Swain David L, Lee Hyunjoo J
Department of Ophthalmology, Boston University School of Medicine, Boston University, Boston, MA, USA.
Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston University, Boston, MA, USA.
Am J Ophthalmol Case Rep. 2022 Jul 8;27:101652. doi: 10.1016/j.ajoc.2022.101652. eCollection 2022 Sep.
To report a case of corneal edema associated with Descemet membrane (DM) damage likely due to shockwave trauma from a bullet passing by the eye.
A 27-year-old man presented to the emergency department with pain, redness, and severely decreased vision in the left eye immediately following a gun assault. Examination of the eye revealed a temporal conjunctival laceration, corneal edema, hyphema, and vitreous hemorrhage. Bullets were found in the patient's left chest and axilla, and a laceration was present on the bridge of his nose, but no foreign bodies were found in or around the eyes. The intraocular hemorrhage and corneal edema gradually resolved, and it became apparent that there were DM irregularities that possibly represented micro-ruptures. After 7 months, uncorrected visual acuity improved to 20/25, and the cornea was free of edema but had persistent small focal areas of DM thickening and scarring.
This case illustrates that DM and possibly endothelial cell damage can occur due to shockwave injury from high-speed projectiles. In our case of presumed small central DM micro-ruptures, the corneal edema resolved, and the vision significantly improved with topical therapy and observation, suggesting an overall good prognosis from such injuries.
报告一例可能因子弹掠过眼睛产生的冲击波创伤导致角膜水肿并伴有后弹力层（DM）损伤的病例。
一名27岁男性在遭枪击后立即前往急诊科，主诉左眼疼痛、发红且视力严重下降。眼部检查发现颞侧结膜撕裂、角膜水肿、前房积血和玻璃体出血。在患者左胸和腋窝发现子弹，鼻梁处有一处撕裂伤，但眼内及眼周未发现异物。眼内出血和角膜水肿逐渐消退，明显可见后弹力层不规则，可能代表微破裂。7个月后，未矫正视力提高到20/25，角膜无水肿，但后弹力层仍有持续的小片状增厚和瘢痕形成。
该病例表明，高速射弹产生的冲击波损伤可导致后弹力层以及可能的内皮细胞损伤。在我们这个推测为中央小范围后弹力层微破裂的病例中，角膜水肿消退，经局部治疗和观察后视力显著改善，提示此类损伤总体预后良好。
