Pediatric open-globe injury in a university-based tertiary hospital

Characteristics of pediatric open globe injuries in preschool-aged and school-aged children

OBJECTIVE

To evaluate the characteristics and outcomes of pediatric open globe injuries in preschool- and school-aged children.

METHOD

Medical records of 93 children were reviewed. Patients were categorized in 2 groups: preschool-aged group (0-7 years) and school-aged group (8-15 years). Demographic data, characteristics of trauma, Ocular Trauma Score (OTS), and initial and final best-corrected visual acuity (BCVA) were recorded and compared between groups.

RESULTS

The preschool-aged group consisted of 54 patients (mean age 4.6 ± 1.8 years), and the school-aged group consisted of 39 patients (mean age 11.5 ± 2.7 years). Most of the injuries were penetrating and caused by nonmetalic sharp objects in both groups. A corneal injury was detected in 45 patients (83.3%) in the preschool-aged group and 29 patients (74.4%) in school-aged group. Localization of the corneal wound was mostly central (46.7%) in the preschool-aged group and peripheral (48.3%) in school-aged group (p = 0.045). Mean corneal wound length was significantly longer in the preschool-aged group (p = 0.018). Most of the cases in the preschool-aged group were OTS group 2 (50%), whereas most of the cases in the school-aged group were OTS group 3 (38.5%). Poor visual outcome was significantly correlated with the following factors in both groups: lower OTS, worse initial BCVA, central corneal wound, longer corneal and total wound length, and presence of lens damage, retinal detachment, and hypotonia (p < 0.05 for all). Poor final BCVA also was significantly correlated with a longer scleral wound in the school-aged group and the presence of vitreous hemorrhage and uveal tissue prolapse in the posterior segment in the preschool-aged group (p < 0.05).

CONCLUSIONS

Localization and length of the corneal wound is closely associated with visual outcome in children with open globe injuries. Especially in preschool-aged children, mostly central localization of a corneal wound can be a challenging factor for visual rehabilitation.

Unusual Penetrating Orbital and Globe Injury With a Veterinary Needle

We present a rare case of a penetrating injury to the globe and orbit by a veterinary needle. The patient underwent globe exploration and retinal detachment repair under general anesthesia after receiving medical treatment for orbital cellulitis. The case was managed by a multidisciplinary team consisting of a pediatric ophthalmologist, an oculoplastic surgeon, and a retina surgeon. The orbital cellulitis resolved gradually, after which the site of globe penetration was found to be self-sealed, and the retinal detachment was repaired. B-scan ultrasonography and magnetic resonance imaging (MRI) were performed to assess the extent of the injury and evaluate the integrity of the globe. Exploration of presumed Self-sealing globe wounds by a needle should be deferred until the treatment of life-threatening complications like orbital cellulitis and optic nerve infiltration is complete. Prompt judicious care was necessary in this case. It is crucial to implement preventive measures to address the risks involved in children manipulating dangerous objects to avoid preventable accidents and mitigate the potential visual outcomes that may arise as a result.

The clinical features and the factors affecting visual prognosis in pediatric open-globe ınjuries

PURPOSE

To investigate clinical features and factors affecting visual prognosis after pediatric open-globe injuries.

METHODS

Retrospective study of 223 children with open-globe injury was conducted. Children with final logMAR visual acuity (LVA) > 0.70 were determined as poor-vision group (group 1, n = 108) and those with final LVA ≤ 0.70 as good-vision group (group 2, n = 115). Demographic characteristics (age, gender, and damaged eye), time between trauma and surgery, ocular trauma score (OTS), follow-up time, injury size, initial and final visual acuity levels, injury type (penetrating injury, globe rupture, perforating injury, and intraocular foreign body injury), injury localization (zone 1 = within the corneal and/or limbal area, zone 2 = within the scleral area extending 5 mm back from the limbus, and zone 3 = within the area posterior to zone 2), injury cause [metal objects (fork, knife, needle), broken glass, blunt objects (ball, punch), pen-pencil, and unidentified objects], and accompanying ocular findings of the groups were detected, and comparisons were done. Additionally, effects of age, time between trauma and surgery, OTS, injury size, follow-up time, initial LVA, injury type, and injury zone on final LVA were analyzed in both groups.

