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Combined anterior and posterior segment injuries in children: a review

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Abstract

Background

Combined anterior and posterior segment injuries in children require special attention to the unique characteristics of children's eyes, including a pronounced tendency to scar formation and proliferation, adherence of the posterior vitreous, as well as the danger of amblyopia.

Methods

This article reviews the current body of literature documenting the main aspects of surgical management, complications, and prognosis of combined anterior and posterior segment injuries in children.

Results

For optimal treatment success, special strategies are necessary with regard to: 1) comprehensive secondary operation for internal reconstruction, 2) encircling buckle surgery, 3) management of the lens, 4) use of a temporary keratoprosthesis, 5) endophthalmitis, and 6) late complications, e.g., secondary glaucoma, secondary strabismus, leukoma cornea, and phthisis bulbi. Further crucial prognostic factors were analyzed.

Conclusion

Combined anterior and posterior segment injuries in children require optimal surgical treatment management that varies from adult treatment with regard to several essential aspects. Care should be provided by pediatric ophthalmology specialists with orthoptic follow-up as necessary, over many years.

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References

  1. Kuhn F, Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G (1996) A standardized classification of ocular trauma. Ophthalmology 103:240–243

    CAS  PubMed  Google Scholar 

  2. Gupta A, Rahman I, Leatherbarrow B (2009) Open globe injuries in children: factors predictive of a poor final visual acuity. Eye 23:621–625

    Article  CAS  PubMed  Google Scholar 

  3. Jandeck C, Kellner U, Bornfeld N, Foerster MH (2000) Open globe injuries in children. Graefes Arch Clin Exp Ophthalmol 238:420–426

    Article  CAS  PubMed  Google Scholar 

  4. Lee CH, Lee L, Kao LY, Lin KK, Yang ML (2009) Prognostic indicators of open globe injuries in children. Am J Emerg Med 27:530–535

    Article  PubMed  Google Scholar 

  5. Sarrazin L, Averbukh E, Halpert M, Hemo I, Rumelt S (2004) Traumatic pediatric retinal detachment: a comparsion between open and closed globe injuries. Am J Ophthalmol 137:1042–1049

    Article  PubMed  Google Scholar 

  6. Saunte JP, Saunte ME (2008) Childhood ocular trauma in the Copenhagen area from 1998 to 2003: eye injuries caused by airsoft guns are twice as common as firework-related injuries. Acta Ophthalmol 86:345–347

    PubMed  Google Scholar 

  7. Kuhn F, Mester V, Morris R (2004) A proactive treatment aproach for eyes with perforating injury. Klin Monatsbl Augenheilkd 221:622–628

    Article  CAS  PubMed  Google Scholar 

  8. Mittra RA, Mieler WF (1999) Controversies in the management of open-globe injuries involving the posterior segment. Surv Ophthalmol 44:215–225

    Article  CAS  PubMed  Google Scholar 

  9. Cleary PE, Ryan SJ (1981) Vitrectomy in penetrating eye injury. Results of a controlled trial of vitrectomy in an experimental posterior penetrating eye injury in the rhesus monkey. Arch Ophthalmol 99:287–292

    CAS  PubMed  Google Scholar 

  10. Wickham L, Xing W, Bunce C, Sullivan P (2006) Outcomes of surgery for posterior segment intraocular foreign bodies—a retrospective review of 17 years of clinical experience. Graefe’s Arch Clin Exp Ophthalmol 244:1620–1626

    Article  Google Scholar 

  11. Colyer MH, Weber ED, Weichel ED, Dick JS, Bower KS, Ward TP, Haller JA (2007) Delayed intraocular foreign body removal without endophthalmitis during Operations Iraqi Freedom and Enduring Freedom. Ophthalmology 114:1439–1447

    Article  PubMed  Google Scholar 

  12. Kuhn F (2008) Ocular trauma in children and in elderly patients. In: Kuhn F (ed) Ocular Traumatology, 1st edn. Springer, Berlin Heidelberg New York, pp 417–435

