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Long-term evaluation of pars plana vitrectomy in children with Abusive head trauma
Pavel Kozner1, Jana Stepankova1, Dagmar Dotrelova1
1Department of Ophthalmology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
Insights
Pars plana vitrectomy (PPV) effectively clears intraocular hemorrhage (IOH) in children suffering from abusive head trauma (AHT). Surgical outcomes correlate with neurological impairment, with earlier intervention yielding better vision and preventing amblyopia.
Area of Science:
- Ophthalmology
- Pediatric Traumatology
- Surgical Innovation
Background:
- Intraocular hemorrhage (IOH) is a critical complication in abusive head trauma (AHT) affecting children.
- The efficacy of surgical intervention for IOH in this vulnerable population requires thorough investigation.
Purpose of the Study:
- To evaluate the effectiveness and safety of pars plana vitrectomy (PPV) for treating IOH in pediatric patients diagnosed with AHT.
- To analyze the anatomical and functional outcomes following PPV in this specific patient group.
Main Methods:
- A retrospective analysis of 18 children with AHT-related IOH treated between 2004 and 2017.
- Evaluation of epidemiological data, management strategies, surgical outcomes, and long-term results of PPV.
Main Results:
- PPV was performed on 36% of affected eyes, with surgery occurring approximately 30 days post-diagnosis.
- Post-operative anatomical improvement was observed in 80% of eyes, with 50% experiencing improved vision.
- Mortality rate in the study group was 17%, primarily affecting infants under 4 months.
Conclusions:
- Pars plana vitrectomy (PPV) is a safe and effective surgical option for managing intraocular hemorrhage (IOH) in children with abusive head trauma (AHT).
- Ophthalmological results are significantly influenced by the severity of neurological impairment.
- Optimal surgical timing between 2-5 weeks post-trauma is crucial for maximizing visual outcomes and preventing deprivation amblyopia.
Purpose:
To determine the efficacy of pars plana vitrectomy (PPV) in children with intraocular hemorrhage (IOH) secondary to Abusive head trauma (AHT).
Methods:
A long-term retrospective analysis evaluating epidemiology, management, safety, anatomical and functional results of PPV for IOH in children with AHT at tertiary referral center for children in the Czech Republic from 2004 to 2017.
Results:
18 children were identified with IOH due to AHT during observation period of 14 years. Overall incidence of IOH related to AHT was 29.6/100 000, in children under 1 year 22.2/100 000, in children 1 to 5 years 7.4/100 000. Mean age at the time of diagnosis was 13.7 (SD±20.53) months, median 5 months. IOH resolved in 56% of children, 64% eyes, spontaneously. 44% children, 36% eyes, underwent PPV. PPV was performed 30.5 (SD±16.98) days after established diagnosis on average. Postoperatively, 80% of eyes had anatomical improvement, 20% eyes had preexisting irreversible changes in the posterior pole. Vision of 50% eyes improved after surgery, vision of 20% eyes remained poor, 30% of eyes was not possible to test due to severe neurological impairment. Mean observational period was 33.4 (SD±38.21) months. Mortality rate of AHT in our group was 17%, all victims were younger 4 months.
Conclusions:
PPV is a safe and effective procedure to clear IOH in children with AHT. Ophthalmology outcomes are strongly associated with degree of neurological impairment. Best outcomes were achieved with PPV performed between 2 and 5 weeks after trauma. Opportunity to plan surgery within this time frame indicates a good neurological prospect and prevents deprivation amblyopia.
