaema, lens dislocation,retinal detachment,vitreous hemorrhage 4) Patient with multiple orbital wallfracture excluding apex. Socio-demographic data and history regarding thecause of the injury were obtained. Data regarding the ocular examinationsincluding visual acuity, gaze,extraocular movements, pupillary rection, IOP,orbital margin palpation, slit lamp examination and fundus examination werecollected. Fracture site was noted from x–ray and Ct scan. In some patient wehave done MRI for diagnosis optic nerve compression and to differentiateedema with hemorrhage. Finally we analyzed the data and association of siteof orbital fracture with presentation,Visual outcome is established.RESULTOut of 790 patients,only 354 (44.8%) pt had orbital wall fracture and 436 (55.2%)no orbital fracture:1178

Trauma Free PapersSingle wall fracture and apex fracture with no other associated 76 (21.5%)cause for decrease v/aMultiple wall fracture with no other associated cause for decrease v/a 82(23.2%)Orbital wall fracture with other associated cause for decrease v/a 196 (55.3%)Total 354Out of 196 pt of orbital wall fracture associated with other cause of decreasevisual acuity ,nature of lesions are for decrease vision are:Hyphaema 54 (27.5%)Lens dislocation 49 (25%)Vitreous hemorrhage 46 (23.5%)Intra-ocular foreign body 32 (16.3%)Ruptured globe 8 (4.1%)Corneal and Scleral perforation 6 (3.1%)Retinal detachment 1 (0.5%)Total 196Out of 76 patients with single wall and apex fracture with no other associatedcause of decrease v/a:40 yrs 16(21%)Male 65 (85.5%)Female 11(14.5%)Table 1: Age and SexRTA 45 (59.2%)H/O fall 18 (23.7%)Injury with blunt object 8 (10.5%)H/O assault 5 (6.6%)Cause of InjuryTable 2: Presentation of Orbital Fracture in Association with Site ofInvolvementMedial Infra Floor Lateral Roof Apex Blowout TotalWall Orbital Wall fracture (76)(8) Wall (22) (18) (12) (1) (9) (6)V/A 7-N 22-N 4-6/12 4-Pl 1-6/9 2-No Pl 1-No Pl 3-6/9:4-6/12:1-6/9 1-6/9 8-N 5-Pl: 1-Pl: 10-Pl13-N 2-N 4-N 3-No Pl:56-NRestrict 2 3 4 3 - 2 1 15(19.7%)Movement1179

Trauma Free Papersinto orbit. They are common after injury with blunt trauma. They may causeimpingement on intraobital soft tissue and muscle causing restriction ofmovements.According to Kamath Et Al 7 site offracture-43% infraorbital rim, 19%floor, 13% lateral wall, 11% medialwall, 14% pureblowout. In our study29% Infraorbitalrim, 23% floor, 16%lateral, 10% medial, 8%pure blowout, 12% apex, 1% roof Al-quarainy 5reported incidence of blow outfractures to be 9.9%, roof fracture 5%.In our study it was blow out fractureis 7.9% and roof 1.3%.According to Lester Et Al 6 periorbitalecchymosis was in seen 100% cases,inability to elevate globe in 90%cases, vertical diplopia in 90% cases,infraorbital hypoesthesia in 56% casesand enophthalmos in 5.75% cases.In our study 81.5% had periorbitalswelling, 19.7% had restriction ofextraocular movements, 17% haddiplopia, 14.4% had infraorbitalhypoesthesia, enophthalmos in 2.6%cases.Cause of InjuryOrbital fracture are more common inmale especially in 20-40 yrs of age.Among cause of injury road trafficaccidents are most common followed by H/O fall, injury by blunt object andH/O assault.In single wall orbital fracture infra-orbital rim fracture is most common,followed by floor fracture, lateral wall, apex, medial wall, pure blow out thenroof fracture is least common. Though medial wall is thinnest; its isolatedfracture is infrequent,concomitant medial wall and floor fracture are frequent;SEVERE visual loss were associated with ORBITAL APEX,LATERAL WALLand PURE BLOW OUT; MODERATE visual loss were associated with FLOORFRACTURE; MILD visual loss were associated with MEDIAL WALL andROOF FRACTURE. Of various gaze restriction most common is supraductionfollowed by lateral gaze and medial gaze restriction. Most commonly caused1181

Trauma Free PapersGroup A – 12 casesIn this group UBM was done preoperatively to assess the site and extentzonular loss.Intraoperatively07 cases – CTR03 cases – Cionni’s02 cases – SFIOLIntraoperative management remained same as predicted preoperatively byUBM depending on the extent of zonular loss except in 01 case (8.33%).Group B – 12 casesIn this group UBM was not done preoperatively and intraoperative assessmentof zonular loss was made.Intraoperatively06 cases – CTR03 cases – Cionni’s02 cases – SFIOL01 case - ACIOLIn 04 cases the intraoperative management had to be changed from the oneplanned preoperatively (33.33%).RESULTS AND DISCUSSIONUltrasoundbiomicroscopy in traumatic subluxated cataracts helps to:(a)Effectively localize and estimate the extent of zonular loss.(b) It helps plan the surgical strategy preoperatively and difficult cases canbe dealt by the more experienced surgeons.(c)Prognosticate and inform the patient accordingly as regards the surgicalprocedure and possible outcome.of1183