Prognostic indicators of open globe injuries in children

Intraocular foreign bodies in children: A retrospective case series

INTRODUCTION

Open globe injuries are a major cause of visual impairment in children, related to the severity of the trauma or secondary to induced amblyopia. Intraocular foreign bodies (IOFB) have been reported in approximately one third of cases of open globe injuries. As clinical presentation and management may differ between adults and children, data is lacking about IOFBs in children under 18years of age. The purpose of this study was to assess the clinical characteristics and visual prognosis of ocular trauma associated with intraocular foreign bodies in children.

MATERIALS AND METHODS

This single-center retrospective study included patients under 18years of age treated for ocular trauma with IOFB. Demographic characteristics, complete initial and final ophthalmological examination, imaging data and details of medical and surgical management were collected.

RESULTS

Fourteen patients were included (78.6% boys), with a mean age of 10.3years (min 7months-max 17years). In 92.9% of cases, patients were found to have a single IOFB, mostly metallic (71.4%). Posterior segment IOFBs were found in 50% of cases, anterior segment IOFBs in 28.6% and orbital IOFBs in 21.4%. The clinical examination permitted detection of the IOFBs in 50% of cases, while they were visible on CT scan in all cases. The mean initial visual acuity was 20/320, and the mean final visual acuity was 20/125. Endophthalmitis occurred in 2 cases (14%).

DISCUSSION

Open globe injuries associated with IOFB are severe and sight-threatening. Localization of the IOFB in the posterior segment has a worse prognosis. CT scan is mandatory, especially in children, as the trauma history is often missing. Retinal detachment and endophthalmitis appear to be the main prognostic factors requiring urgent specialized pediatric ophthalmology management.

Ocular injuries in a paediatric population at a child eye health tertiary facility, Ibadan, Nigeria

PURPOSE

To determine the pattern, causes and risk factors for ocular injuries amongst children presenting to a tertiary facility in Ibadan, southwest Nigeria METHODS: A retrospective review of clinical records of patients aged 16 years and below who presented with ocular injuries to the eye emergency unit between May 2010 and April 2016. Information extracted includes patient's demography, location and circumstances of injury, clinical findings, and management. Data was analysed using IBM SPSS Statistics for Windows, Version 26.0. Descriptive and inferential statistics were calculated. Odds ratio were derived from regression models adjusted for confounders. Significance was set at a P-value of 0.05.

RESULTS

A total of 109 children were studied. Majority were boys (male to female ratio=2.9:1). The median age at presentation was 9 years. Injury occurred at home in 67 (61.5%) children, and at school in 30 (27.5%). More than half of the children were injured during play, 18 (16.5%) during corporal punishment, and 34 (31.2%) by accidents during domestic/schoolwork. Majority (73.4%) were closed globe injuries. The odds of injury with sharp objects and ocular trauma score of 4 or less was were 3.2 times (95% Confidence interval {CI}: 1.3-7.7) and 3.9 times (95% CI:1.4-11.4) higher in children aged 0-5 years respectively. The odds of open globe injury was 9.8 times (95% CI: 3.4-28.6) higher in injury from sharp objects. Wood/stick, cane, stone, broomstick and fist/palm/finger were the agents responsible for two-thirds of injuries.

CONCLUSION

This study revealed that children predominantly sustain ocular injuries at home and younger children have greater odds of severe injuries with profound implications for visual disability. Health education, adult supervision and the application of appropriate measures necessary for reducing the incidence and severity of childhood ocular trauma are advocated.

High risk and low prevalence diseases: Open globe injury

INTRODUCTION

Open globe injury (OGI) is a rare but serious condition that carries with it a high rate of morbidity.

OBJECTIVE

This review highlights the pearls and pitfalls of OGI, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

DISCUSSION

OGI refers to full-thickness injury to the layers of the eye. OGI can be caused by blunt or sharp trauma, and subtypes include penetration, perforation, intraocular foreign body (IOFB), globe rupture, or mixed types. OGI is more common in males and usually secondary to work-related injury, but in women it is most commonly associated with falls. Emergency clinicians should first assess for and manage other critical, life-threatening injuries. Following this assessment, a thorough eye examination is necessary. Computed tomography (CT) may suggest the disease, but it cannot definitively exclude the diagnosis. While point-of-care ultrasound (POCUS) is highly sensitive and specific for some findings in OGI, its use is controversial due to potential globe content extrusion. Management includes protecting the affected eye from further injury, preventing Valsalva maneuvers that could extrude ocular contents, updating tetanus vaccination status, administering broad-spectrum antibiotics, and ophthalmology consultation for surgical intervention to prevent the sequelae of blindness and endophthalmitis.

CONCLUSION

An understanding of OGI can assist emergency clinicians in diagnosing and managing this sight-threatening traumatic process.

Characteristics of pediatric traumatic cataract and factors affecting visual outcomes

PURPOSE

To evaluate the clinical characteristics, surgical approach and visual results in pediatric traumatic cataract.

MATERIAL AND METHODS

Data of pediatric and adult traumatic cataract patients were retrospectively analyzed. Age, gender, cause and zone of trauma, additional clinical findings, initial and final visual acuity (VA) were analyzed and compared between groups.

