Traumatic Pediatric Retinal Detachment following Open Globe Injury

Abstract

Purpose: It was the aim of this study to describe the clinical features and surgical outcomes of retinal detachment following open globe injuries in a pediatric population. Methods: The study was a retrospective chart review of 33 children who had undergone surgery for retinal detachment after open globe injury. Results: The mean age was 11 years (range 4–18) and the mean follow-up period was 57.1 months (range 6–204). Twenty-five patients (76%) were males. Of the open globe injuries, 21 (64%) were penetrations, 6 (18%) intraocular foreign bodies, and 6 (18%) ruptures. Eighteen retinal detachments (55%) were identified by B-scan. Eighteen eyes (55%) had total retinal detachment and 23 eyes (70%) showed macular involvement. Twenty-one eyes (64%) presented with proliferative vitreoretinopathy (PVR) grade C or worse. Retinal reattachment was successful in 12 eyes (36%). Best-corrected visual acuity of 20/100 or better was noted in 4 eyes (12%) preoperatively and in 12 eyes (35%) postoperatively. Features seen in patients with a poor surgical outcome included undetermined or light perception only preoperative vision (p = 0.012), diagnosis by B-scan (p = 0.003), the presence of PVR grade C or worse (p = 0.001), total retinal detachment (p = 0.001), and macula-off status (p = 0.016). Conclusions: Our findings suggest that retinal detachment caused by open globe injuries in the pediatric population is associated with worse surgical results and unsatisfied visual outcomes. Early vitrectomy, before a diagnosis of retinal detachment is made by serial echographic examinations, may be considered to reduce the incidence of PVR. Further clinical research is required to identify ways to improve the outcomes for these patients.

Pediatric open-globe injuries: clinical characteristics and factors associated with poor visual and anatomical success

“…PVR is seen in up to 64 % of traumatic pediatric RD cases and is the most frequent cause of anatomical failure after surgical intervention [26]. In our study, however, anatomical success was not associated with PVR, visual outcomes were significantly lower in eyes with PVR.…”

“…Furthermore, half of the eyes had two or more surgeries in anatomically successful cases. Additionally, macular attachment before surgery has been associated with a good visual outcome by some previous reports [24,26]. However in our study, all patients had macula off RD.…”

“…However in our study, all patients had macula off RD. Therefore, delays in surgical intervention, anatomical failures after surgical intervention and macula off status before surgery can cause irreversible damage to the macula and amblyopia that are thought to be the main reasons for the low functional successes in the treatment of traumatic RD [4,24,26].…”

Clinical Features and Outcome of Paediatric Retinal Detachment

“…In the trauma group, the percentage of boys was even higher (87%). As stated in previous papers, this fact is very likely associated with the different playing habits and increased adventurous behaviour of boys compared to girls [10,12,19] . Regarding clinical symptoms, as in our study impaired VA is generally the most frequent presenting symptom [5,9,17] .…”

“…Many studies, however, have analysed Asian populations [1,[12][13][14] , focused on specific predisposing pathologies [12,15] or solely included rhegmatogenous RD [3,9,10] . Here, we present a large European case series of a unit with 20 years' experience in RD management that includes all types of RD in 95 eyes of 87 children below 18 years of age.…”