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Adrian W. Jachens, Gerald W. Zaidman; Management of Visually Significant Corneal Lacerations in the Pediatric Population. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2023.
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To analyze the management options in pediatric corneal lacerations in order to improve long-term visual results.
We performed a retrospective chart review of all pediatric patients with corneal lacerations treated from 1999- 2010. We analyzed initial management, time from referral to repair, need for secondary surgery, complications and final visual result.
Seven patients were identified ranging from 20 months to 9 years of age. Follow up ranged from 3 to 89 months. All patients had primary closure of their wound within 24 hours of the trauma. The time between referral and secondary surgery ranged from nine to twenty two weeks with an average of 14.4 weeks. All patients had secondary surgeries with all having a penetrating keratoplasty (PKP), and five having a cataract extraction. All cataract extractions had acrylic posterior chamber intra-ocular lens (IOL) implantation. One patient was aphakic and had a secondary sulcus-fixated lens implant performed in conjunction with the PKP. Five patients also needed an iridoplasty; one needed an anterior vitrectomy. Significant complications included medically controlled glaucoma and non compliance. No patients required glaucoma surgery and there have been no graft rejections. Four patients, ages five to nine, had vision better or equal to 20/60 with the time between injury and secondary surgery ranging from nine to twenty weeks with an average of 14 weeks. One patient, age three, had 20/200 vision with twelve weeks between injury and secondary surgery. One patient, age two, had hand motion vision with twenty-two weeks between injury and secondary surgery, mostly due to poor compliance. Finally, one patient is too early in his clinical course to determine their outcome.
We found that time between original injury and secondary surgery did not correlate with final visual acuity. Glaucoma occurred in a majority of the patients but it was well controlled and did not affect final vision. We found that the most important predictors of a good visual outcome were older age at time of injury and compliance to treatment by parent and patient.
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