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S. Rashid, M. T. Andreoli, C. E. Kloek, R. Wee, C. M. Andreoli; Mechanism of Open Globe Injuries and Visual Outcome in Pediatric Population at Tertiary Eye Care Center. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1452.
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The purpose of our study is to review a large series of open globe injuries in children less than 18 years of age in order to identify the mechanism of injury, clinical presentation, and outcomes.
The charts of 692 consecutive patients with open globe injuries presenting to a major eye trauma center were reviewed for age, gender, mechanism, best corrected pre- and post-op visual acuity, type of surgery and complications.
Of the 692 open globe patients, 109 patients (15.8%) were age 18 or less, and 32 (4.6%) were under 8. Of the patients age 18 or less, male: female ratio was 3.5:1. The various mechanisms of injury included projectiles 43 (39.4%; BB 10, paintball 4 and others 29), blunt trauma 10 (9.2%), glass related 7 (6.4%), scissors 5 (4.5%), nail related 5 (4.5%), fall 4 (3.7%), sports related 3 (2.8%) and animal related 2 (1.8%). The average follow up period was 350 days.Nearly half the patients had counting fingers (CF) or worse vision at presentation: CF 21 (19.3%), light perception (LP) 24 (22%), and no light perception (NLP) 12 (11%). During open globe repair, intraocular foreign body was found in 17 patients (15.6%). Location of injury was zone I in 65 (59.6%), zone II in 34 (31.2%), and zone III in 27 patients (24.8%). During initial surgery, 54 patients (49.5%) had uveal excision or reposition, 24 required lensectomy (22%), and only 2 (1.8%) required primary enucleation. On follow-up, another 13 patients (11.9%) required secondary enucleation. The most common complication was traumatic cataract (24, 22.0%). Others included phthisis (5, 4.6%), sympathetic ophthalmia (1, 0.9%), and endophthalmitis (1, 0.9%). Second surgery was needed in 52.3% patients: vitrectomy 33 (30.3%), scleral buckle 13 (11.9%), secondary IOL 11 (10.1%). Best post-operative vision was 20/40 or better in over half the patients (55, 50.5%), between 20/40 and 20/400 in 13 patients (11.9%), CF 11 (10.1%), LP 9 (8.3%) and NLP 18 patients (16.5%). The percentage of children with final visual acuity of 20/40 or better was significantly higher at last post-op follow up as compared to the pre-op period (18.3% pre-op vs. 50.5% post-op, p<0.001).
Open globe injuries in children occur with relatively high frequency. The majority of these injuries were projectile in nature occurring mostly in males. Surgical repair results in improved visual outcome in majority of cases. The most common complication is cataract. With early intervention, infectious complications and enucleation are extremely rare.
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