Surgical Indications and Ophthalmologic Considerations for Repair of Isolated Pediatric Orbital Fractures: Multidisciplinary Experience in 150 Children
Devin Coon, M.D., M.S.E., Martin Kosztowski, M.D., Gerhard S. Mundinger, M.D., Michael P. Grant, M.D., P.h.D., Richard J. Redett, M.D..
Johns Hopkins University, Baltimore, MD, USA.
Pediatric orbital fractures represent a challenging and sometimes controversial clinical problem. Patients can present with clear indications, but most require balancing benefits against intra-operative and late complications. We assessed these fractures at a state designated eye trauma center to develop criteria for surgery.
IRB approval was obtained to analyze pediatric patients with ICD-9 orbital fracture diagnoses at Wilmer Eye Institute over ten years. Patients were excluded if they did not undergo a full opthalmologic examination, did not follow-up after their injury, or had significant facial fractures outside of the orbit.
150 patients met selection criteria; 116 patients (77%) completed all follow-up (average 309 days). 107 patients underwent surgery (Fig 1); ninety-six underwent acute repair (<3 weeks) while eleven underwent delayed repair (median 49 days). Twenty-five patients (17%) had hyphema, prompting surgical delay while twenty-six (18%) had commotio retinae.
Two patients had 20/40 vision or worse; one with a retinal injury and the other with traumatic neuropathy. Three patients required reoperation; two for plate infection and one for hyperglobus, with an overall complication rate of 4.7%.
We analyzed the largest series of isolated pediatric orbital fractures to propose appropriate criteria for surgical intervention and management of concomitant ophthalmologic injuries. Early intervention to restore normal orbital anatomy provides excellent long-term outcomes in globe position and binocular eye function with an acceptably low complication profile.
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