Ophthalmic complications after bungee jumping.

Abstract

Reply EDITOR,-We read with interest the letter of A P Moriarty concerning ICG enhanced treatment using diode laser for choroidal neovascularisation. We are aware of the literature on this matter and the significance for the potential ofthis treatment mode. However, our pilot study was aimed at assessing whether the near infrared diode laser was as effective as the other laser wavelengths. Clearly, there is much future work to be done on the effect of indocyanine green and the role of laser treatment of occult neovascular membranes. As yet we are not aware of any clinical study which confirms improved efficacy of combined dye enhanced diode laser treatment compared with non-enhanced diode treatment of choroidal neovascularisation. However, the first clinical results of ICG enhanced diode laser treatment, as now presented by Carmen Puliafito at the Annual Meeting of the American Academy of Ophthalmology in Chicago, did not show significant advantages over non-enhanced treatment. Clearly Puliafito's post-treatment slides showed marked areas of choroidal and retinal pigment epithelium atrophy. This may reflect no lesser damage of the retina as in our study with non-enhanced infrared treatment. In conclusion, a comparative study will be required. resulting from unilateral locked facet and another case of non-fatal hanging injury were reported by Hite et al.' Periorbital bruising has also been reported by Harries.2 Hanbury report-ed one case of bilateral subconjunctival chemosis and haemorrhages.3 In this case, the manifestations of gross bilateral subconjunctival and retinal haemorrhages could be due to the sudden change in the hydrostatic pressure in the ciliary and retinal circulation respectively, in relation to the wide swing of change of the gravitational force during the dive. The potential ocular complications of this sport should not be ignored.

Ocular pathology in shaken baby syndrome and other forms of infantile non-accidental head injury

“…The resulting stress forces cause vitreoretinal tractional trauma to the retina and its blood vessels and thus lead to RH [50, 103,123], retinoschisis [28,51], and retinal folds [28,77]. In adults, similar acceleration-deceleration mechanisms in various circumstances, ranging from emergency aircraft ejection [74] to bungee jumping [17,21,31,58,59,109,118], have been reported to cause RH. Furthermore, vitreous hemorrhage and retinal detachment have been reported in severely retarded children repeatedly beating their heads against walls or other hard objects [89].…”

Pulmonary Hemorrhage Resulting From Bungee Jumping

“…[5][6][7][8][9][10] However, in a report of a comminuted femur fracture sustained during a bungee jump, the authors stated that the patient experienced sudden thigh pain during descent. 13 Similarly, the timing of the chest pain in the current case also implies the injury occurred during descent, that is the initial downward freefall rather than the rebound portion of the bungee jump.…”

Ocular injury due to bungee jumping

“…Alternatively, gravitational forces may be the most important aetiological factor 10 and considering the forces involved, it is surprising that there have not been more ocular injuries. 2 The increase in intravascular pressure, 6 particularly venous, 8 may be caused by the reverse of direction of acceleration and the accompanying increase in negative G force.…”

“…When assessed, there were no pupillary anomalies 2 and neurological, x-ray, blood and liver tests were normal. 6,10,11 The mechanism by which these ocular changes become manifest is uncertain. Several causes have been postulated.…”

“…Sub-conjunctival haemorrhage has been reported by several other authors. 8,10 Intraocular bleeding has been described as small, single or multiple/retinal haemorrhages, 8,10 which may be foveal, 7 parafoveal in the form of dot and blot haemorrhages 10 or scattered throughout the fundus. 6,11 Haemorrhages may also be subhyaloid, 2 pre-retinal, 6 sub-internal limiting membrane 9,11 or into the vitreous.…”