Transcript Bilateral PCIOL Dislocation following Airbag Deployment

Authors:
Evan Lagouros MD, Lawrence Lohman MD
FACS
Department of Ophthalmology
SUMMA Health Systems
Northeast Ohio Universities College of Medicine
Financial Disclosures:
The authors have no financial interest in the
subject matter of this –e-poster
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88 year-old female presented after automobile
accident at unknown speed, in which airbag
deployment occurred.
Her previous ocular history is significant for
pseudophakia with PCIOL OU with both implants
well positioned
Immediately after the accident, she complained of
decreased vision OU and sensitivity to light. Her
pre-accident BCVA was 20/40 OD, 20/30 OS.
Post accident she was count fingers in both eyes
with a potential acuity meter of 20/70, 20/60 OD
and OS respectively.
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Initial imaging revealed a small, non-displaced
nasal bone fracture without any other signs of
ocular trauma.
Initial exam revealed bilateral traumatic iritis,
irregular pupils OU, and bilateral lens
dislocation. Intraocular pressure was 24
(mmhg) OU.
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With treatment her iritis resolved, however she
developed ocular hypertension, which was
treated medically.
Planned for surgical repair of bilateral dislocation
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The left eye was operated on first, due to the
contraction and instability of the bag. Lens
removal with ciliary sulcus sutured lens
placement and anterior vitrectomy was
performed.
Shortly after, the same procedure was
performed OD
Post operative BCVA was 20/40+ OU. At last
visit, the patient was still continuing IOP lower
agents OU, and had been weaned off all other
post-op drops.
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Air bags have become a standard feature on
automobiles over the last 10 to 15 years.
Despite the countless severe injuries prevented by
their use, air bag deployment is the most common
cause of ocular injury in motor vehicle
accidents(MVAs)1.
Air bags have been associated with a two fold
increase in eye injuries1
Lens dislocation following air bag deployment is
rarely reported 1,3,6,7. Only 1 report of bilateral
dislocation was discovered by the author 7. It is
unclear if this case was an artificial lens or a
crystalline lens.
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Surgical management: the authors would
recommend an individualized approach on a case
by case basis.
However, as with other causes of traumatic
dislocation, bag integrity is often compromised;
somewhat limiting surgical options.
Most importantly, the patient should be educated
regarding, the possible need for multiple surgeries,
and possible limits of best corrected visual acuity
despite surgical correction.
Wearing a safety belt resulted in a two-fold
decrease in risk of ocular trauma during MVAs 1.
References
1. McGwin G Jr, Owsley C. “Risk factors for motor vehicle collision-related eye injuries”.
Arch Ophthalmol. 2005 Jan;123(1):89-95. Department of Epidemiology and International
Health, School of Public Health, University of Alabama at Birmingham, USA.
2. Duma SM, Rath AL, Jernigan MV, Stitzel JD, Herring IP. “The effects of depowered airbags
on eye injuries in frontal automobile crashes”. Am J Emerg Med. 2005 Jan;23(1):13-9.
Virginia Tech-Wake Forest, Mechanical Engineering, Center for Injury Biomechanics,
Blacksburg, VA 24061, USA. [email protected].
3. Ball DC, Bouchard CS. “Ocular Morbidity Associated with Airbag Deployment”. Cornea
20(2): 159-163, 2001.
4. Uchio E, Kadonosono K, Matsuoka Y, Goto S. “Simulation of air-bag impact on an eye
with transsclerally fixated posterior chamber intraocular lens using finite element
analysis”. J Cataract Refract Surg. 2004 Feb;30(2):483-90.
5. Stitzel JD, Hansen GA, Herring IP, Duma SM. “Blunt trauma of the aging eye: injury
mechanisms and increasing lens stiffness”. Arch Ophthalmol. 2005 Jun;123(6):789-94.
Virginia Tech--Wake Forest Center for Injury Biomechanics, Winston-Salem, NC, USA.
6. Blackmon SM, Fekrat S, Setlik DE, Afshari NA. “Posterior dislocation of a crystalline lens
associated with airbag deployment.” J Cataract Refract Surg. 2005 Dec;31(12):2431-2.
7. Onwuzuruigbo CJ, Fulda GJ, Larned D, Hailstone D. “Traumatic blindness after airbag
deployment: bilateral lenticular dislocation”. J Trauma. 1996 Feb;40(2):314-6. Department
of Surgery, Medical Center of Delaware, Wilmington, USA.