RESULTS

Mean age was 9.1 ± 2.0 years. There were 151 males and 72 females. Compared to group 1, group 2 had better initial and final visions (1.21 ± 0.26 vs 0.60 ± 0.28, p < 0.001 for initial LVA; 1.00 ± 0.32 vs 0.30 ± 0.13, p < 0.001 for final LVA), greater OTS (1.72 ± 0.53 vs 3.73 ± 0.61, p = 0.025), and smaller injury size (10.4 ± 3.5 vs 5.8 ± 2.4 mm, p = 0.002). Globe rupture (p = 0.015) and relative afferent pupillary defect (RAPD) (p = 0.037) were higher in group 1, while penetrating injury (p = 0.044), zone 1 involvement (p = 0.038), and metal object injury (p = 0.041) were higher in group 2. Based on multivariate analysis, the presences of globe rupture (p = 0.024) and RAPD (p = 0.035), the involvement without zone 1 (p = 0.042), and the injury without metal object (fork, knife, needle) (p = 0.046) were associated with poor final vision. Final LVA (for group 1 and group 2) was negatively correlated with OTS (r =  - 0.398, p = 0.037; r =  - 0.369, p = 0.040), while positively correlated with injury size (r = 0.412, p = 0.031; r = 0.318, p = 0.046) and initial LVA (r = 0.335, p = 0.043; r = 0.402, p = 0.034).

CONCLUSION

In our study, poor prognostic factors affecting final vision were low OTS, poor initial vision, the presences of globe rupture and RAPD, the large injury size, the involvement without zone 1, and the injury without metal object (fork, knife, needle).

Pediatric Open Globe Injury in a University-Based Tertiary Hospital in the Anatolian Region

Objective: Evaluation of the epidemiological and clinical features of pediatric open globe injury. Methods: Medical records of 51 patients under the age of 18 who presented to the emergency department with open globe injury (OGI) between 2009 and 2021 were evaluated retrospectively. Patient demographics, Birmingham Eye Trauma Terminology (BETT) category, pediatric ocular trauma score (POTS), visual acuity (VA), site of injury, and seasonal distribution were evaluated. Results: Of all patients included, 40 (78.4%) were male, 11 (21.6%) were female, and the mean age was 9.6±5.2 years. Zone I injury was detected in 31 (60.8%) patients. The most common cause of injury was sharp objects such as metal or wood splinters. Of all injuries, 29 (56.9%) occurred outdoors. Ocular trauma occurred more frequently in boys, especially in the summer months. Initial VA was less than 0,1 in 21 (41.2%) of the patients, between 0.1-0.5 in 9 (17.6%) and 0.6 and above in 5 (9.8%) patients. At the final visit, VA was less than 0.1 in 9 (17.6%) patients, 0.1-0.5 in 10 (19.6%) patients, and 0.6 and above in 18 (35.3%) patients. Final VA was related to the Zone and was lower as the Zone increased (p:0.011). VA and POTS scores were positively correlated at the final visit (p=0.001). Conclusion: It is substantial for emergency physicians to have a comprehensive understanding of pediatric globe injuries so that children with suspected ocular trauma should be evaluated by an ophthalmologist to prevent medicolegal problems.

Pediatric Open Globe Injury in Central China

Purpose

To describe the characteristics, managements, and outcomes of pediatric open globe injury (OGI) in central China.

Methods

Retrospective chart review of pediatric diagnosis in patients with OGI between 2017 and 2020 at Henan Eye Hospital. Four hundred and one eyes of the patients younger than 17 years were included in this study. Open globe injury was classified according to the Birmingham Eye Trauma Terminology system (BETT). Age, sex, history, cause, month of trauma, treatment received, and outcomes were recorded. Visual acuity was documented according to standard visual acuity chart (decimals).

