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B.M. Debroff, J. Young, G. Haffner, C. Gonzalez; Change in Best Corrected Visual Acuity following Surgical Treatment of Pediatric Ruptured Globes as a Result of Blunt versus Penetrating Mechanism of Injury . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1949.
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Purpose: Ruptured globes can have a devastating impact on eye function and visual acuity. The pediatric population is further at risk of amblyopia and increased inflammatory response. Our purpose was to evaluate changes in best corrected visual acuity (BCVA) following surgical treatment of pediatric ruptured globes and compare visual outcomes in blunt versus penetrating mechanism of injury. Methods:We performed a retrospective institutional review of all pediatric patients (under age 18) with ruptured globes at a tertiary eye center over a 3 year period. 14 patients met the criteria. Demographic data was collected in addition to initial BCVA and final BCVA. Results:The mean age at the time of penetrating eye injury was 9.3 years old (range 2-16 years). The male to female ratio was 1:1. None of the patients had any significant past ophthalmic history. The mechanism of injury varied: 9 sustained open globes from objects that directly penetrated the cornea, while 5 sustained open globes from blunt trauma. 8 patients sustained one corneal laceration, 2 patients sustained 2 or more corneal lacerations, 2 patients sustained a corneal/scleral laceration, and 2 patients sustained a scleral laceration. Initial BCVA of the affected eye prior to surgical intervention was 20/30 or better in 3 patients, 20/50 - 20/200 in 3 patients, count fingers - hand motion only in 2 patients and 6 patients were unable to cooperate with the exam. All 14 underwent surgical repair within 24 hours of initial exam. In addition to primary surgical repair, 7 patients underwent additional surgical procedures at a later date. Of the 8 eight cases in which initial and final BCVA were obtained, there was a mean improvement of 4.5 lines of visual acuity following surgical treatment. In only one case was there a loss of BCVA (one line). The eyes with blunt trauma leading to rupture demonstrated a greater mean improvement in BCVA (5.67 lines) as compared to the mean improvment in BCVA in the penetrating group (2.20 lines), though not statistically significant (p = 0.243). Conclusions:Pediatric patients with ruptured globes are at risk of serious visual impairment or monocular blindness. In addition, children under the age of six are particularly vulnerable to ocular trauma because of the ongoing development of the visual pathways. This study demonstrates that in pediatric cases of ruptured globes, surgical intervention can lead to improvement in mean BCVA. The mean improvement of BCVA was not significantly greater for blunt mechanism of injury as compared with penetrating mechanism of injury.
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