Forensic identification of one cases of retinal detachment

     Author: Gao Xin, a single German

    constitution, Li Ming, Shi-Jun Hong, Li-Ping Zhao

     【Key Words】 Retinal detachment

     The special structure of the retina is a clinical

    anatomical basis of retinal detachment, when the eyeball encounter outside of combat and intraocular pressure is too high, high incidence of retinal detachment. Retinal detachment in forensic identification more see, however, in the forensic

    science profession is called a "causal relationship between the critical type of" special retinal detachment is rare in the assessment process, easy to be controversial, has brought to the identification of certain difficulties. I have encountered in the assessment process in 1 case, now on the analysis of the causes of retinal detachment is as follows.

     A clinical data

     Patients, male, 28 years old, Han. On February 28, 2006 by others, right eye and hand injuries, the injured was a

    sense of right eye pain, photophobia, tearing, eyes floating objects, depending on the material is unclear, and gradually increased. On March 2, 2006 admitted in a hospital, after examination, the patient right eyelid subcutaneous ecchymosis, edema, eyelid conjunctival hemorrhage, corneal rubbing contusion, right eye visual acuity number refers to ~ 10 cm, left eye visual acuity 0.09, right eye, vitreous opacity (), fundus heavy bleeding, not a glimpse of the retina, after treatment, see 10 o'clock at the retina away from the tooth

    edge of hole edema, optic nerve border clear temporal side, and blood vessels beneath the retina affect macular tortuous on it, macular degeneration. Diagnosed as follows: (1) right eye, traumatic rhegmatogenous retinal detachment; (2) eyes

    with high myopia; (3) binocular refractive errors. The right eye through the sclera outer tie-line press release liquid

    condensate pad treatment, the condition improved and discharged. On April 25, 2006 to conduct forensic identification, the injured private prosecution, his childhood binocular distant objects is not clear, after correction, we could see things, but the injury now, right eye had been blind. Clinical forensic medicine examination, see: the injured right eye is slightly narrower fissure, eyelid bulbar

    conjunctival hyperemia, corneal transparency, the pupil is slightly larger than the left eye, light reflex retardation, anterior chamber depth can be seen, vitreous opacity (), leopard-like fundus, retinal light degree of atrophy, subretinal new capillary formation, arc spots, macular degeneration, eye movements freely, visual index of ~ 80 cm, left eye vision 0.09, corrected visual acuity 0.1, mild vitreous opacities, retinal see mild atrophy, eyes the other depending on function significantly affected, the rest

    revealed no injury exception.

     2 Discussion

     The information from the injured private prosecution after injury of the ophthalmic medical records and clinical information on forensic tests to prove: his high myopia is a

    vicious genetic eye disease, there is a serious retinal disease, was highly myopic eyes at the end of retinal changes, vitreous opacities, liquefied. Facts have proved that [1], the wounded eyes of pathological myopia network itself is linked to risk factors, even without the injury, he is also

    vulnerable to the retina caused by rhegmatogenous retinal detachment and blindness.

     The retina known as the eye intima, the innermost wall of the eye can be divided into the outer pigment epithelium and the inner layer of nerve cells, a potential gap between the two, the structure of the clinical anatomy of retinal detachment Fundamentals, in the event external and intraocular pressure is too high, easy to peel, that is, retinal detachment; the same time, fundus complex structure, blood

    supply is more specific [2], when the eye easily occur when blood vessels are damaged retinal degeneration.

     Rhegmatogenous retinal detachment occurred in the formation of retinal breaks, based on the liquefaction of the

    vitreous through the hole into the sensory layer of the retina (RPE) and retinal pigment epithelium, between the formation of retinal detachment. More common in high myopia and eye trauma. Fundus rational disease, aphakia and artificial lens (LOL) eyes, one had retinal detachment (RD) or a family history are also risk factors.

