Sir,An unusual case of severe penetrating ocular injury with the shank of a triplet fish hook

No abstract

PurposeTo describe the characteristics and outcomes of patients presenting with rhegmatogenous retinal detachment (RRD) after ocriplasmin (OCP) injection.MethodsRetrospective, multi-centre, observational case series with case note review.ResultsEight patients with symptomatic vitreomacular traction (six with concomitant macular hole) were diagnosed with RRD after a median of 16 days (range 3–131 days) post-OCP injection. Presentation was within 3 weeks of the OCP injection in six of the cases. Five patients presented with symptoms post-OCP, and three were diagnosed asymptomatically on planned visits. Seven cases were phakic, one had high myopia (>8 dioptres), and two cases had lattice degeneration. Following RRD surgery, hole closure was achieved in 5/6 MH cases. The final median BCVA at 7 months was 20/80 (range 20/40–20/1200) similar to the baseline BCVA 20/80, with four patients gaining ≥1 line of vision compared to baseline but three losing ≥3 lines.ConclusionsRRD is a non-negligible risk associated with intravitreal OCP, and it should be used with caution in eyes with high myopia and peripheral retinal pathology predisposing to RRD. Detailed peripheral retinal examination is recommended pre- and postoperatively at all visits. Patients should be advised to seek attention if symptoms recur after initial presentation.

Visual loss in the wilderness setting is potentially fatal. Firstly it may be a warning sign of a serious systemic problem and secondly the patient may lose their functional independence and ability to respond to objective danger. The issues discussed in this paper fall broadly into two categories, those that are unique to the high altitude setting and those that could happen anywhere but require treatment to protect vision then standard ophthalmological care is unavailable. The aims are to provide practical knowledge on how to manage simple eye problems and also how to recognize the warning signs when evacuation may be required. In keeping with all wilderness medicine, preparation and prevention are essential to avoid eye problems in the mountains. This paper is intended for physicians, interested non-medical people and expedition operators as a practical guide to the treatment and prevention of eye problems on expeditions.