Ocular Fat Embolism Syndrome Following Surgical Repair of a Long Bone Fracture

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript is interesting and deals with important clinical problem, however, it needs revision.

1. The prevalence of fat embolism syndrome should be added in the Introduction section

2. It is necessary to describe precisely what distinguishes this case from the others

3. The follow up period should be specified

4. Treatment should be added

5. Clinical value of the manuscript should be emphasized in the Conclusion section 

6. The Authors should add differential diagnosis in the Method section

 

 

Author Response

Please see attached file.

Thank you for your helpful comments.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The article presents a rare and well-documented case of fat embolism syndrome (FES) with ocular involvement, adding valuable insight into a less commonly recognized manifestation of the condition.The inclusion of detailed retinal imaging and radiological findings, such as OCT, fluorescein angiography, and MRI, strengthens the case presentation and allows for a thorough understanding of the pathology.The manuscript is logically organized, with clear delineation of case presentation, diagnostics, and discussion.

The discussion could be enriched by incorporating more recent literature on FES and Purtscher-like retinopathy (PLR), such as recent cases highlighting atypical presentations or different etiologies. While the article mentions mechanical and biochemical theories, the discussion on pathophysiology could be more comprehensive, particularly regarding the mechanisms leading to ocular involvement without predisposing cardiac or pulmonary anomalies.

The conclusions drawn are highly specific to this case and do not extrapolate broader implications for clinical practice, such as recommendations for screening protocols in similar scenarios.

 

Consider citing this article doi: 10.3389/fmed.2024.1394614. PMID: 39493714; PMCID: PMC11527711.  regarding alternative mechanisms and systemic associations of PAMM, which could enhance the discussion on its pathophysiology.

 

and this article: doi: 10.1016/j.cjtee.2021.02.005. Epub 2021 Feb 9. PMID: 33627294; PMCID: PMC8071712. as it discusses a rare neurological manifestation of FES, which could enrich the discussion of variable clinical presentations, including neuro-ophthalmic complications.

Author Response

Thank you for your helpful comments.

Please see attached file with point by point responses.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The manuscript entitled “Ocular fat embolism syndrome (FES) following surgical repair of a long bone fracture” shows interesting information for physicians and health care providers to concern the relationship between these two disorders because they are not directly involved each other.  The authors reported that FES and Purtscher-like retinopathy (PLR) were found in a previously healthy 19 years old male with a commuted femur fracture.  Finally, he was spontaneously recovered with six weeks because of his good health before the skiing accident. 

This manuscript was prepared well with clarified evidences.  However, there are a few comments and questions as follows:

1. Could the authors explain why this patient was not received any medications to increase the recovery rate from FES-related PLR? Please provide the reasons for the decision and add in the manuscript.

2. The authors should specify when this patient was completely recovered from the PLR in the manuscript.

3. The authors should inform the standard medication for the treatment of PLR with FES to increase its recovery rate. Please add the information into the Discussion section of this manuscript.

4. In the materials and methods, the authors should specify the years of the current literature that were used for a literature review.  They must be related to the references cited in this manuscript.

Author Response

Thank you for your helpful comments.

Please see attached file with point by point responses.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript has been revised sufficiently.

Reviewer 3 Report

Comments and Suggestions for Authors

The authors responded all comments and questions with reasonable explanations.  Therefore, the manuscript can be accepted for publishing with this journal in the current form.