Pediatric open-globe injuries at an urban academic medical center

Abstract

Introduction
We investigate pediatric open globe injuries (OGIs) presenting to an urban academic medical center.
Methods
A retrospective chart review of electronic medical records was completed to identify patients ages 0 to 18 years with OGI from 2015 to 2021. Included patients underwent primary open globe repair (OGR) and followed up at our institution for at least 14 days postoperatively.
Results
From 2015 to 2021, there were 47 OGIs in patients aged 0-18 years, 39 of which occurred in males and 9 in females at a mean age of 10.3 years. Mean presenting visual acuity was logMAR 1.7. Associated presenting ocular injuries included lens injury (17 [36%]), lens dislocation (5 [11%]), hyphema (17 [36%]), uveal prolapse (34 [72%]), vitreous hemorrhage (9 [19%]), retinal detachment (9 [19%]), choroidal rupture / detachment (6, 12.8%), orbital fracture (1 [2%]), and intraocular foreign body (2 [4%]). OGIs occurred in BETT Zones 1 (29 [62%]), 2 (10 [21%]), and 3 (8 [17%]). Retinal detachment occurred most frequently in zone 3 injuries (4 [44%]). Fourteen patients were lost to follow up after OGR and subsequently excluded from follow up analyses. Zone I injuries most frequently required additional surgery (58 [9%] of reoperations). Following OGR, 16 patients (49%) underwent reoperations including pars plana vitrectomy (7 [21%]), intraocular lens placement (8 [24%]), penetrating keratoplasty (2 [6%]), and enucleation (2 [6%]). The mean interval between OGR and reoperation was 49.8 days. Mean duration of follow up after OGR was 632.0 days (range, 21-2,555). Mean visual acuity at the most recent follow up visit was logMAR 1.08, an improvement of logMAR –0.50 relative to mean preoperative acuity.
Conclusion
Pediatric OGIs frequently involve myriad injuries of both the anterior and posterior segments of afflicted eyes, many of which require more than one surgery to rehabilitate.