Pediatric Ocular Penetrating Trauma: A Multi-step Approach



Ocular trauma still represent an important problem wiht high social impact due to its incidence and possible consequences, predominantly affecting young people in the prime of social, recreational and professional life. Any visual, functional and aesthetical impairment lead to a socio-economic damage and psychological impact with quality of life reduction. Furthermore, trauma is the most important cause of rhegmatogenous retinal detachment in pediatric age (55% during the first couple of years after trauma), during which eye surgery is even mo re challenging. In this video we present the case of a trauma with penetrating wound (BETT) and lens expulsion caused by an accidental trauma with wire mesh in a 12 year-old boy. Ocular trauma score (OTS) of 3 was calculated, giving 41% foreseen result of a final visual acuity of 5/10 or more. The patient showed a wide superior beveled corneal wound with iris dialysis and prolapse, BCVA: motu manu. During first surgery a corneal suture has been practiced to seal the wound, removal of dialytic prolapsed iris together with intumescent lens residues, posterior vitrectomy and PDMS tamponade. Three months later, in the second scheduled procedure, an episcleral prophylactic cerclage with silicone band was carried out, followed by posterior hyaloid detachment induction and whole vitrectomy; exploring peripheral retinal we detected retinal tears and performed laser-barrage; the tamponade of choice was SF6 20%. After corneal wound stitches removal, at 6th month control third surgery was performed with IOL scleral fixation resulting in a BCVA 7/10 at the 18th month control. This video wants to highlights how a surgical multistep approach may be associated with a better anatomical and functional outcome.



Carla Enrica Gallenga
Ferrara, Italy
Email :
Cell Phone: +393288767725
Work Phone: +393288767725