Vitreoretinal surgery after childhood ocular trauma

Abstract

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. Retrospective case note review of 61 children (age 16 years or less) undergoing vitreoretinal surgical procedures following ocular trauma at a tertiary referral centre. 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). 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).