Surgical Sequential Management Of Ocular Childhood Trauma - From Corneal Laceration Repair To Late Retinal Detachment And Secondary Glaucoma
Published 2023 - 41st Congress of the ESCRS
Reference: PO0004 | Type: Case report | DOI: 10.82333/gywn-c298
Authors: Anca Delia Pantalon-Werkmeister* 1 , Marius Giurgica 2 , Crenguta Feraru 3 , Dorin Chiselita 3
1Moorfields Eye Hospital,London,United Kingdom, 2Ophthalmology,"St. Spiridon" University Hospitak,Iasi,Romania, 3Ophthalmology,"Gr.T.Popa" University of Medicine and Pharmacy,Iasi,Romania
To present the clinical case and surgical sequential challenges in a child with early infancy penetrant ocular trauma and subsequent multiple eye surgeries addressing the complications that were monitored for over 17 years.
Clinical/ surgical sequence: left corneal laceration at the age of two, traumatic cataract extraction with scleral sutured PC-IOL, IOL dislocation and repositioning, retinal detachment repair, secondary siliconic glaucoma with failed augmented trabeculectomy, scleral melting and intercalary staphyloma in the superior quadrant, artificial drainage system.
Teenage girl, aged 18, monitored in our department after the childhood ocuar trauma initial repair; current status - corneal scar, left pseudophakic eye with a 3 piece IOL lens partially sutured to the scleral wall - training haptic in oblique positioneye, uncontrolled secondary glaucoma with traumatic backgoround overimposed with remnants of emulsified silicone oil blocking the angle (retinal detachment repair 6 years before). Vision in this eyes is hand movement, IOP=45 mmHg under maximal topical and systemic medication, C/D ratio=1. Previous trabeculectomy failed after 1 year due to extenssive scarring and scleral melting in the superior sector. Taking into account the risks and benefits of various artificial drainage systems we opted for a fast solution of decompressing this globe. As such in this myopic, low vision, vitrectomised eye, where either hypertension or hypotension needed to be avoided, we opted for an Ahmed glaucoma valve (FP8). Endothelial cell count revealed reasonable number in OS 1804/mm2. Ocular findings and vision were normal in the fellow eye.
Two years after the procedure, with two needeling procedures and one cyclodiode cilliary body coagulation procedure, the IOP was reasonably controlled; medication was needed for a optimised IOP control
Despite a successful surgery and good IOP control (medium term), long term monitoring is neeed, cosmesis and function wise; poor prognosis is still a rather realistic perspective, that should be considered in this young patient.