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Kamiar Mireskandari, Howard J. Bunting; Paediatric Open Globe Trauma: A Seventeen-Year Experience. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1572.
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Open globe trauma has a disproportionate presentation in childhood, and is the leading cause of non-congenital monocular blindness in children. This study determines the features and severity of such injuries, surgical requirements during rehabilitation, and visual outcomes.
We performed a retrospective chart review of open globe injuries presenting between 1992 and 2009. Data concerning injury characteristics as previously validated by the Ocular Trauma Classification Group, surgical repair and rehabilitation, complications, and visual outcomes.
One hundred and twenty six patients were identified (93 male; 33 female), with a mean age 7.4 years (range 7 months - 16 years). Penetrating injury was found in 67% of patients; globe rupture in 28%; and perforation in 3%. An intraocular or intraorbital foreign body was present in 5 patients. Significant higher proportion of injuries occurred in the afternoon (12:00-18:00 hours) and in an indoor environment (p=0.05). Entry through the cornea alone occurred in 76% of patients, whereas involvement of the anterior sclera was observed in 21%, and a more posterior scleral entry site was seen in 3% of patients. Retinal detachment developed after trauma in 12% of children, and endophthalmitis in 2%. Significantly more severe injuries involving the lens and/or posterior segment occurred in boys compared to girls (p=0.05). Primary repair was restricted to wound closure in 72%, while interventions including lensectomy, retinal detachment repair and intraocular foreign body removal were incorporated into the primary procedure in 17%. Injuries were seal-sealing in 10% of patients, although the majority of these still required subsequent intraocular surgery. Overall, cataract extraction was performed in 52% of patients. Visual acuity equal or better than 20/40 following trauma was achieved in 56% of children, with vision 20/200 - LP vision in 17%, and no perception of light in 5%. Two or more operations were required in almost half of the children (range 0-7).
These data are amongst the largest collected concerning paediatric open globe trauma, and demonstrate favourable visual outcomes and complication rates compared to previous studies. However, further surgeries are often required following the initial repair. Majority of trauma occurs indoors and in the afternoon. Key factors limiting visual rehabilitation are corneal scarring and astigmatism, amblyopia in younger children, and severe initial injury involving both the anterior and posterior segments.
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