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TIMSIT AURELIE, ANA CLEMENT, Sabine Derrien, MAYA BENALI ABDALLAH, Pascal Dureau, Georges Caputo, Florence Metge; PEDIATRIC PENETRATING OPEN-GLOBE INJURIES:WHICH PROGNOSIS FOR WHICH MANAGEMENT?. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6394. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Penetrating open-globe injuries represent a major cause of monocular vision loss in childhood. Despite early management, the visual and anatomic prognosis is poor. The aim of this study is to describe the clinical characteristics of pediatric open-globe injuries (OGI) with posterior segment involvement, and to analyze prognosis factors in order to determine the best management strategy.
A retrospective observational study was conducted. The records of patients aged 16 years or under and during a period of 24 months were reviewed. They presented with OGI with posterior segment involvement, more or less lens injury. Data collected were age, initial and final visual acuity, lens status, presence of vitreous hemorrhage (VH) or retinal injury, type of management, secondary complications, final anatomical result.
The charts of 55 patients were reviewed. The median age at the time of diagnosis was 6.5 years (3-15 years) and 76.5 % were males. A lens injury was noted in 71% of cases, a VH in 65% and a retinal injury in 40%. Vitrectomy was performed in 62.5% of cases, with a mean delay of 12.5 days from initial feature. A retinal detachment (RD) was noted in 26% of patients, 15% were inaugural and 11% occurred secondary (meanly 26 months after the trauma). The overall rate of anatomical success was 82%, but it was only 25% when RD had occurred. The final visual acuity was 20/200 or more in 71% of cases but in 7% of patients who were diagnosed with RD. The follow-up ranged from 2 to 24 months (mean 11.5 months).
Penetrating open-globe injuries associated with a primary or secondary retinal detachment represent the most severe cases yielding poor visual outcome and low rate of anatomical success. The appearance of RD seems to be correlated to the presence of retinal injury and vitreous incarceration.Therefore, an early vitrectomy appears indicated to treat a possible retinal wound and remove vitreous incarceration, preventing secondary RD (in all cases of OGI with VH, lens injury with posterior capsule rupture or scleral wound with vitreous issue).Visual rehabilitation deals with the management of an eventual corneal scar, lens status and amblyopia.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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