Abstract

SA.10.07

Combined anterior and posterior segment injuries in children

Petra Meier
Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Leipzig

Objective
In children combined anterior and posterior segment injuries occur rarely compared to the number of these injuries in adults. In pediatric eyes particular consideration must be given to some special factors, especially the anatomical landmarks regarding the surgical technique, a high rate of scarring and intraocular proliferation, the absence of posterior vitreous detachment, and development of amblyopia.
Methods
We analyzed data from 30 consecutive children (aged 0-18 years) who were treated for combined trauma of the anterior and posterior segment at our hospital between February 1994 and February 2009. Corneal and/or scleral laceration were associated with vitreous hemorrhage (24), intraocular foreign body (6), retinal detachment (6), posterior perforation (4), endophthalmitis (2).
Results
The primary surgery included the external reconstruction, i. e. close of the penetrating wound. Internal reconstruction involves anterior segment reconstruction and vitrectomy and should be performed after some days in a second step. A delaying internal reconstruction reduces the risk of an intraocular bleeding and improves the possibility to create a posterior vitreous detachment.
Anterior segment reconstruction (included blood removing, lens aspiration, and temporary keratoprothesis) and vitrectomy were performed in our series after 2-28 days after injuries.
In summary, penetration keratoplasty was performed in two eyes; vitreoretinal surgery was necessary in 55 cases, anatomic reattachment was ultimately accomplished with a mean of 1.8 surgeries per eye in our study. The follow-up period was 6-120 months. We observed a high incidence of posttraumatic proliferative vitreoretinopathy (PVR), especially in eyes of extensive tissue damage, and in all eyes it is important to perform consistent postoperative follow-up. Optical defects from astigmatism and lens damage will need correction, and close orthoptic supervision will be needed at an early stage.
Conclusions
In children and young adults combined anterior and posterior segment injuries have the least favorable prognosis. The prognosis is determined particularly by the primary damage to the eye. Extensive retinal tears and posterior perforations are associated with the develoment of PVR. It is important to perform consistent postoperative follow-up and aggressive antiamblyopic treatment. Further efforts are required to reduce the incidence of PVR.

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