     Pathological high myopia refers to the above-6D myopia

    (commonly known as 600 degrees), the majority of the Department of autosomal recessive genetic disorders, in addition to refractive errors associated with other

    organizations outside the more pathological changes, fundus, and axial length changes are obvious. Prevalence in our population is high at approximately 1% [3]. Pathological prone to retinal detachment in high myopia, in the external blows,

    retinal detachment is a normal 7 to 8 times [4]. Pathological congenital high myopia due to axial lengthening, and extended with increasing age, a high degree of axial deformation, the retina was pulling and thinning, atrophy; the same time, the

    eyes under the effect of blood vessels in the stretch, and constantly hyperplasia, brittle, necrosis, which led to insufficient blood supply to the eyes, vitreous opacity, liquefaction, retinal degeneration, necrosis, and there a small hole, the gap widened, flexible lower. Liquefaction of the above basis the retina into the vitreous space through the hole while the occurrence of spontaneous retinal detachment. Pathological high myopia is manifested mainly for pre-school

    vision decreased, axial length longer (axial length is

    proportional to the lengthening and decreased vision), vitreous opacity, liquefaction, fundus changes (macular hemorrhage, macular degeneration, retinal atrophy slightly, retina newborn retinal capillaries under a slight shrinking of

    Leopard-like fundus, arc spot, optic atrophy, etc.); also affect other visual functions (vision, dark adaptation, light-

    sensitive contrast), and a variety of serious complications. Reposted elsewhere in the paper for free download http://

     Since the special structure of the retina itself, in a certain intensity of the external blows can easily lead to

    retinal detachment. The patient's right eye because it was boxing that blunt external force, the right eyelid began to bleed, the right eye blunt contusion, a large number of

    retinal bleeding, we can see the wounded suffer the power of the eye is relatively large, this violence even if the hit normal eyes was also easily lead to retinal detachment. When the patient self-inductance of the injured right eye pain,

    photophobia, tearing, eyes floating objects, depending on the material is unclear, flash and other symptoms, the fact that [5], he was affected by violence, strikes, it may have taken place in the retina hole or retinal detachment.

     Injured while outside of the original ophthalmopathy (pathologic high myopia and retinal degeneration) working together, leading to injury after the right eye, retinal rhegmatogenous retinal perforation caused by blind, is blind right eye, the direct and underlying causes. Circumstances,

    external, and eye injuries leading to retinal perforation occurred after the cause of equal importance, both stand-alone

    can not lead to the time that is the occurrence of such serious consequences, that is, forensic science call "post-

    critical-type causal relationship" [6], disease or multiple injuries exist, and between them led to the final results have an equally important role, according to injury and disease, the relationship between the degree of participation [1],

    trauma 12.5% lighter and 25%, trauma 50% co-existence with

    disease, trauma, disease, heavy and light is greater than 50% to 75%, the injured retinal detachment may wish to consider the relationship between that injury and illness co-exist each

    with 50%.

     Forensic eye focused on the consequences of injury, that is, whether caused by visual changes and changes in level. According to "people to sign the standard weight Kam injuries," the provisions of the first paragraph of Article XIX, single-blind, that is, the best corrected monocular

    visual acuity 0.05 following injuries, visible damage to the injured constitutes a serious injury, but this standard should be referred to health , the normal organs and tissues, inherent disease, they should consider the relationship

    between injury and disease. Comprehensive analysis, when the effects of trauma and injury there is a "critical-type causal

    relationship", the injury to reduce one level, this damage to the injured belong to such a relationship, so the damage

constitutes a slightly injured.

     【References】

     1, Yu. Practical forensic eye injury. Dalian: Dalian Press ,1996,80-81.

     2 SUN proud of. Ophthalmic Pathology. Beijing: People's Health Publishing House, 1997.

     3 Wang Yousheng, Liao Ruirui, Liu Quan. Modern ophthalmology. Guangzhou: Guangdong Science and Technology Press, 2005.

     4 Shi Dian-hung. Practical ophthalmology diagnostics. Shanghai: Shanghai Science and Technology Press, 2005,272.

     5 ZHU Zhen-Shan. Traumatic retinal detachment. Eye injury and occupational eye magazine, 1998,4:196.

     6 Wu. Injury and disease. Journal of Forensic Medicine, 1995,11:40. Reposted elsewhere in the paper for free download http://