The edition · Ophthalmology
A festival-season eye-burn outbreak, and repeat trabeculectomy holds its own
Carbide-gun explosions are causing severe ocular burns in adolescents; how pathogen identity shapes endogenous endophthalmitis outcomes; fundus-photo vascular features that track glaucoma progression; and repeat trabeculectomy versus an Ahmed valve after a failed first operation.
The edition in brief
Today's ophthalmology edition opens on a preventable festival-season injury. An outbreak series of 37 patients with carbide-gun ocular trauma, all male and a median age of 15, found severe thermochemical burns (Dua grade IV-VI) in 64.8%, mostly while inspecting a misfiring home-made device; early amniotic membrane transplantation improved short-term vision but severe burns still risked limbal stem cell deficiency, and the authors call for regulation and public awareness. A 12-year multicentre cohort of 305 eyes with endogenous endophthalmitis showed outcomes differ by organism: gram-negative infections, especially Serratia, carried much higher enucleation rates, while presenting visual acuity was the dominant prognostic factor. In 1,595 eyes, deep-learning retinal vasculometry from baseline fundus photographs was associated with later visual-field change in glaucoma, a possible prognostic marker needing validation. A clinic pearl restates immediate irrigation for ocular chemical burns. The practice-changer: in eyes with a failed trabeculectomy, repeat same-site trabeculectomy gave visual-field progression similar to an Ahmed glaucoma valve, with lower pressure, fewer medications and a greater reduction in progression versus the preoperative rate, making it a viable option.
Carbide-gun explosions are burning adolescents' eyes
Treat carbide-gun eye injuries as severe thermochemical burns with immediate irrigation, early grading and early amniotic membrane transplantation, and push prevention for this adolescent, home-based hazard.
In endogenous endophthalmitis, the organism shapes the outcome
Treat endogenous endophthalmitis as organism-dependent: chase the systemic source, flag gram-negative (especially Serratia) as high risk for globe loss, and use blood cultures given low intraocular yield.
Fundus-photo vascular features track glaucoma progression
Automated retinal vascular features from fundus photographs were linked to later glaucoma visual-field change, a promising but unvalidated prognostic signal.
Irrigate the chemical eye burn before anything else
In an ocular chemical burn, irrigate copiously at once until the pH normalises and sweep the fornices for particles, before any other assessment.
Repeat trabeculectomy is a viable choice after a failed first one
After a failed trabeculectomy, consider repeat same-site trabeculectomy rather than defaulting to a drainage device, and aim to control peak pressure, not just mean pressure.
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