Posterior segment ultrasonic evaluation of cases of traumatic corneo-scleral lacerations in pediatric eyes

Abstract

Background: From harmless corneal abrasion to vision-threatening retinal detachment, ocular injuries manifest in a wide variety of ways. Frequently, injuries are preventable, and these incidents in children can result in lifelong disabilities which pose a substantial socioeconomic burden on society. Ophthalmic ultrasound is a medical imaging tool used to assess posterior segment lesions in eyes with opaque ocular media. Whenever other radiological tests (X-Ray) are negative, B-scan ultrasound offers beneficial data with regard to the existence of any type of ocular foreign body. It guides therapeutic decision-making concerning the late impacts of ocular trauma.Aim of the Work: the purpose of this prospective work was to assess the posterior segment in pediatric patients with corneo-scleral lacerations using B-scan ultrasonography.Patients and Methods: This prospective work was performed on 50 eyes of 50 kids with traumatic corneo-scleral lacerations was attending the Ophthalmology Hospital in Tanta University during the period from January 2020 to January 2021. Each participant had received the following: Comprehensive taking of history (A detailed history about trauma), Comprehensive ophthalmologic assessment (fundus examination, anterior segment assessment utilizing slit lamp, Uncorrected distance visual acuity (UDVA)), plain X-ray to exclude intraocular foreign bodies, Surgical repair, Postoperative medications (Antibiotic, steroids, cycloplegics and mydriatics), Postoperative ultrasonic follow up and finally, Postoperative evaluation by B scan.Results: Our prospective work consist of 50 eyes of 50 individuals with eye trauma (34 males and 16 females). Age ranging between 3 and 17 years. Time for seeking medical advice ranged from 1 - 72 hrs. The most traumatic agent was metal 24 (48%), The wound presented in the right eye of 30 (60%) of eyes. there were 47 (94%) eyes had corneo-scleral wound. the scleral length ranged from 1-6 mm. there were 35 (70%) eyes had monopolar scleral wound. The site of wound ranged from 1-12 O'clock. Regarding ultrasound of vitreous during follow-up, in the 1st visit there were 48 (96%) eyes had dense floaters and 2 (4%) eye had moderate floaters. In the 5th visit, there were 6 (12.8%) eyes had complete PVD, 7 (14.9%) eyes had partial PVD, 19 (40.4%) eyes had minimal floaters while 15 (31.9%) eyes were normal as 1 (2%) case excluded due to retinal detachment. Regarding ultrasound of choroid during follow-up, in the 1st visit, 16 (32%) eyes had normal choroid and 34 (68%) eyes has thickened choroid. In the 5th visit, 46 (97.9%) eyes had normal choroid and 1 (2.1%) eye had thickened as 1 (2%) eye was excluded due to retinal detachment. Regarding ultrasound during the follow-up, the retina was in place in 50 (100%) eyes in the 1st and 2nd visit. In the 3rd visit, the retina was in place in 49 (98%) eyes while 1 (2%) case had retinal detachment which then excluded. During the 4th visit the retina was in place in 47 (95.9%) eyes, while 2 (4.1%) eyes had retinal detachment which then excluded. In the 5th visit, the retina was in place in 45 (95.7%) eyes while 2 (4.3%) eyes had retinal detachment which then excluded.Conclusion: Posterior Segment Ultrasonic Evaluation of Cases of Traumatic Corneo-Scleral Lacerations in Pediatric Eyes is proven to be very important imaging modality in the management of corneoscleral lacerations. Wound length was a significant predictor for retinal detachment. The frequency of RD was higher in neglection of medical advice.