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Impact of Tape-Ball Injuries on the Eyes Salman Naveed Sadiq Aga Khan University

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Impact of Tape-Ball Injuries on the Eyes Salman Naveed Sadiq Aga Khan University eCommons@AKU Department of Surgery Department of Surgery January 2017 Bowled over by cricket: impact of tape-ball injuries on the eyes Salman Naveed Sadiq Aga Khan University Azam Ali Aga Khan University, [email protected] Bushra Usmani Aga Khan University, [email protected] Khabir Ahmed Aga Khan University, [email protected] Follow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_surg Part of the Ophthalmology Commons, and the Surgery Commons Recommended Citation Sadiq, S., Ali, A., Usmani, B., Ahmed, K. (2017). Bowled over by cricket: impact of tape-ball injuries on the eyes. Asia Pac J Ophthalmol (Phila)., 6(1), 50-53. Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_surg/528 ORIGINAL CLINICAL STUDY Bowled Over by Cricket: Impact of Tape-Ball Injuries on the Eyes Salman Naveed Sadiq, Azam Ali, Bushra Usmani, and Khabir Ahmad of eye injuries in the United States include baseball and basketball, Purpose: The aim of this study was to describe the type and severity of followed by ice hockey, racquet sports, fencing, lacrosse, paint- tape-ball cricket–related eye injuries seen at a tertiary care hospital. ball, and boxing. In South Asia, millions of people play tape-ball Design: A descriptive case series. cricket. However, there has been no published analysis of the Methods: This study included all cases of tape-ball cricket–related eye spectrum of eye injuries it causes. injuries presenting to the Section of Ophthalmology, Aga Khan Univer- The aims of this report are to describe the type and severity sity Hospital, Karachi, from January 2014 to January 2015. of tape-ball cricket–related eye injuries and highlight the impor- Results: A total of 20 patients with tape-ball cricket–related eye inju- tance of protective headgear in this form of cricket. ries were treated during this period. The right eye was involved in most (14/20) of the cases. The commonest presenting symptoms included re- duced/blurred vision, ocular pain, redness, and floaters. Sixty percent MATERIALS AND METHODS (12/20) of the affected eyes had a best corrected visual acuity of less This was a descriptive case series involving individuals who than 20/200 at presentation, with the retina being the most commonly in- presented to the Section of Ophthalmology, Aga Khan University volved ocular structure. All patients reported that they were not wearing Hospital, Karachi, Pakistan, with a recent history of tape-ball eye protective eyewear at the time of trauma. Despite standard management, injuries between January 2014 and January 2015. The study was half of the eyes had severe or total vision loss at the last follow-up (mini- approved by the ethics review committee of Aga Khan Universi- mum, 3 months), mainly due to retinal damage. ty, Karachi (3412-Sur-ERC-14). Patients with a history of ocular Conclusions: Our study calls for the compulsory use of protective eye- trauma and those who underwent any surgical management before wear by cricket players and for countrywide surveillance data on the true presenting to us were excluded. Data were collected from medical burden of this “unnoticed” preventable cause of unilateral eye injuries records using a pretested pro forma. Data collected included the and associated vision loss. complete case history, demographic details, best corrected visual acuity (BCVA), anterior and posterior segment findings, and in- Key Words: eye injuries, tape ball, cricket, blindness, preventable traocular pressure. Vision impairment and blindness were defined injury, blunt trauma, protective eyewear according to World Health Organization (International Classifica- tion of Diseases, 10th Revision) grading. (Asia-Pac J Ophthalmol 2017;1:50–53) Patients received standard treatment and were followed up for at least 3 months. Final corrected VA was recorded at the last follow-up. Fifteen patients (75.0%) required surgical interven- ape-ball cricket is a very popular sport in South Asian coun- tion. The main surgery performed was retinal detachment repair Ttries, including Pakistan, India, Sri Lanka, and Bangladesh. (n = 7) followed by intravitreal anti-vascular endothelial growth Because of the limited number of playgrounds and a lack of ad- factor injections (n = 3). Argon laser photocoagulation was used equate regulations in these countries, the game is increasingly be- to treat retinal breaks (n = 2). Other procedures included primary ing played on streets and sidewalks. A tape ball is a tennis ball repair of corneoscleral laceration and cataract extraction. Two pa- wrapped in electrical tape to give it the proper weight and speed.1 tients did not show up for the surgery. It is less dangerous to use than a conventional cricket ball, which Data of additional investigations, including B-scan ultraso- is made of cork and covered with leather. The