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E. M. Salcone, A. V. Turalba, M. T. Andreoli, C. M. Andreoli; Pediatric Lensectomy Following Penetrating Globe Trauma: The Massachusetts Eye and Ear Infirmary Experience. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4692.
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To describe the demographics and postoperative functional outcomes of pediatric open globe injuries requiring lensectomy at a tertiary ocular trauma center.
The charts of pediatric patients with open globe injuries who had undergone primary or secondary lensectomy at the Massachusetts Eye and Ear Infirmary from 1981-2008 were retrospectively reviewed.
A total of 131 open globe injuries involving children age ≤ 18 years were identified from 1981-2008. Of these, 29 patients with a mean age of 11.77 years underwent lensectomy at the time of globe repair (primary lensectomy) and 14 patients with a mean age of 10.6 years underwent lensectomy during a second surgery (secondary lensectomy). 46.7% of the patients who underwent primary lensectomy had a final best corrected visual acuity (BCVA) of 20/40 or better and 26.7% had a BCVA worse than 20/200. Two patients were too young to measure visual acuity, but were deemed to have the ability to fix and follow. Patients who underwent secondary lensectomy had worse visual outcomes overall, with 42.9% having a BCVA of at least 20/40 and 57.1% worse than 20/200. One patient underwent primary IOL placement (BCVA 20/20) and four patients underwent IOL placement at a subsequent surgery (BCVA range 20/20-20/80). 12 of 29 (41.4%) patients were fitted for aphakic contact lenses after primary lensectomy, all but one of whom had better than 20/60 BCVA (range 20/20-20/160).Post-operative follow-up ranged from 2 weeks to 43.7 months (mean 10 months). Mechanism of open globe injury was most commonly from a penetrating injury (72.4%). Injuries involved the anterior segment among the majority of primary lensectomy eyes (75.9% with isolated corneal lacerations), but only 7% among those that underwent secondary lensectomy. Only one aphakic patient developed post-operative glaucoma.
These results suggest that fewer children who undergo primary lensectomy have profound vision loss than those who undergo secondary lensectomy, which may be related to their zone of injury. Intraocular lens implantation in the traumatic pediatric open globe population resulted in favorable visual outcomes in the few patients where it was performed. Aphakic contact lenses appear to provide comparable visual outcomes to IOL implantation. Though the majority of patients were left aphakic, glaucoma was rare.
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