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A COMPARATIVE ANALYSIS OF TRAUMATIC RETINAL DETACHMENT AFTER OPEN AND CLOSED GLOBE INJURIES IN CHILDREN
Daniel A Wenzel1, Caroline J Gassel, Vasyl Druchkiv
1University Eye Hospital, Centre for Ophthalmology, University Hospital Tübingen, Tübingen, Germany.
Insights
Pediatric traumatic retinal detachment (RD) outcomes differ significantly between closed globe injuries (CGIs) and open globe injuries (OGIs). CGIs show better visual acuity and prognosis, highlighting the need for tailored management strategies.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Trauma Surgery
Background:
- Pediatric traumatic retinal detachment (RD) presents complex challenges with potential for lifelong visual impairment.
- Distinguishing outcomes between open globe injuries (OGIs) and closed globe injuries (CGIs) is crucial for effective management.
Purpose of the Study:
- To compare the outcomes and prognostic factors of pediatric traumatic RD following OGI versus CGI.
- To identify key determinants of visual prognosis in pediatric eyes affected by traumatic RD.
Main Methods:
- Retrospective analysis of 47 pediatric patients (<18 years) undergoing RD surgery (2002-2021).
- Categorization into 25 CGI and 22 OGI cases.
- Assessment of demographics, RD characteristics, surgical procedures, and visual outcomes (BCVA).
Main Results:
- Closed globe injury (CGI) cases demonstrated significantly better preoperative and follow-up best-corrected visual acuity (BCVA) compared to open globe injury (OGI) cases.
- Initial BCVA improvement was noted exclusively in the CGI group.
- Multivariable analysis identified higher preoperative BCVA, older age, and absence of proliferative vitreoretinopathy as favorable prognostic factors.
Conclusions:
- Visual prognosis for pediatric traumatic RD is generally limited, with closed globe injuries (CGIs) offering a better outlook than open globe injuries (OGIs).
- Baseline best-corrected visual acuity (BCVA) is a primary predictor of final visual outcomes.
- Personalized treatment strategies are essential for optimizing results in pediatric traumatic RD.
Purpose:
Pediatric traumatic retinal detachment (RD) resulting from open globe injuries (OGIs) or closed globe injuries (CGIs) presents unique challenges due to complexity often resulting in lifelong sequelae. This study compares pediatric traumatic RD outcomes and prognostic factors following OGI and CGI.
Methods:
A retrospective analysis reviewed 47 cases of pediatric traumatic RD in children (age <18 years), who underwent RD surgery between 2002 and 2021. Among them, 25 cases were caused by CGI and 22 cases by OGI. Demographics, RD characteristics, surgical procedures, and anatomical and functional results were assessed. Predictive factors for visual outcomes were investigated.
Results:
In the CGI group, mean (±SD) age was 11 years ± 4 years, and 10 years ± 5 years in the OGI group. Closed globe injury traumatic RD had significantly better preoperative (CGI: logarithm of the minimum angle of resolution 1.39 ± 0.19 (mean ± standard error); OGI: logarithm of the minimum angle of resolution 2.12 ± 0.20) and follow-up (CGI: logarithm of the minimum angle of resolution 0.94 ± 0.19; OGI: logarithm of the minimum angle of resolution 1.85 ± 0.20) best-corrected visual acuity (BCVA) ( P < 0.05). Initial BCVA improvement was observed in CGI only. In multivariable analysis, prognostic factors for favorable BCVA outcomes included higher preoperative BCVA, older age, and absence of proliferative vitreoretinopathy ( P < 0.05).
Conclusion:
Visual prognosis for pediatric traumatic RD remains limited, favoring CGI cases compared with OGI. Baseline BCVA emerged as a major determinant of final visual acuity. Tailored management approaches can optimize treatment results.
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