NOV 14, 2021
Pediatric Ocular Trauma: 5 Surgical Pearls
During the symposium “Management of Pediatric Ocular Trauma” on Saturday, Ankoor S. Shah, MD, PhD, shared his five top pearls for surgical management of ocular trauma in children. He divided his approach into preoperative and intraoperative advice for open-globe injuries.
- Administer intravenous antibiotics. Shah prescribes a 48-hour pulse of ceftazidime and vancomycin. This protocol is based on a 2019 study, but he was further convinced of its value after working with colleagues at three other hospitals. Although their OR and postoperative regimens varied, they all agreed on the value of using these antibiotics in the ER.
- Always perform computed tomography (CT) imaging. Since patient history does not always match clinical findings, CT can help prevent unwanted operative or postoperative surprises.
- Use nylon sutures. Although there is debate on the best sutures to use, Dr. Shah recommends nylon or nonabsorbable sutures. Since the laceration will take several weeks to heal, the suture can provide the necessary support during this time.
- Reposit uveal tissue. According to Dr. Shah, the prolapsed uveal tissue is usually viable and should be saved. In his experience, the approach to repositing is nuanced and depends on the laceration’s location.
- Practice damage control. This is the most important pearl, said Dr. Shah. He was taught that his goal should be to stabilize and close the globe to prevent infection. More complicated or specialized care can be deferred to secondary procedures. “I think this is critical to our approach to the open-globe injury,” he added.
—Kanaga Rajan, PhD
Financial Disclosure: Dr. Shah: Medtronic: O; Pfizer, Inc.: O; Rebion: P.
Disclosure key. C = Consultant/Advisor; E = Employee; L = Lecture Fees; O = Equity Owner; P = Patents/Royalty; S = Grant Support