Results

Four hundred and one eyes of patients were included in the study. The mean age was 6.6 ± 3.4 years with the range from 8 months to 16 years. Open globe injuries (OGIs) occurred most frequently in the 2–8 year age and significant male predominance was noted (70.8%). The incidence of pediatric OGIs was lowest in summer months while it increased in the winter months. The most common type of pediatric OGI was penetration (89%). Scissors/knife accounted for 22%, followed by pen/pencil (15.2%), and wood/bamboo sticks (14.5%) of all the pediatric OGIs. Among the injuries, the most frequently involved is the zone I (76.1%). Initially, 70.8% of the eyes received primary debridement and wound closure without any additional intervention, while only one eye has no possibility of anatomical reconstruction when it received an evisceration. After the initial management, 198 eyes received subsequent operation, including 44 eyes that underwent cataract removal + intraocular lens (IOL) implantation, and 24 eyes underwent IOL implantation. Finally, over 6 months of follow-up, 129 eyes (32.2%) got visual acuity (VA) of 0.3–1.5 and, 63 eyes (15.7%) got VA of 0.01–0.25, while 11 eyes (2.7%) were eviscerated.

Conclusion

This study showed that pediatric OGIs in central China are most seen in 2–8-year age group with significant male predominance. Scissors/knife, pen/pencil, and wood/bamboo sticks accounted for over half of all cases. Pediatric OGIs often result in significant vision loss. In some severe cases (2.7%), evisceration was ultimately performed. We should call on the public to pay more attention to their children and build a safer environment for them.

Pediatric Open Globe Injury in Tertiary Hospitals of Khobar and Dhahran

Background

Every year, 3.3 to 5.7 million eye injuries occur worldwide in children. Open globe injury is a common type of trauma that leads to blindness in all age groups. This study aimed to review and discuss the epidemiology, causes, and clinical outcome of pediatric open globe injury.

Methods

A retrospective chart review of all pediatric open globe injuries presented to King Fahad Hospital of the University and Dhahran Eye Specialist Hospital was conducted between 2010 and 2020. Data analyses were done to identify factors predicting ultimate visual acuity.

Results

The overall number of cases was 502, of which 120 cases were children and of the documented 118 cases, around 82 (69.5%) were males with an average age of 5.1 years. The traumatic object was sharp in 90 (89.1%) cases. The most common object was glass, presented in 18 (18.4%) cases. Most injuries were accidental (68.9%) and 48 (71.6%) cases out of 67 occurred inside the house. The factors associated with better visual outcome (20/40 or better) were sharp injuries, absence of hyphema, absence of vitreous hemorrhage, trauma with intraocular foreign body, undergone one operation, and absence of cataract at presentation.

Conclusion

The ultimate visual outcome post open globe injury could be predicted from the severity of the presenting signs. Also, the household environment carries the highest risk, hence it is not always a safe haven for children. Thus, childproofing the house and adult supervision is advisable.

Open globe injuries in geriatric population in Iran: characteristics and outcomes

AIM

To investigate the patterns and outcomes of open globe injuries in the elderly population in Iran.

METHODS

In this retrospective cross-sectional chart review, medical records of 248 patients (aged 60y and more) with the diagnosis of open globe injury from 2006 to 2016 were reviewed. Demographic features, type, and mechanism of open globe injury, ocular trauma score (OTS), visual acuity before and after treatment, the zone of injuries, and the associated injuries found at the presentation or thereafter were documented.

RESULTS

A total of 248 eyes of 248 patients were included. The mean age was 69.2±5.8y (range: 60-90y). Male/ female ratio was about 3:1 (187 vs 61). The three most common causes of injury were falling (25.2%), sharp objects (18.9%), and tree branches (13.9%). Penetrating injury accounted for most of the geriatric ocular trauma (50.4%), followed by globe rupture (40.3%), intraocular foreign body (IOFB; 7.3%), and perforating injury (2.0%). The median raw OTS for the population was 60.5 and the most common OTS class was 3. The injuries tend to affect zone I more than zone II and zone III. The only predictor of final visual acuity was the class of OTS (P<0.001).

CONCLUSION

Geriatric open globe injury should be valued specifically. The most common type of open globe injury in Iran is penetrating injuries but falling remain the main cause. The OTS class must be considered as an important predictor of final visual acuity.

Predictors of visual outcomes in pediatric open globe injuries

PURPOSE

To identify predictors of visual outcomes in children with open globe injuries.

METHODS

The medical records of patients (≤18 years of age) with open globe injury from 2012 to 2020 at a single institution were retrospectively reviewed. The Pediatric Ocular Trauma Scores (POTS) and Toddler Ocular Trauma Scores (TOTS) were assessed against our cohort. Univariate and multivariate linear regression analysis was performed to identify predictors of visual outcome.

