Initial Evaluation:
18-year-old was seen in the office on 12/30/08. He suffered a shotgun injury to his face on December 25th. You emergently repaired his left eye, which was ruptured. He still has some vision, especially inferiorly, out of the left eye and you suggested he come in here for evaluation. He is currently on Cyclogyl, Pred Forte, and ciprofloxacin in the left eye. His vision in the right eye is good.
VISUAL ACUITY: Vision OD is 20/20, OS is hand motion. IOP: OD 17, OS 15.
SLIT LAMP EXAM: The right eye has 3+ subconjunctival hemorrhage, clear cornea and clear lens. The left eye has 3+ subconjunctival hemorrhage. There is a suture repairing the laceration about 3 mm in from the corneoscleral limbus at 7:00 o’clock. There is an iris defect there. The lens is white.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There are commotio retinae temporally, and then nasally at 3:00 o’clock at the equator there is a hemorrhage with a dark center to it, suggesting a possible localized choroidal rupture.
ULTRASOUND: Ultrasound of the right eye shows an elevation where the hemorrhage is, but there is no evidence of any hyperreflective lesions, so I do not think there is a foreign body in that area. The left eye ultrasound shows the superior to look to be intact or totally detached and avulsed. Either way, there are no masses in the superior periphery. The inferior periphery does have a mass and a track which looks to be from a perforating injury. I do not see any intraocular foreign bodies on the ultrasound.
IMPRESSION:
1. TRAUMATIC RETINOPATHY – BOTH EYES
2. RETINAL HEMORRHAGE – RIGHT EYE
3. COMMOTIO RETINA – RIGHT EYE
4. REPAIR OF CORNEAL LACERATION – LEFT EYE
5. WHITE CATARACT – LEFT EYE
DISCUSSION: I explained to the patient the right eye unfortunately does have a retinal hemorrhage, but it is not in an area that is important, but I will need to watch it closely though. It is possible the eye could develop a retinal detachment.
The left eye looks like there is some retina superiorly, which looks salvageable. The inferior retina does look deranged from the injury. I am going to take him to surgery tomorrow to remove his lens and probably laser a barrier of the area of abnormal retina and fill the eye with silicone oil to stabilize the superior retina.
Patient had 2 vitrectomies - the second with oil 3 weeks post injury when his vitreous separated. Had oil removed 2 years later with 20/400 vision and never had a retinal detachment.
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Shotgun wound to face with Perforating Pellet - Final Vision 20/400 470 views18-year-old had a gunshot wound to the left eye. He had surgery on December 31st (1 week post injury) and February 4th and his vision has remarkably done well.
VISUAL ACUITY: Vision OS is 3/200. 
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Shotgun wound to face with Perforating Pellet - Final Vision 20/400 408 views18-year-old had a gunshot wound to the left eye. He had surgery on December 31st (1 week post injury) and February 4th and his vision has remarkably done well.
VISUAL ACUITY: Vision OS is 3/200.
(0 votes)
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Shotgun wound to face with Perforating Pellet - Final Vision 20/400 573 views18-year-old had a gunshot wound to the left eye. He had surgery on December 31st (1 week post injury) and February 4th and his vision has remarkably done well.
VISUAL ACUITY: Vision OS is 3/200.
(0 votes)
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Shotgun Injury 2.5 Years later - 10/200398 viewson 4/5/2011. This pleasant 19-year-old had a gunshot injury to the face in December of 2008. He has had several surgeries and his vision is remarkably good. He is aphakic. He is not wearing his contact much but he notices no change. If anything, his vision is a little better.
VISUAL ACUITY: Vision OS is 10/200.
(0 votes)
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Shotgun Injury 2.5 Years later - 10/200407 viewson 4/5/2011. This pleasant 19-year-old had a gunshot injury to the face in December of 2008. He has had several surgeries and his vision is remarkably good. He is aphakic. He is not wearing his contact much but he notices no change. If anything, his vision is a little better.
VISUAL ACUITY: Vision OS is 10/200.
(0 votes)
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Shotgun Injury 2.5 Years later - 10/200325 viewson 4/5/2011. This pleasant 19-year-old had a gunshot injury to the face in December of 2008. He has had several surgeries and his vision is remarkably good. He is aphakic. He is not wearing his contact much but he notices no change. If anything, his vision is a little better.
VISUAL ACUITY: Vision OS is 10/200.
(0 votes)
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Shotgun Injury 2.5 Years later - 10/200435 viewson 4/5/2011. This pleasant 19-year-old had a gunshot injury to the face in December of 2008. He has had several surgeries and his vision is remarkably good. He is aphakic. He is not wearing his contact much but he notices no change. If anything, his vision is a little better.
VISUAL ACUITY: Vision OS is 10/200.
(0 votes)
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Initial Evaluation:
18-year-old was seen in the office on 12/30/08. He suffered a shotgun injury to his face on December 25th. You emergently repaired his left eye, which was ruptured. He still has some vision, especially inferiorly, out of the left eye and you suggested he come in here for evaluation. He is currently on Cyclogyl, Pred Forte, and ciprofloxacin in the left eye. His vision in the right eye is good.
VISUAL ACUITY: Vision OD is 20/20, OS is hand motion. IOP: OD 17, OS 15.
SLIT LAMP EXAM: The right eye has 3+ subconjunctival hemorrhage, clear cornea and clear lens. The left eye has 3+ subconjunctival hemorrhage. There is a suture repairing the laceration about 3 mm in from the corneoscleral limbus at 7:00 o’clock. There is an iris defect there. The lens is white.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There are commotio retinae temporally, and then nasally at 3:00 o’clock at the equator there is a hemorrhage with a dark center to it, suggesting a possible localized choroidal rupture.
ULTRASOUND: Ultrasound of the right eye shows an elevation where the hemorrhage is, but there is no evidence of any hyperreflective lesions, so I do not think there is a foreign body in that area. The left eye ultrasound shows the superior to look to be intact or totally detached and avulsed. Either way, there are no masses in the superior periphery. The inferior periphery does have a mass and a track which looks to be from a perforating injury. I do not see any intraocular foreign bodies on the ultrasound.
IMPRESSION:
1. TRAUMATIC RETINOPATHY – BOTH EYES
2. RETINAL HEMORRHAGE – RIGHT EYE
3. COMMOTIO RETINA – RIGHT EYE
4. REPAIR OF CORNEAL LACERATION – LEFT EYE
5. WHITE CATARACT – LEFT EYE
DISCUSSION: I explained to the patient the right eye unfortunately does have a retinal hemorrhage, but it is not in an area that is important, but I will need to watch it closely though. It is possible the eye could develop a retinal detachment.
The left eye looks like there is some retina superiorly, which looks salvageable. The inferior retina does look deranged from the injury. I am going to take him to surgery tomorrow to remove his lens and probably laser a barrier of the area of abnormal retina and fill the eye with silicone oil to stabilize the superior retina.
Patient had 2 vitrectomies - the second with oil 3 weeks post injury when his vitreous separated. Had oil removed 2 years later with 20/400 vision and never had a retinal detachment.