    Google Scholar 

  13. Schrader WF, Viestenz A (2008) Severe open globe injury. New treatment concepts. Ophthalmologe 105:965–975

    Article  CAS  PubMed  Google Scholar 

  14. Viestenz A, Schrader W, Küchle M, Walter S, Behrens-Baumann W (2008) Management of a ruptured globe. Ophthalmologe 105:1163–1174

    Article  CAS  PubMed  Google Scholar 

  15. Hsu HT, Ryan SJ (1986) Natural history of penetrating ocular injury with retinal laceration in the monkey. Graefes Arch Clin Exp Ophthalmol 224:1–6

    Article  CAS  PubMed  Google Scholar 

  16. Burke JM, Foster SJ (1982) Injured vitreous stimulates DNA synthesis in retinal pigment epithelium cells in culture and within the vitreous. Graefes Arch Clin Exp Ophthalmol 218:153–155

    Article  CAS  PubMed  Google Scholar 

  17. Coleman DJ (1982) Early vitrectomy in the management of the severely traumatized eye. Am J Ophthalmol 93:543–551

    CAS  PubMed  Google Scholar 

  18. de Juan E, Sternberg P, Michels RG (1984) Timing of vitrectomy after penetrating ocular injuries. Ophthalmology 91:1072–1074

    PubMed  Google Scholar 

  19. Meier P, Wiedemann P (2005) Surgical aspects of children vitreoretinal disease. Chapter 145. In: Ryan SJ (ed) Retina, 4th ed. Elsevier Mosby, Philadelphia, pp 2477–2498

    Google Scholar 

  20. Ziemssen F, Bartz-Schmidt KU (2004) Vitrectomy with or without cerclage in the treatment of retinal detachment. Ophthalmologe 101:554–562

    Article  CAS  PubMed  Google Scholar 

  21. Hutton WL, Fuller DG (1984) Factors influencing final visual results in severely injured eyes. Am J Ophthalmol 97:715–722

    CAS  PubMed  Google Scholar 

  22. Hermsen V (1984) Vitrectomy in severe ocular trauma. Ophthalmologica 189:86–92

    Article  CAS  PubMed  Google Scholar 

  23. Ahmadieh H, Soheilian M, Sajjadi H, Azarmina M, Abrishami M (1993) Vitrectomy in ocular trauma. Factors influencing final visual outcome. Retina 13:107–113

    Article  CAS  PubMed  Google Scholar 

  24. Haut J, Allagui M, Lepvrier N, Morel C (1993) Preventive surgical scleral buckling of retinal detachment after severe ocular injuries. J Fr Ophtalmol 16:668–672

    CAS  PubMed  Google Scholar 

  25. Azad RV, Kumar N, Sharma YR, Vohra R (2004) Role of prophylactic scleral buckling in the management of retained intraocular foreign bodies. Clin Experiment Ophthalmol 32:58–61

    Article  PubMed  Google Scholar 

  26. Boiko E, Shishkin M, Dolgih V (2008) Indications for the encircling buckle (EB) procedure in severe open-globe eye injury (OGI). 21st Annual Meeting of the German Retina Society and 8th Symposium of the International Society of Ocular Trauma (ISOT), Würzburg, 19–22 June 2008. German Medical Science GMS Publishing House, Düsseldorf, http://www.egms.de/en//meetings/rg2008/08rg024.shtml

  27. Chow DR, Ferrone PJ, Trese MT (1998) Refractive changes associated with scleral buckling and division in retinopathy of prematurity. Arch Ophthalmol 116:1446–1448

    CAS  PubMed  Google Scholar 

  28. Ricci B, Santo A, Ricci F, Minicucci G, Molle F (1996) Scleral buckling surgery in stage 4 retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol 234:38–41

    Article  Google Scholar 

  29. Kuhn F, Slezakb Z (2004) Damage control surgery in ocular traumatology. Injury 35:690–696

    Article  PubMed  Google Scholar 

  30. Anderoli CM, Anderoli MT, Kloek CE, Ahuero AE, Vavvas D, Durand ML (2009) Low rate of endophthalmitis in a large series of open globe injuries. Am J Ophthalmol 147:601–608