RESULTS

A total of 85 eyes of 85 pediatric patients (63 males [74%]) were included. Median patient age was 8.9 years. Final best-corrected visual acuity was significantly associated with presenting vision (P = 0.0001), age at injury (P = 0.02), lens involvement (P < 0.0001), retinal detachment (P < 0.0001), and location of injury (P < 0.0001). In a multivariate linear regression model, only presenting visual acuity and retinal detachment were independent predictors of outcome. When visual acuity was unknown, age at injury, lens involvement, and retinal detachment were independently associated with final visual acuity. POTS and TOTS scores moderately correlated with final best-corrected visual acuity (R² = 0.51 and R² = 0.53, resp.).

CONCLUSIONS

We identified patient characteristics predicting visual outcomes in a large US-based cohort of pediatric open globe injuries. POTS and TOTS scores moderately correlated with final visual acuity; however, the small study sizes from which they were derived preclude our identifying which predictors are most important. Development of a more predictive model will require a large multicenter study population or registry.

Risk Factors for Post–Open-Globe Injury Endophthalmitis

Purpose:

The objective of our project is to use the National Inpatient Sample Database to identify risk factors for endophthalmitis in cases of open-globe injury (OGI).

Methods:

This is a cross-sectional observational study of 48 627 cases of OGI from the National Inpatient Sample Database. We performed regression analysis using IBM SPSS Statistics 23. Codes from the International Classification of Disease, Ninth Revision were used to identify ocular findings and conditions. Variables with P values less than .05 on univariate analysis were included in the multivariable regression model; Bonferroni correction was applied to these results.

Results:

Of the 48 627 cases of OGI, 37 440 (77.0%) occurred in the adult group (21 years and older). Overall, 1018 (2.1%) cases developed posttraumatic endophthalmitis, with 74.5% cases in the adult group. Endophthalmitis developed in 293 (4.5%) eyes with an intraocular foreign body (IOFB). Results of binary logistic regression showed the clinical findings of traumatic cataracts, hypopyon, vitreous inflammation, corneal ulcers, or IOFBs were associated with an increased risk of developing endophthalmitis after OGI. Conversely, orbital fractures, rupture-type injuries, and intraocular tissue prolapse were associated with a decreased likelihood of being diagnosed with endophthalmitis.

Conclusions:

Endophthalmitis developed in 2.4% of pediatric OGIs and 2.0% of adult OGIs. Traumatic cataract, hypopyon, vitreous inflammation, corneal ulcer, keratitis, retinal detachment, IOFB, and diabetes increased the risk of post-open-globe endophthalmitis.

Clinical and Microbiological Features of Pediatric Endopthalmitis After Open Globe Injury in the North of VietNam

BACKGROUND

Pediatric endophthalmitis after open-globe injury had its clinical features, microbiological profile different from those in aldults. In Viet Nam, there was no report on the clinical and microbiological characteristics of pediatric posttraumatic endophthalmitis. Therefore, we conduct this study.

AIM

To describe clinical features, ultrasound results, gram stain and culture results of endophthalmitis in pediatric open globe injuries.

METHODS

Prospective non-controlled study. Case series of 30 eyes presenting with post-traumatic endophthalmitis between 2015 and 2016 were reviewed.

RESULTS

Mean age was 8.03 ± 3.99 years. Metallic and organic etiologies were the most common causes for injuries (n = 11). 27 cases had penetrating corneal trauma. Dense opaque vitreous was seen in 25 eyes. Retinal necrosis < 1 quadrant and chorioretinal abscess > 1 quadrant were the most common fundus lesions. Dense vitreous opacity on ultrasound was most common (n = 28). Gram stain bacteria positivity was 93.3%, gram-positive was isolated in 63.3%. Vitreous samples were more often positive than aqueous (P = 0,002).

CONCLUSION

Posttraumatic endophthalmitis in children is more common in boys aged 6-10 years and most often caused by injury with metallic and organic matters. Culture results were very low. Vitreous samples were more often positive than aqueous. Gram-positive bacteria were the most common causative organism.