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Yevgeniy Shildkrot, Christopher M. Andreoli, Michael T. Andreoli, Shizuo Mukai; Vitreoretinal Surgery Outcomes Following Ruptured Globe Repair In A Pediatric Cohort. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5624.
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To evaluate visual and anatomic outcomes in children and young adults undergoing vitreoretinal (VR) surgery following open-globe trauma.
A retrospective chart review of all patients 18 years and younger with open-globe repair, requiring VR surgery from 2/1/1999 to 4/1/2009.
36 eyes of 36 patients were identified. Follow-up information (median 37 months, range 0.2 to 111) was available for 32 patients; 25 (78%) were male, left eye was affected in 19 (59.4%), and median age at VR surgery was 15.2 years (range 0.9 to 18.7). A median of 1.5 (range 1-3) VR surgeries was performed. Initial indication for VR surgery included retinal detachment (RD, 14, 43.7%), intraocular foreign body (IOFB, 11, 34.4%) and vitreous hemorrhage (VH, 6, 18.8%). Median time to VR surgery was 37.0 months (range 0.2 to 111.6) from the original repair. Final best corrected visual acuity (BCVA) was 20/40 or better in 9 patients (28%), while 22 (68.8%) had BCVA worse than 20/200. Six eyes (18.8%) ultimately came to enucleation and three (9.4%) additional eyes became phthisical. One case of endophthalmitis was observed. Eyes with IOFB had a significantly higher chance of becoming phthisical or being enucleated (OR 9.92, 95% CI 1.6 - 61.6). Patients with eyes that were enucleated or developed phthisis tended to be older at the time of the initial injury (p = 0.058), although the age or the delay to VR surgery did not appear to have an impact on the rate of poor visual outcomes (p > 0.23). Final BCVA <20/200 correlated significantly with the indication for VR surgery and was seen in 14/14 eyes with RD, 6/10 eyes with IOFB, and 2/6 eyes with only VH (p= 0.0056). Multivariate analysis revealed only the presence of RD or IOFB as the main predictors of BCVA <20/200 and not the surgical techniques used or the age of the patient.
Presence of retinal detachment or intraocular foreign body in pediatric eyes following open-globe trauma augured a grave prognosis for visual outcome and ocular salvage regardless of the repair techniques used.
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