    Article  Google Scholar 

  31. Meier P, Sterker I, Tegetmeyer H, Wiedemann P (2010) 23-gauge-lentectomy for the treatment of congenital cataract. Ophthalmologe 107(3): 241–245

    Article  CAS  PubMed  Google Scholar 

  32. Chen TC, Bhatia LS, Walton DS (2005) Complications of pediatric lensectomy in 193 eyes. Ophthalmic Surg Lasers Imaging 36:6–13

    PubMed  Google Scholar 

  33. Gradin D, Yoston D (2001) Intraocular lens implantation for traumatic cataract in children in East Africa. J Cataract Refract Surg 27:2017–2025

    Article  CAS  PubMed  Google Scholar 

  34. Trivedi RH, Wilson ME, Facciani J (2005) Secondary intraocular lens implantation for pediatric aphakia. JAAPOS 9:346–352

    Google Scholar 

  35. Wiedemann R, Konen W, Heimann K (1994) Reconstruction of the anterior and posterior segment of the eye after massive injury. Germ J Ophthalmol 3:84–89

    CAS  Google Scholar 

  36. Gallemore RP, Bokosky JE (1995) Penetrating keratoplasty with vitreoretinal surgery using the Eckardt temporary keratoprosthesis: modified technique allowing use of larger corneal grafts. Cornea 14:33–38

    Article  CAS  PubMed  Google Scholar 

  37. Garcia-Valenzuela E, Blair NP, Shapiro MJ, Gieser JP, Resnick KI, Solomon MJ, Sugar J (1999) Outcome of vitreoretinal surgery and penetrating keratoplasty using temporary keratoprosthesis. Retina 19:424–429

    Article  CAS  PubMed  Google Scholar 

  38. Roters S, Szurman P, Hermes S, Thumann G, Bartz-Schmidt KU, Kirchhof B (2003) Outcome of combined penetrating keratoplasty with vitreoretinal surgery for management of severe ocular injuries. Retina 23:48–5620

    Article  PubMed  Google Scholar 

  39. Yan H, Cui J, Zhang J, Chen S, Xu Y (2006) Penetrating keratoplasty combined with vitreoretinal surgery for severe ocular injury with blood-stained cornea and no light perception. Ophthalmologica 220:186–189

    Article  PubMed  Google Scholar 

  40. Dong X, Wang W, Xie L, Chiu AM (2006) Long-term outcome of combined penetrating keratoplasty and vitreoretinal surgery using temporary keratoprosthesis. Eye 20:59–63

    Article  CAS  PubMed  Google Scholar 

  41. Karel I, Kalvodova B, Kuthan P (1998) Results of penetrating keratoplasty in bullous silicone oil keratopathy. Graefes Arch Clin Exp Ophthalmol 236:255–258

    Article  CAS  PubMed  Google Scholar 

  42. Vanathi M, Panda A, Vengayil S, Chaudhuri Z, Dada T (2009) Pediatric keratoplasty. Surv Ophthalmol 54:245–271

    Article  CAS  PubMed  Google Scholar 

  43. Stulting RD, Sumers KD, Cavanagh HD, Waring GO, Gammon JA (1984) Penetrating keratoplasty in children. Ophthalmology 91:1222–1229

    CAS  PubMed  Google Scholar 

  44. Cowden JW (1990) Penetrating keratoplasty in infants and children. Ophthalmology 97:324–329

    CAS  PubMed  Google Scholar 

  45. Dana MR, Schaumberg DA, Moyes AL, Gomes JA, Laibson PR, Holland EJ, Sugar A, Sugar J (1995) Outcome of penetrating keratoplasty after ocular trauma in children. Arch Ophthalmol 113:1503–1507

    CAS  PubMed  Google Scholar 

  46. Patel HY, Ormonde S, Brookes NH, Moffatt LS, McGhee CN (2005) The indications and outcome of paediatric corneal transplantation in New Zealand: 1991–2003. Br J Ophthalmol 89:404–408

    Article  CAS  PubMed  Google Scholar 

  47. Vajpayee RB, Angra SK, Honavar SG (1994) Combined keratoplasty, cataract extraction, and intraocular lens implantation after corneolenticular laceration in children. Am J Ophthalmol 117:507–511

