Volume 15 Number 1 / February 2011 e29

107 Pediatric open-globe injuries: A large-scale, retrospectivereview. Ankoor S. Shah, Michael T. Andreoli, Christopher M.Andreoli, Gena HeidaryPurpose: Few studies of open-globe injuries (OGI) focus on demo-graphics, outcomes, and complications in the pediatric population.Here, we report the first large-scale, US-based study of pediatricOGIs.Methods: We reviewed charts of all OGI patients who presented tothe Massachusetts Eye & Ear Infirmary Eye Trauma Service betweenFebruary 1999 and April 2009. All patients underwent a standard sur-gical protocol for OGI repair. In this study, we included all pediatricpatients (\ 18 years old).Results: Of the 852 consecutive OGI patients identified, we found 124pediatric patients with a median age of 12.7 years (range 9 months to17 years). Seventy-five percent were male. Common mechanisms ofinjury included projectiles such as pencils and sticks (28%), BB andpaintball-related traumas (14%), and sharp objects (11%). Medianpreoperative visual acuity was hand motions, while median final vi-sual acuity was 20/40. Intraocular foreign-bodies were found in12% overall but in 75% of BB-related traumas. Average follow-upwas approximately 1 year. There were no cases of endophthalmitis,1 case of sympathetic ophthalmia, and 16 cases requiring enucle-ation for pain.Discussion: This is the first large series of pediatric open-globe in-juries studied in the United States. The majority of cases occurfrom projectiles, guns, and sharp objects, and most benefit fromprompt surgical intervention. The major adverse outcome seems tobe enucleation, an obviously undesirable outcome.Conclusions: Open-globe injuries in children are not uncommon, andthis study may highlight areas where better child education effortsare needed to prevent injury.

108 Visual surveillance protocol for syndromiccraniosynostosis—does it make a difference? Kate A. Smith, AlkiLiasis, Minakshi Jain, Ken K. NischalPurpose: Visual loss in craniosynostosis is multi-factorial andearly detection and surgical intervention prevent irreversibledamage. In our unit a study prior to 1999 revealed best-correctedvisual acuity (BCVA) in the better eye to be worse than 0.3 log-MAR in 40% of cases, 1 in children with syndromic craniosynos-tosis (SC). We aimed to determine if a protocol in ophthalmicsurveillance established in 2000 has improved visual outcomesin SC in our unit.Methods: Retrospective study of visual outcomes in patients withSC who presented to the department between 2000 and 2003 (co-hort-2). These data were compared to visual outcomes in childrenwith SC who presented prior to 1999 (cohort-1). Diagnosis, age,BCVA, refraction and optic disc appearance were collated.Results: Age of presentation differed between the two cohorts ([co-hort-1, 20.3months], [cohort-2, 16.2 months]). Better eye BCVA wasstatistically better in C2 compared to C1 (X2 5 3.891, p \ 0.05).BCVA in cohort-1 was worse than 0.3 logMAR in 40% compared to19% in cohort-2. The majority of optic discs appeared normal atlast visit with only 22% being abnormal.Discussion: Visual loss in craniosynostosis is multifactorial.Our extended ophthalmic surveillance protocol detects changes invisual function prompting early intervention that improves visualoutcomes.Conclusions: To the best of our knowledge this is the first study toshow an improvement in visual outcome using a visual surveillanceprotocol for syndromic craniosynostoses.

Journal of AAPOS

109 Combined intravitreal and subconjunctival carboplatin forintraocular retinoblastoma. Stephen J. Smith, Jose S. Pulido,Diva R. Salom~ao, Brian G. MohneyPurpose: To evaluate the safety of intravitreal chemotherapypreceded by subconjunctival chemotherapy in the treatment ofadvanced stage retinoblastoma.Methods: This noncomparative interventional case series retro-spectively reviewed the medical records and post-enucleationhistopathologic findings of two patients with bilateral retinoblas-toma, Reese-Ellsworth stage Vb in the worse eye. Both patientshad failed traditional therapy prior to receiving 0.5 ml (5 mg per0.5 ml) of subconjunctival Carboplatin, through which 0.05 ml(3 mcg per 0.05 ml) of Carboplatin was injected into the vitreous.(Case 2 received 0.1 ml of intravitreal carboplatin). Following enu-cleation, ocular toxicity and the presence or absence of viabletumor cells at the intravitreal injection site was recorded.Results: Histopathologic examination did not reveal patency of thepars plana intravitreal penetration site in either case at 6 weekspost-treatment, nor was malignant seeding detected in the area ofinjection. Further pathologic examination of the 2 enucleated eyesdid not demonstrate structural toxicity to the cornea, anterior seg-ment, iris, or retina. Additionally, both cases were followed for over16 months post-treatment, without the occurrence of orbital malig-nancy.Discussion: Intravitreal injection of chemotherapy has occasionallybeen used to treat vitreous seeds in cases of advancedretinoblastoma; however, significant concern regarding orbital tumorseeding has discouraged widespread acceptance of this treatmentmodality. Injecting carboplatin at cytotoxic levels in the subconjunc-tival space may reduce this risk by killing any cells that mightotherwise have escaped the globe via the intravitreal needle track.Conclusions: Injecting a bleb of subconjunctival chemotherapy priorto intravitreal drug delivery appeared to mitigate the risk of orbital tu-mor seeding in 2 patients with advanced stage retinoblastoma. Incor-porating this technique may allow further investigation of intravitrealchemotherapy for the treatment of vitreous seeds in retinoblastoma.

110 Transscleral diode laser cyclophotocoagulation as an initialprocedure in congenital glaucoma: Is it a good alternative?Carlos E. Solarte, Jose Morales, Abdulaziz H. AwadIntroduction: Certain circumstances prevent to perform angle sur-gery in congenital glaucoma as primary procedure. Different treat-ment options must be considered to prevent severe permanentdamage, including Transscleral Diode Laser Cyclophotocoagulation(TLDC). The aim of the present study is to revise the efficacy ofTLDC and its safety when performed as primary procedure forcongenital glaucoma.Methods: Retrospective reviews of patients from 2001 to 2007 thatundergo TLDC as primary procedure not eligible for angle surgery.All follow up evaluations were done under sedation or Anesthesia.Successful was defined as IOP less than 22mmHg, improved cornealclarity and/or without changes in corneal diameter with only onesession of TLDC using standard parameters. The information wasanalyzed using Kaplan-Meier Analysis to calculate survival curves.Student's T (Paired - two tailed t-test) was also utilizedResults: 26 eyes from 13 boys and 9 girls were included. Age range atpresentation was 1-15 Months. Mean follow up was 44 months (9-65).23 eyes (88%) had IOP less or equal to 22 mmHg and improved cor-neal clarity at three months follow up. 6 eyes (23%) were under con-trol at one year follow up. Ten eyes required additional sessions ofTLDC with good control at one year while the rest undergo different