O Pearl

Tenting of the retina^ during surgical PVD is a sign of very strong vit-reoretinal adherence; it signals to the surgeon that the maneuver may have to be stopped.

• The microbiological spectrum of endophthalmitis is slightly different in children, with various Streptococcus species being the most common organism. If early and "aggressive" therapy (i.e., as complete as possible vitrectomy; see Chap. 2.17) is performed, most eyes regain at least ambulatory vision [3].

• In children presenting with proptosis, orbital, or ocular™ trauma should be high on the differential diagnosis list [5].

• The consequences of serious injury are often more complex in children than in adults, due to increased postoperative inflammation and scar formation [21, 28, 38, 47]. PVR may be more pronounced in children [22, 25], presenting earlier and possibly in a more fulminant fashion. Scarring is a risk regardless of the intraocular tissue involved, with secondary complications such as corneal opacity, glaucoma, posterior capsule opacification, and retinal detachment. In one report, 28% of eyes with posterior segment injury developed PVR [28]. Vitrectomy performed within 2 weeks may prevent PVR development [28].

19 An advancing white line is visible as the detaching vitreous elevates the retina.

20 e.g., endophthalmitis.

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