    CAS  PubMed  Google Scholar 

  48. Reidy JJ (2001) Penetrating keratoplasty in infancy and early childhood. Curr Opin Ophthalmol 12:258–261

    Article  CAS  PubMed  Google Scholar 

  49. Narang S, Gupta V, Simalandhi P, Gupta A, Raj S, Dogra MR (2004) Pediatric open globe injuries. Visual outcome and risk factors for endophthalmitis. Indian J Ophthalmol 52:29–34

    PubMed  Google Scholar 

  50. Verbraeken H, Rysselaere M (1994) Post-traumatic endophthalmitis. Eur J Ophthalmol 4:1–5

    CAS  PubMed  Google Scholar 

  51. Thompson WS, Rubsamen PE, Flynn HW Jr, Schiffman J, Cousins SW (1995) Endophthalmitis after penetrating trauma. Risk factors and visual acuity outcomes. Ophthalmology 102:1696–1701

    CAS  PubMed  Google Scholar 

  52. Duch-Samper AM, Menezo JL, Hurtado-Sarrió M (1997) Endophthalmitis following penetrating eye injuries. Acta Ophthalmol Scand 75:104–106

    Article  CAS  PubMed  Google Scholar 

  53. Essex RW, Yi Q, Charles PG, Allen PJ (2004) Post-traumatic endophthalmitis. Ophthalmology 111:2015–2022

    Article  PubMed  Google Scholar 

  54. Ariyasu RG, Kumar S, Labree LD, Wagner DG, Smith RE (1995) Microorganisms cultured from the anterior chamber of ruptured globes at the time of repair. Am J Ophthalmol 119:181–188

    CAS  PubMed  Google Scholar 

  55. Cakir M, Cekic O, Pekel G, Yilmaz OF (2010) Pars plana vitrectomy results of exogenous endophthalmitis in children. Eur J Ophthalmol 20(3):565–571

    PubMed  Google Scholar 

  56. Kuhn F, Gini G (2005) Ten years after... are findings of the Endophthalmitis Vitrectomy Study still relevant today? Graefes Arch Clin Exp Ophthalmol 243:1197–1199

    Article  PubMed  Google Scholar 

  57. Sabaci G, Bayer A, Mutlu FM, Karagül S, Yildirim E (2002) Endophthalmitis after deadly-weapon-related open-globe injuries: risk factors, value of prophylactic antibiotics, and visual outcomes. Am J Ophthalmol 133:62–69

    Article  PubMed  Google Scholar 

  58. Soheilian M, Rafati N, Mohebbi MR, Yazdani S, Habibabadi HF, Feghhi M, Shahriary HA, Eslamipour J, Piri N, Peyman GA, Traumatic Endophthalmitis Trial Research Group (2007) Prophylaxis of acute posttraumatic bacterial endophthalmitis: a multicenter, randomized clinical trial of intraocular antibiotic injection, report 2. Arch Ophthalmol 125:460–465

    Article  CAS  PubMed  Google Scholar 

  59. Hariprasad SM, Mieler WF, Holz ER (2003) Vitreous and aqueous penetration of orally administered gatifloxacin in humans. Arch Ophthalmol 121:345–350

    CAS  PubMed  Google Scholar 

  60. Hariprasad SM, Shah GK, Mieler WF, Feiner L, Blinder KJ, Holekamp NM, Gao H, Prince RA (2006) Vitreous and aqueous penetration of orally administered moxifloxacin in humans. Arch Ophthalmol 124:178–182

    Article  CAS  PubMed  Google Scholar 

  61. Alfaro DV, Chaudhry NA, Walnoker AF, Saito Y, Liggett PE (1994) Penetrating eye injuries in young children. Retina 14:201–205

    Article  CAS  PubMed  Google Scholar 

  62. Thordsen JE, Harris L, Hubbard GB (2008) Pediatric endophthalmitis. A 10-year consecutive series. Retina 28:3–7

    Article  Google Scholar 

  63. Alfaro DV, Roth DB, Laughlin RM, Goyal M, Liggett PE (1995) Paediatric post-traumatic endophthalmitis. Br J Ophthalmol 79:888–891

