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      Changes in Anterior Chamber Depth due to Contusion

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          Purpose: We aimed to investigate changes in anterior chamber depth (ACD) prospectively in patients with recent unilateral contusion but no signs of angle recession, using a scanning peripheral anterior chamber depth analyzer (SPAC). Methods: Among patients whose chief complaint was recent unilateral contusion and who showed no signs of angle recession by gonioscopy in 2006 and 2007, those who satisfied the following criteria were subjected to SPAC evaluation of ACD from the central to the peripheral region: no history of ocular diseases or ocular surgery including laser treatment, and similar refractory error in both eyes before trauma. Results: Thirty-seven patients satisfied the criteria (29 males, 8 females; age: 28.6 ± 23.5 years). Fourteen patients presented with commotio retinae. Fifteen showed no ocular manifestations related to the contusion. The mean SPAC-determined ACD grades of contused and noncontused eyes were 10.7 ± 1.6 and 9.8 ± 2.1, respectively, demonstrating that the contused eyes had significantly larger ACD values than the noncontused ones (p = 0.0005). The contused eyes had larger ACD values in both the central and the peripheral regions. The difference in ACD between the contused and noncontused eyes tended to increase with greater distance from the center. The equivalent refractive errors were –2.3 ± 2.2 and –1.7 ± 2.1 dpt, respectively (p = 0.004). There were no significant differences in best-corrected visual acuity and intraocular pressure between the contused and the noncontused eyes. Conclusion: Contusion may increase ACD particularly in the peripheral region even in patients who have no apparent manifestations in the anterior ocular segment.

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          Most cited references 6

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          Epidemiology of ocular trauma in Australia.

          To describe the prevalence and risk factors of ocular trauma in a representative sample of Australians aged 40 and over who reside in the state of Victoria. Population-based cross-sectional study. Australians aged 40 years and older living in Victoria. Cluster, stratified sampling was used to identify permanent residents for a population-based study of eye disease. A standardized examination that included visual acuity and information about ocular trauma was conducted. Self-reported history of ocular trauma and circumstances surrounding the events. A total of 3271 (83% of eligible) Melbourne residents and 1473 (92% of eligible) rural residents were examined. The overall rate of eye injury history in Victoria was 21.1% (95% confidence limits [CL] 19.6%, 22.5%). Men were far more likely than women to have ever experienced an eye injury (34.2% versus 9.9%), and rural men were more likely than Melbourne men to have ever had an eye injury (42.1 % versus 30.5%). The workplace accounted for the majority of eye injuries (60%), followed by the home (24%). The location with the highest percent of people reporting the use of eye protection at the time of the injury was the workplace (18.5%); the workplace accounted for the lowest rate of hospitalization (4.9%). The industry with highest cumulative rate of eye injuries was communication (14 per 1000), whereas the highest occupation-specific cumulative rates of eye injury were recorded for tradespersons (18 per 1000). Although ocular trauma is usually not associated with bilateral vision impairment, it is a major public health problem in Australia. Rural men, people engaged in hammering or sport, and those in the trades are at highest risk and require specific, targeted, prevention messages.
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            Pathogenesis of transient high myopia after blunt eye trauma.

            To determine the pathogenesis of transient high myopia after blunt eye trauma. Two observational case reports and literature review. Refraction was measured in two patients with an autorefractometer in the acute and convalescent stages after a blunt eye injury. The anterior chamber angle, the ciliary body, and the choroid were examined by ultrasound biomicroscopy (UBM) in the acute and convalescent stages. In one patient, the anterior chamber depth, lens thickness, and axial length were measured by A-scan ultrasonography in the acute and convalescent stages. Comparison of the refraction, anterior chamber depth, lens thickness, axial length, and the UBM-determined appearance of the choroid and ciliary body during the acute stage with the values during the convalescent stages. The first patient showed a myopic shift of -9.75 diopters (D) and an anterior chamber shallowing of 0.94 mm measured 3 days after trauma by an air bag inflation compared with the measurements at the convalescent phase. UBM showed an annular ciliochoroidal effusion with ciliary body edema, anterior rotation of the ciliary processes, and disappearance of the ciliary sulcus. Eleven days after the injury, these UBM findings normalized, and the myopia decreased to -0.75 D, 27 days after trauma. The second patient had a myopic shift of -8.9 D compared with the convalescent phase, immediately after blunt trauma by a firework. Seven days after the injury, UBM revealed a partial cyclodialysis in addition to findings similar to those in the first patient. Ten days after injury, a myopic shift (-4.75 D), anterior chamber shallowing (by 1.1 mm), and thickening of the crystalline lens (by 0.27 mm) were observed compared with the convalescent phase. Associated UBM findings confirmed the anterior shift of the lens-iris diaphragm. Seventeen days after trauma, the UBM findings, including the cyclodialysis, were normalized, and the myopia had decreased to -1.0 D. Transient high myopia after blunt trauma is caused by anatomic changes in the ciliary body and crystalline lens. The anterior shift of the lens-iris diaphragm caused by ciliochoroidal effusion with ciliary body edema and thickening of the crystalline lens from blunt eye trauma are involved in traumatic high myopia.
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              Anterior segment consequences of blunt ocular injury.

               D Archer,  Y. Canavan (1982)
              The anterior segments of 212 eyes (205 patients) were evaluated one to 14 years after contusional eye injuries. Anterior chamber angle recession was the commonest complication, occurring in 153 of 190 eyes examined (80.5%). However, only one patient developed ocular hypertension. Iris abnormalities were found in 37.3% of eye injured, the most common abnormalities being marginal tears and pupillary defects. Cataract or lens dislocation attributable to trauma occurred in 24.5% of eyes, but most lens opacities were localised, stationary, and not associated with significant loss of vision. 15.4% of eyes developing lens opacities had cataract extraction within 18 months of the injury. Functional corneal sequelae were rare, but occasionally corneal opacities masked perforating injuries.

                Author and article information

                Ophthalmic Res
                Ophthalmic Research
                S. Karger AG
                November 2009
                07 August 2009
                : 42
                : 4
                : 193-198
                aDepartment of Ophthalmology, Faculty of Medicine, University of Yamanashi, Chuo, and bKashiwagi Ophthalmic Clinic, Kofu, Japan
                232402 Ophthalmic Res 2009;42:193–198
                © 2009 S. Karger AG, Basel

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                Page count
                Figures: 3, Tables: 1, References: 10, Pages: 6
                Original Paper


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