Traumatic pediatric retinal detachment: a comparison between open and closed globe injuries

Abstract

Purpose: To compare retinal detachment as a result of open and closed globe trauma in a pediatric age group.

Design: Retrospective, comparative, consecutive, interventional case series study.

Setting: Tertiary referral medical center.

Patients and methods: One-hundred thirty-eight (5.7%) of 2,408 retinal detachments that were treated at our facility between 1980 and 2000 occurred in children aged 18 years or younger. Of these, 37 eyes (26%, n = 36) had retinal detachment following open globe injury and 23 eyes (14%, n = 20) had retinal detachment following closed globe injury. Those were compared with regard to the retinal detachment characteristics, number, types and timing of surgeries, and the anatomic and functional surgical outcome.

Results: Similar incidence was found in the type of retinal detachment, number of tears, extent, macular attachment type, and timing of surgery. Anatomic surgical success was achieved in 16 eyes (46%) with open globe injury and in 13 eyes (65%) with closed globe injury. The improvement in visual acuity was limited and comparable in both groups (23% to 25%), and lower than the expected according to the Ocular Trauma Score (OTS). The only predictor for favorable visual outcome of > or =20/200 was preoperative macular attachment (P =.003, Fisher exact test).

Conclusion: The type, extent, and severity of the retinal detachment were similar in both open and closed globe injuries, suggesting that the detachment is caused by secondary indirect impact of globe deformation. The anatomic and functional surgical outcome was guarded and similar, suggesting that further surgical innovation is required to improve the visual outcome in this age group.