conventional ball nography, fundus angiography, and optical coherence tomogra- used in professional cricket is hard, weighs 155.9 to 163.0 g, and phy (Heidelberg Engineering Spectralis), were reviewed where requires protective gear to play with. necessary to confirm the clinical diagnosis. Sports trauma remains a significant cause of ocular morbid- All data were entered and analyzed using SPSS software ity worldwide, and most of these injuries can be prevented. Ac- version 19.0 for Windows. Frequencies and percentages were cording to the National Eye Institute, sports with the highest rate calculated for categorical variables such as sex. The median was computed for numerical variables such as age and intraocular pressure. Tables and charts were used to present the results. From the Section of Ophthalmology, Department of Surgery, Aga Khan University, Karachi, Pakistan. Received for publication August 17, 2015; accepted February 23, 2016. The authors have no funding or conflicts of interest to declare. RESULTS Reprints: Salman Naveed Sadiq, Section of Ophthalmology, Department of Surgery, Aga Khan University, Stadium Rd, PO Box 3500, Karachi 74800, Twenty patients (20 injured eyes) were included in the study Pakistan. E-mail: [email protected]. (Table 1). The median age of the patients was 20.5 years (range, Copyright © 2016 by Asia Pacific Academy of Ophthalmology ISSN: 2162-0989 11.0–78.0 years). All of them were men except an 11-year-old girl DOI: 10.1097/APO.0000000000000202 who was a bystander accidentally hit by the ball. 50 | www.apjo.org Asia-Pacific Journal of Ophthalmology• Volume 6, Number 1, January/February 2017 Copyright © 2017 Asia-Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited. Asia-Pacific Journal of Ophthalmology• Volume 6, Number 1, January/February 2017 Impact of Tape-Ball Injuries on the Eyes FIGURE 1. Snellen BCVA of the affected eyes at presentation and follow-up. *Categories of vision impairment according to World Health Organization 2015 (International Classification of Diseases, 10th Revision). †Four patients were lost to follow-up. The right eye was involved in 14 patients (70.0%). Blurring neovascularization after choroidal tear (n = 2), and macular hole of vision was the most common symptom and was experienced formation in 1 case. Six patients who underwent retinal surgery by almost all patients with variable severity (Fig. 1). Less com- achieved favorable outcomes in anatomical reattachment of the mon symptoms included ocular pain, redness, and floaters. The median intraocular pressure at presentation was 11.5 mm Hg (range, 4.0–50.0 mm Hg). Severe vision impairment (BCVA < TABLE 2. Clinical Diagnosis at Presentation and Follow-Up* 20/200) was seen in 12 patients (60.0%) at presentation. Despite standard treatment, 6 patients (37.5%) continued to have severe Ocular Tissue Clinical Diagnosis n % vision impairment (in at least 3 months of follow-up). Four pa- Lids Bruising 2 10.0 tients (20.0%) were lost to follow-up. Conjunctiva Subconjunctival hemorrhage 2 10.0 Traumatic involvement of almost every ocular tissue was seen Cornea Edema 1 5.0 (Table 2). The cornea was affected in 5 (25.0%) of the patients. In Corneal abrasion 1 5.0 8 patients (40.0%), the iris was affected. The crystalline lens and Corneoscleral laceration 1 5.0 vitreous were each involved in 4 patients (20.0%). The retina was Anterior chamber Hyphema 4 20.0 by far themost commonly involved ocular structure, affecting 15 Angle recession 1 5.0 (75.0%) of the patients. Furthermore, 9 patients (45.0%) experi- Iris Iridodialysis 1 5.0 enced rhegmatogenous retinal detachment, of which most (n = 7) Traumatic mydriasis 4 20.0 had complete detachment involving the macula. Traumatic involve- Traumatic uveitis 3 15.0 ment of the choroid (Fig. 2) and optic nerve was also observed in 4 Crystalline lens Cataract 3 15.0 (20.0%) and 2 (10.0%) patients, respectively. None of the patients Cataract subluxed 1 5.0 were wearing any ocular protection at the time of injury. Vitreous Hemorrhage 4 20.0 The reasons for severely impaired final vision included reti- Retina Complete detachment (rhegmatogenous) 7 35.0 nal detachment with advanced PVR (n = 3), persistent choroidal Partial detachment (rhegmatogenous) 2 10.0 Retinal hemorrhage 1 5.0 Macular hole 1 5.0 TABLE 1. Demographic Characteristics of Patients Retinal tear(s) 2 10.0 Median (range) age, y 20.5 (11.0–78.0) Commotio retina 1 5.0 Sex Retinal dialysis 1 5.0 Male 19 Macular scar 1 5.0 Female 1 Choroid Tears/rupture 4 20.0 Eye involved Choroidal neovascularization* 3 15.0 Right 14 Optic nerve Traumatic neuropathy 1 5.0 Left 6 Glaucomatous cupping* 1 5.0 © 2017 Asia-Pacific Academy of Ophthalmology www.apjo.org | 51 Copyright © 2017 Asia-Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited. Sadiq et al Asia-Pacific Journal of Ophthalmology• Volume 6, Number 1, January/February 2017 retina and improved vision (Table 3). TABLE 3. BCVA of Patients Who Underwent Retinal Detachment Surgery DISCUSSION Case No.
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