Ocular trauma is a topic of unresolved controversies and there are continuous controversial and debatable management strategies for open-globe injuries (OGIs). International classification of ocular trauma proposed almost 15 years ago needs to be reviewed and to be more robust in predicting the outcome in the setting of OGIs. Anterior segment trauma involves controversies related to patching for corneal abrasion, corneal laceration repair, and medical management of hyphema. Timing of cataract surgery and intraocular lens implantation in the setting of trauma is still debated worldwide. There are unresolved issues regarding the management of OGIs involving the posterior segment. Timing of vitrectomy has been and will continue to be debated by proponents of early versus delayed intervention. The use of prophylactic cryotherapy and scleral buckle is still practiced differently throughout the world. The role of intravitreal antibiotics in posterior segment trauma in the absence of infection is still debated. Similarly, the use of vitrectomy versus vitreous tap in the setting of traumatic endophthalmitis is not fully resolved. In optic neuropathy, the role of intravenous methylprednisolone versus conservative management is always debated and still there are no evidence-based guidelines about the beneficial role of pulse steroid therapy. The role of optic canal decompression in the setting of acute traumatic optic neuropathy is also not conclusive. Orbital and adnexal trauma has been shown to adversely affect the outcome of OGI patients but both lids and orbital injury are not taken as preoperative variables in international ocular trauma classification. The timing of intervention in blow-out fracture is still debated. The pediatric age group, owing to the high risk of amblyopia and intraocular inflammation as well as strong vitreoretinal adhesions, has to be managed by different principles. Although the risk of sympathetic ophthalmia is very rare, it is always one of the key debated issues while managing traumatized eyes with no light perception vision. Prospective, controlled clinical studies are not possible in the OGI setting and this article reviews pertinent data regarding these management issues and controversies, and provides recommendations for treatment based on the available published data and the authors' personal experience.

Background/Aims: Mutations in the inwardly-rectifying K⁺ channel KCNJ10/Kir4.1 cause an autosomal recessive disorder characterized by epilepsy, ataxia, sensorineural deafness and tubulopathy (EAST syndrome). KCNJ10 is expressed in the kidney distal convoluted tubule, cochlear stria vascularis and brain glial cells. Patients clinically diagnosed with EAST syndrome were genotyped to identify and study mutations in KCNJ10. Methods: Patient DNA was sequenced and new mutations identified. Mutant and wild-type KCNJ10 constructs were cloned and heterologously expressed in Xenopus oocytes. Whole-cell K⁺ currents were measured by two-electrode voltage clamping. Results: Three new mutations in KCNJ10 (p.R65C, p.F75L and p.V259fs259X) were identified, and mutation p.R297C, previously only seen in a compound heterozygous patient, was found in a homozygous state. Wild-type human KCNJ10-expressing oocytes showed strongly inwardly-rectified currents, which by comparison were significantly reduced in all the mutants (p < 0.001). Specific inhibition of KCNJ10 currents by Ba²⁺ demonstrated residual function in all mutant channels (p < 0.05) but V259X. Conclusion: This study confirms that EAST syndrome can be caused by many different mutations in KCNJ10 that significantly reduce K⁺ conductance. EAST syndrome should be considered in any patient with a renal Gitelman-like phenotype with additional neurological signs and symptoms like ataxia, epilepsy or sensorineural deafness.

AimTo study the morphology of traumatic cataract as an important predictor for final visual outcome after treatment of traumatic cataracts.SettingTertiary eye care centre in Dahod at the trijunction of Gujarat, Madhya Pradesh, and Rajasthan states in central western India.MethodsThis was a prospective observational cohort study among all patients presenting at the hospital with traumatic cataracts between January 2003 and December 2009. All information regarding demographic and ocular trauma was collected on a pretested World Eye Trauma Registry form for both the first visit and follow-up. In particular, the authors collected specific information about the morphology of traumatic cataracts; the surgical technique was determined accordingly. Data were entered and analysed with regard to the relationship between type of trauma and resulting injury, results achieved with particular surgical techniques, and the relationship between morphology and final visual outcome.Outcome measuresFinal visual outcome.ResultsTraumatic cataracts of different morphologies showed significant differences in the final visual outcome (χ2 test, p=0.014).ConclusionThe morphology of traumatic cataract plays an important role in the final visual outcome.

Aim:The aim was to evaluate the visual recovery after managing traumatic cataracts and determine the predictors of a better visual prognosis.Materials and Methods:This was a prospective study. We enrolled patients with specific inclusion criteria, examined their eyes to review the comorbidities due to trauma, performed surgery for traumatic cataracts, and implanted lenses. The patients were reexamined 6 weeks postoperatively. We divided the cases of traumatic cataract into two groups, the “open globe” (Group 1) and “closed globe” (Group 2) groups, according to the ocular trauma based on the Birmingham Eye Trauma Terminology System (BETTS) and compared the determinants of visual acuity.Results:Our cohort of 555 eyes with traumatic cataracts included 394 eyes in Group 1 and 161 in Group 2. Six weeks postoperatively, the visual acuity in the operated eye was >20/60 in 193 (48%) and 49 (29%) eyes in Groups 1 and 2, respectively (P = 0.002, ANOVA). At follow-up, >20/60 vision was significantly higher in Group 1 than in Group 2 (OR = 1.61; 95% CI, 0.85–3.02). Overall 242 (43.5%) eyes gained a final visual acuity of >20/60.Conclusion:Open globe injury has a favorable prognosis for satisfactory (>20/60) visual recovery after the management of traumatic cataracts.

The OTS was a reliable predictor of the final visual outcome in cases of pediatric traumatic cataract.