    Article  CAS  PubMed  Google Scholar 

  64. Endophthalmitis Vitrectomy Study Group (1995) Results of the endophthalmitis vitrectomy study. Arch Ophthalmol 113:1479–1496

    Google Scholar 

  65. Moisseiev J, Vidne O, Treister G (1998) Vitrectomy and silicone oil injection in pediatric patients. Retina 18:221–227

    Article  CAS  PubMed  Google Scholar 

  66. Scott IU, Flynn HW, Azen SP, Lai MY, Schwartz S, Trese M (1999) Silicone oil in the repair of pediatric complex retinal detachment. A prospective, observational, multicenter study. Ophthalmology 106:1399–1408

    Article  CAS  PubMed  Google Scholar 

  67. Wang NK, Chen KP, Yeung L, Chen KJ, Chao AN, Kuo YH (2007) Traumatic pediatric retinal detachment following open globe injury. Ophthalmologica 221:255–263

    Article  PubMed  Google Scholar 

  68. De Decker W (2007) Heterophorie (Manifester Strabismus). In: Kaufmann H (ed) Strabismus, 3rd ed. Ferdinand Enke, Stuttgart, pp 188–243

    Google Scholar 

  69. Entezari M, Rabei HM, Badalabadi MM, Mohebbi M (2006) Visual outcome and ocular survival in open-globe injuries. Injury 37:633–637

    Article  PubMed  Google Scholar 

  70. Cillino S, Casuccio A, Di Pace F, Pillitteri F, Cillino G (2008 ) A five-year retrospective study of the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in a Mediterranean area. BMC Ophthalmol 8:6

    Article  PubMed  Google Scholar 

  71. Schmidt GW, Broman AT, Hindman HB, Grant MP (2008) Vision survival after open globe injury predicted by classification and regression tree analysis. Ophthalmology 115:202–209

    Article  CAS  PubMed  Google Scholar 

  72. Savar A, Andreoli MT, Kloek CE, Andreoli CM (2009) Enucleation for open globe injury. Am J Ophthalmol 147:595–600

    Article  PubMed  Google Scholar 

  73. Kaltreider SA, Peake LR, Carter BT (2001) Pediatric enucleation: analysis of volume replacement. Arch Ophthalmol 119:379–384

    CAS  PubMed  Google Scholar 

  74. Hintschich C (2003) Dermis-fat graft. Possibilities and limitations. Ophthalmologe 100:518–524

    Article  CAS  PubMed  Google Scholar 

  75. Haase W, Gräf M (2007) Amblyopie. In: Kaufmann H (ed) Strabismus, 3rd ed. Ferdinand Enke Stuttgart, pp 243–318

    Google Scholar 

  76. Goble PR, Franks WA, Avery D, Chignell AH (1993) Successful treatment of anisometropic amblyopia and strabismus following intravitreal silicone oil. Br J Ophthalmol 77:321–322

    Article  CAS  PubMed  Google Scholar 

  77. Kuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD (2002) The Ocular Trauma Score (OTS). Ophthalmol Clin North Am 15:163–165

    Article  PubMed  Google Scholar 

  78. Ferrone PJ, McCuen BW, de Juan E, Machemer R (1994) The efficacy of silicone oil for complicated retinal detachments in the pediatric population. Arch Ophthalmol 112:773–777

    CAS  PubMed  Google Scholar 

  79. Farr AK, Hairston RJ, Humayun MU (2001) Open globe injuries in children: a retrospective analysis. J Ped Ophthalmol Strab 38:72–77

    CAS  Google Scholar 

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Correspondence to Petra Meier.

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Presentation in part at the congress of the German Ophthalmological Society (DOG, 24.-27. September 2009, Leipzig, Germany).

The author has no conflict of interests or financial disclosures.

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Meier, P. Combined anterior and posterior segment injuries in children: a review. Graefes Arch Clin Exp Ophthalmol 248, 1207–1219 (2010). https://doi.org/10.1007/s00417-010-1414-x

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