RECONSTRUCTION OF THE ORBITS AFTER GUNSHOT WITH THE DAMAGE OF EYEBALLS (A CASE REPORT)

The authors present an unusual case and clinical case report of a 21 year old patient who sustained a penetrating gunshot injury of his head (and both orbits). The left eye was dislocated in front of the eyelids and heavily damaged. The right eye looked normal. The place where the bullet entered the scull was located near the temporal margin of the right orbit, the exit wound was close to the temporal margin of the left orbit. After the accident the patient was conscious but his visual functions were not examined. The patient was consequently given sedatives and intubated. After his transportation to the hospital, he has undertaken several procedures under a complex intensive care and continual sedation. These included primary enucleation of the left eye, reconstruction of the margin of the left orbit and bilateral revision of the medial area of the orbits with the removal of bone fragments. After the completion of all imaging examinations there was no other pathology found except for the penetration wound of both orbits and ethmoid bones. The ophthalmoscopy could not be evaluated due to a heavy bleeding into the vitreous. The ultrasound examination revealed a heavy traumatic damage of the posterior segment of the eye and therefore a reconstructive surgery (pars plana vitrectomy) was indicated. However, during the surgical intervention the avulsion of nerve fibres from the neuroretina was diagnosed and the state was classified as further unsolvable

Grand Challenges in global eye health: a global prioritisation process using Delphi method

Background We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenge

Reconstruction of the orbits after gunshot with the damage eyeballs (case report)

ABSTRACT The authors present an unusual case and clinical case report of a 21 year old patient who sustained a penetrating gunshot injury of his head (and both orbits). The left eye was dislocated in front of the eyelids and heavily damaged. The right eye looked normal. The place where the bullet entered the scull was located near the temporal margin of the right orbit, the exit wound was close to the temporal margin of the left orbit. After the accident the patient was conscious but his visual functions were not examined. The patient was consequently given sedatives and intubated. After his transportation to the hospital, he has undertaken several procedures under a complex intensive care and continual sedation. These included primary enucleation of the left eye, reconstruction of the margin of the left orbit and bilateral revision of the medial area of the orbits with the removal of bone fragments. After the completion of all imaging examinations there was no other pathology found except for the penetration wound of both orbits and ethmoid bones. The ophthalmoscopy could not be evaluated due to a heavy bleeding into the vitreous. The ultrasound examination revealed a heavy traumatic damage of the posterior segment of the eye and therefore a reconstructive surgery (pars planavitrectomy) was indicated. However, during the surgical intervention the avulsion of nerve fibres from the neuroretina was diagnosed and the state was classified as further unsolvable

CLINICAL OUTCOMES OF THE TREATMENT OF EXUDATIVE AGE-RELATED MACULAR DEGENERATION WITH PEGAPTANIB

Purpose. To evaluate the results of intravitreal use of Pegaptanib in patients with exudative age-related macular degeneration (AMD). Material end methods. Our study includes 77 patients with exudative AMD, who received 9 injections of Pegaptanib 0.3mg with 6-weeks intervals between them. So the primary treatment lasted one year. During and after the treatment these patients underwent fluorescent angiography (FAG), optical coherence tomography (OCT), fundus photography and best corrected visual acuity (BCVA) examination. According to the results of these examinations a decision about a further treatment, whether it was necessary, was taken. Results. By the end of our 2-year study 38 patients after therapy with Pegaptanib had complete obliteration of the choroidal neovascularization (CNV), 19 patients were switched to Ranibizumab, one patient underwent photodynamic therapy with Visudyne, 14 patients had severe progression of AMD, when there was no sense in further treatment, 2 patients dropped out the study because of cerebral insult, 3 patients refused of any further treatment, in spite of persisting exudative activity of the CNV after the primary treatment. Conclusion. Intravitreal аpplication of Pegaptanib is a relatively effective treatment option of exudative AMD as BCVA was stabilized or improved in 55.8% of patients, macular edema decreased in 67.5% of patients and neovascular membrane was obliterated in 49.35% of patients

Clinical outcomes of the treatment of exudative age-related macular degeneration with Pegaptanib

ABSTRACT Purpose. To evaluate the results of intravitreal use of Pegaptanib in patients with exudative age-related macular degeneration (AMD). Material end methods. Our study includes 77 patients with exudative AMD, who received 9 injections of Pegaptanib 0.3mg with 6-weeks intervals between them. So the primary treatment lasted one year. During and after the treatment these patients underwent fluorescent angiography (FAG), optical coherence tomography (OCT), fundus photography and best corrected visual acuity (BCVA) examination. According to the results of these examinations a decision about a further treatment, whether it was necessary, was taken. Results. By the end of our 2-year study 38 patients after therapy with Pegaptanib had complete obliteration of the choroidal neovascularization (CNV), 19 patients were switched to Ranibizumab, one patient underwent photodynamic therapy with Visudyne, 14 patients had severe progression of AMD, when there was no sense in further treatment, 2 patients dropped out the study because of cerebral insult, 3 patients refused of any further treatment, in spite of persisting exudative activity of the CNV after the primary treatment. Conclusion. Intravitreal аpplication of Pegaptanib is a relatively effective treatment option of exudative AMD as BCVA was stabilized or improved in 55.8% of patients, macular edema decreased in 67.5% of patients and neovascular membrane was obliterated in 49.35% of patients

Spontaneous suprachoroidal hemorrhage due to the excessive anticoagulation therapy. Case report

Anticoagulant therapy is often used to treat various conditions. This often can deviate in the hemostatic system in the direction of hypocoagulation and increase risk of hemostatic complications. The article describes suprachoroidal hemorrhage in the eye of a patient with AMD who received anticoagulants

Acute posterior multifocal placoid pigment epitheliopathy in a child. Case report

To present our findings and the course of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) with macular edema in a child