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Rahul S. Tonk, S. Lesniak, M. Zarbin, P. Langer, N. Bhagat; Posterior Segment Complications in Pediatric Open Globe Injuries. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5584.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the characteristics of posterior segment (PS) injuries in pediatric traumatic open globe injuries.
Retrospective chart review. Of 103 pediatric eyes with traumatic open globes presenting to University Hospital, Newark from 1997-2008, 29 (28%) were identified with PS injuries.
25 (86.2%) cases were male. The average age at presentation was 5.2 years. The average follow-up length was 27 months. The average presenting visual acuity (VA) was 2.33 and the final VA was 1.93 in logMAR. Ocular injury type was penetrating in 15 (51.7%), rupture in 13 (44.8%) and perforating in 1 (3.4%). Zone 1 (Z1) injuries represented 8 (27.6%) of the injuries; Zone 2 (Z2), 12 (41.4%); and Zone 3 (Z3), 9 (31%). PS complications identified included retinal detachment (RD), vitreous hemorrhage (VH), intraocular foreign bodies (IOFB), hemorrhagic choroidals (HC), retinal incarceration, cataracts, and dislocated lens fragments. 20 eyes (69%) had RD; 1 (5%) had concurrent IOFB and 19 (95%) concurrent VH. 4 (20%) were Z1 injuries, 8 (40%) were Z2 and 8 (40%) were Z3. 18 eyes (90%) underwent RD repair (RDR) by pars plana vitrectomy (PPV), 5 (27.8%) of which also underwent scleral buckling. The other 2 RD eyes received palliative care on account of being pre-phthisical or with VA of no light perception (NLP). 5/18 eyes (27.8%) achieved anatomic success after the first RDR. Proliferative vitreo-retinopathy (PVR) was the major cause of recurrent RD in 12/13 (92.3%) eyes. 7 (53.8%) of these eyes underwent one or more additional PPV with 5 (71.4%) ultimately achieving anatomic success. The overall anatomic success for RD was 55% (10/18 eyes); this required on average 1.5 PPV. 27 eyes (93.1%) had VH; etiologies included RD, traumatic cataract with anterior segment injury, retinal tear, incarcerated retina, subretinal hemorrhage, choroidal rupture, and HC. 10 eyes (37%) were treated operatively with PPV and 17 (63%) were observed. Of the observed VH, 6 (35.3%) resolved completely over an average period of 71.5 days. 1 eye (3.4%) had a PS IOFB; this eye also had RD and VH, and underwent primary PPV with open globe repair. 11 eyes (37.9%) had HC. These were either drained at the time of PPV or resolved spontaneously. 6 (21%) of 29 eyes presented with lens fragments in the vitreous; all of which underwent pars plana lensectomy. No eyes underwent enucleation.
Twenty-eight percent of pediatric open-globe injuries were associated with PS complications in our study. Most of the eyes underwent PS surgery with PPV and had a poor visual outcome.
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