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J.R. Hill, B.D. Crawford, M.A. Samuel, K.A. Tawansy; Evaluation of Open Globe Injuries of Children in the Last 15 Years . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5542.
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Purpose: Open globe injury remains a leading cause of unilateral blindness in children. We sought to determine whether advances in vitreo–retinal surgical techniques have translated into improved anatomic and visual outcomes. Methods: Retrospective review of a consecutive case series managed at one center between 1990 and 2002. Open globe injury was defined as a full thickness wound of the cornea or sclera. Data included patient age and sex, mechanism of injury, presenting acuity, and surgeries performed, length of follow up, and most recent visual acutiy. Injury mechanisms were classified as sharp, blunt, and projectile. Visual acuities were grouped as better than or equal to 20/40, 20/50 to 20/200, 20/400 to LP and NLP. Results: A total of 59 open globe injuries in 59 patients were identified. Their mean age was 7.1, with a range from 13 months to 17 years. Males represented 78% of cases. Amongst the females, 100% of the injuries were sharp, while in males 9% were blunt and 17% were projectile. Glass fragments and bottles accounted for 15% of the injuries, sharp school supplies accounted for another 15%, and knives accounted for 14%. When a secondary surgical intervention was necessary, 48% of the cases required anterior vitrectomy and lensectomy, while 41% required pars plana vitrectomy. The average follow–up time was 17 months. Of the 60% of patients that were 1 to 8 years old, 68% had presenting vision of 20/400 or worse, and 71% went on to recover acuity of 20/200 or better. Of the remaining 40% in the 9–17 year old group, 86% presented with initial visual acuity of 20/400 or worse, and 44% recovered 20/200 or better. Of the 12 patients who underwent pars plana vitrectomy, all presented with an initial visual acuity of count fingers or worse. Fifty–eight percent of these patients improved to 20/200 or better, and 50% achieved 20/50 or better. Conclusions: In keeping with prior studies, the majority of injuries occurred in males under 8 years with sharp objects such as knives, glass, or sharp school supplies. Despite potential problems with amblyopia and proliferative vitreo–retinopathy, aggressive surgery and patch therapy resulted in the majority of younger children recovering acuity of 20/200 or better. While presenting vision did relate to final acuity, this association was not as strong as demonstrated in previous studies, and mechanism of injury was equally important. Advances in vitrectomy and lensectomy techniques likely account for improved outcomes in the more severe cases, with 50% achieving 20/50 or better.
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