Air bag-associated trauma may necessitate surgery in children

Permanent visual loss and possible endothelial cell loss are possible in children involved in motor vehicle accidents and air bag deployment, according to the largest case series on the subject to date.

W. Walker Motley III, MD, MS, and colleagues at Cincinnati Children’s Medical Center retrospectively reviewed the charts of all patients between 1995 and 2001 with air bag-associated ocular trauma.

A total of 16 pediatric patients were identified who had air bag-associated ocular trauma. Patients ranged in age from 3 to 16; all were seated in the front passenger side of the car. The patient was restrained with a safety belt in 11 cases and unrestrained in one case. In the other four cases, the use of a restraint was not documented.

Documented, clinically apparent bilateral air bag-associated ocular trauma occurred in six patients. Anterior segment structure injuries were four times more likely than posterior segment injuries. Penetrating keratoplasty, cataract extraction and IOL implantation and vitrectomy were the most common surgical procedures that needed to be performed.

All patients had periocular abrasions, edema and/or ecchymosis. Other ocular injuries included corneal abrasions, corneal edema, hyphema, lens opacities and macular scars. Unilateral visual loss occurred in two patients.

From 2001 to 2002, endothelial cell counts were taken from nine eyes of six patients (median age 12) of air bag-associated ocular trauma and compared with 22 eyes of control patients. A difference of 547 cells/mm² was found between the means of the trauma group and control group endothelial cell counts.

“The present study includes the largest reported case series of pediatric air bag-associated ocular trauma and the first reported pediatric case of air bag-associated bullous keratopathy requiring penetrating keratoplasty,” the authors wrote in the December issue of Journal of AAPOS.