JUN 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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50 EW International June 2013 International outlook What to expect when you're expecting terrorism by Matt Young EyeWorld Contributing Writer M anagement of ocular trauma is something all ophthalmologists learn during their residencies. Fortunately this is not a large part of most practices, but there are unique circumstances that make eye trauma a more common concern. In this article, EyeWorld explores the world of Tsvi Sheleg, MD, who has experience with eye injuries from war zones, natural disasters, and terrorist attacks. Presented here are unique insights into causes of eye trauma that sadly remain part of the world today. John A. Vukich, MD, international editor Tsvi Sheleg, MD Israeli ophthalmologist at heart of darkness shares thoughts on ophthalmic trauma treatment U nfortunately, the Boston Marathon bombing is another wake-up call for surgeons worldwide to keep their skills honed since terrorism won't stop anytime soon. As far as ocular trauma is concerned, there are certain people who have a particularly good understanding of the matter. Tsvi Sheleg, MD, senior ophthalmologist, Western Galilee Hospital, Israel, is one of them. You may not hear his name prominently at academic meetings, but his experience with ocular trauma by virtue—or vice—of location is undeniable. Roughly seven years ago, Western Galilee Hospital—six miles from Lebanon—received the largest number of civilian and military casualties during the 2006 Lebanon War, also known as the 2006 Israel-Hezbollah War. The hospital itself also sustained direct missile attack. "One of the missiles hit the ophthalmology department," Dr. Sheleg said. "I was on call and remember it clearly. The day after the war started we evacuated all of our patients and staff to our underground hospital—the first one to be built in Israel. The missile hit the ophthalmology department and caused a devastating effect on infrastructure but not life. Plus we received civilians who were hit by missiles. We were quite active." Dr. Sheleg examines a wounded Israeli soldier during the 2006 Lebanon War. During that war, two local civilians died from missile attack, and their families decided to donate their organs. "Under missile attack, we performed operations for corneal transplantation," Dr. Sheleg said. "This is a very complex situation. In the operating room in the underground sheltered hospital you felt quite safe. When your shift is over, you have to drive home and sometimes you see missiles falling in the vicinity of the road. It was quite a difficult time, but we are used to it unfortunately." Dr. Sheleg has many more intriguing stories to tell, such as how Dr. Sheleg performs a slit lamp exam. the donated corneas from those local Jewish victims were used in Muslims despite the politically delicate situation during war times between the groups. The point is that he clearly knows something about trauma— especially ocular trauma—and he'd like to share a few tips with the ophthalmic world. Here are some of the more important ones: • During an emergency, it's important for a medical center that is in proximity of 30 minutes from the unfolding events to stay on call. "The whole north of Israel was under attack [in 2006]," Dr. Sheleg said. "Some doctors evacuated their families to the center of Israel where missiles did not reach— back then." Yet the retinal, corneal, and oculoplastic surgeons still made themselves available at any time. • Drills are helpful. "Our hospital is always drilling and preparing itself not only for missile attacks but also for non-conventional chemical missiles," Dr. Sheleg said. "We just did a drill with the army a couple weeks ago. We are prepared at all times." • If an earthquake occurs near you, don't expect severe ophthalmic damage. Dr. Sheleg was the first ophthalmologist at the scene of relief work after the 2010 Haiti earthquake. He was surprised to find that only mild ocular injuries were present, rather than fractures of the orbit or penetrating eye in- Source (all): Tsvi Sheleg, MD

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