Vitreoretinal surgery after childhood ocular trauma

Abstract

Aim: In adults modern vitreoretinal surgery allows many traumatised eyes to be salvaged. However, one third of serious eye injuries occur in the paediatric age group and trauma is a leading cause of monocular blindness in childhood. This study aims to report the indications, complications and outcomes for vitreoretinal surgical intervention after childhood ocular trauma. Methods: Retrospective case note review of 61 children (age 16 years or less) undergoing vitreoretinal surgical procedures following ocular trauma at a tertiary referral centre. Results: Twenty-eight children (45.9%) had open globe injuries (OGI) and 33 closed globe injuries (CGI, 54.1%). The mean age of children with OGI was 9.5 years and with CGI 12.3 years (P=0.0068). Forty-seven children had traumatic retinal detachments (77.1%), which in 17 cases were treated with conventional scleral buckling surgery and in 30 by vitrectomy. Retinal re-attachment was achieved after one procedure in 70.6% with scleral buckling and 46.7% with vitrectomy. Fourteen children (22.9%) had attached retinas but required vitrectomy for other reasons. After a mean follow-up of 19.6 months, the median visual acuity (VA) of the children improved from counting fingers at presentation to 6/36 at final review (P=0.0031). Traumatic retinal detachment requiring vitrectomy was associated with poor visual outcome (P=0.0003). Conclusion: Vitreoretinal intervention resulted in an improvement in vision in 32 children (57.1%) and stabilised 11 at their presenting acuity (19.6%). Two thirds of the children attained a final VA of 6/60 or better. Proliferative vitreoretinopathy was the cause of redetachment in 68.2% of cases and was significantly associated with a poor outcome (P<0.0001).