RESULTS

The mean age of 18 patients in the pediatric group was 9.4(SD 5.7); 18 patients in the adult group was 47.8(16.2) years. There was a male predominance in both groups (12/16 male, respectively). The most common cause of trauma was sharp metal objects (50%) in the pediatric group and wooden and traffic accidents (33%) in the adult group. The initial mean VA of the patients were 0.03(0.09), 0.09(0.1) in the pediatric and adult groups, respectively, (p: 0.34). The mean ocular trauma score (OTS) was 51.4(16.4) and 59.6(10.5) in the pediatric and adult groups, respectively (p: 0.09). Simultaneous surgery was performed in 5 (28%) eyes in both groups. Subsequent lens extraction and IOL implantation were performed in 10 of pediatric and 13 of adult patients. The final VA was 0.3(0.7), 0.3(0.4) in the pediatric and adult group, respectively (p: 0.94). Final VA was correlated with OTS in both of the groups and the presence of additional surgery in the pediatric group.

CONCLUSION

Traumatic cataract is a major cause of visual loss in children. Lower OTS and presence of additional surgery were the prognostic factors for poor final VA in the pediatric cases. Optimal timing and accurate management of traumatic cataract are important in the pediatric population.

A modified pediatric ocular trauma score for predicting visual outcome post open globe injury

PURPOSE

To construct a new pediatric ocular trauma score for predicting visual outcome after open globe injuries (OGI) and to compare it to the ocular trauma score (OTS) and pediatric ocular trauma score (POTS).

METHODS

This is a retrospective chart review study. For each case, the following data were collected: demographics, mechanism of the injury, initial ophthalmologic findings, presented and last follow-up visual acuity (VA), ocular treatments, and final ocular findings. We then analyzed the risk factors for the poor visual outcome (VA ≤ 20/200), and a modified pediatric ocular trauma score (MPOTS) was constructed accordingly and compared to the OTS and POTS for predicting poor outcome. Finally, a different cohort of pediatric OGIs was used for score validation.

RESULTS

Forty-five cases were included, significant predicting factors for poor visual outcome were initial VA ≤ 20/200, zone 2-3 locations of injury, presence of retinal detachment, vitreous hemorrhage, hyphema, and iris prolapse at initial presentation. The calculated Spearman correlation coefficients between each system score and poor visual outcome were OTS 0.56, POTS 0.57, and MPOTS 0.64 (P < 0.001 for all). A total of 71 new cases were used as validation cohort, and calculated Spearman correlation coefficients between each system score and poor visual outcome were: OTS 0.50, POTS 0.51, and MPOTS 0.53 (P < 0.001 for all).

CONCLUSIONS

We suggest a new scoring system for predicting poor final visual outcomes after OGI's in children, which is simpler and more clinically suitable for this study population. It was found to be a better predictor of visual outcome in this scenario compared with existing scoring systems.

Characteristics and visual prognosis of pediatric open globe injury in Shanghai, China

Introduction To describe the characteristics of open globe injury and the relationship between the complications and visual outcomes in children with this type of injury. Methods This was a retrospective chart review of 1664 children, under the age of 16 years, who were hospitalized for open globe injury between January 1, 2007, and December 31, 2015. Each patient's age, sex, cause and agent of injury, complications, visual acuity, and classification of ocular trauma were collected for review and analysis. Results The mean age was 5.6 ± 3.4 years. Right eyes were particularly vulnerable to injury (right eye:left eye ratio = 1.2:1). Traumatic cataract was the most common complication. The average initial and final best-corrected visual acuity (BCVA) were logMAR 2.04 ± 0.78 and logMAR 1.74 ± 0.88, respectively. Logistic regression analysis showed that hyphema (OR = 1.850), iris prolapse (OR = 1.702), vitreous hemorrhage (OR = 9.703), retinal detachment (OR = 11.938), endophthalmia (OR = 5.377), intraocular foreign body (OR = 3.346), and initial visual acuity < 0.05 (OR = 9.017) were risk factors for visual acuity < 0.05 at hospital discharge. Conclusion Open globe injury was most frequent in preschool children and boys. Right eyes were more vulnerable than left eyes. Poor visual outcomes were associated with hyphema, iris prolapse, vitreous hemorrhage, retinal detachment, endophthalmia, intraocular foreign body, and an initial visual acuity < 0.05.

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.

Post-traumatic endophthalmitis caused by streptococcus species in preschool children: clinical features, antibiotic susceptibilities and outcomes

BACKGROUND/OBJECTIVES

Streptococcus is a common cause of post-traumatic endophthalmitis in children. This study aimed to analyse the clinical features, antibiotic susceptibilities and outcomes of traumatic endophthalmitis caused by streptococcus in preschool children.

SUBJECTS/METHODS

Patients aged ≤6 years with traumatic streptococcal endophthalmitis seen at Zhongshan Ophthalmic Center between January 2013 and December 2018 were included in this retrospective study.

RESULTS

In total, 21 patients (21 eyes) were included. The mean age of the patients was 3.3 ± 1.7 years, where 57.1% were males. Scissors (28.6%, n = 6) were the most common cause of injury; 86.7% of patients were injured at home. Zone I (80.9%) was the most common wound site; 90.5% of patients presented with a traumatic cataract. In general, Streptococcus pneumoniae (47.6%) was the most common isolate. Viridans group streptococci accounted for 58.3% of cases in children aged 0-3 years, while S. pneumoniae accounted for 66.7% of cases in children aged 4-6 years. The susceptibility rates of streptococcus to cefuroxime, levofloxacin and ofloxacin were 100%, 95.0% and 90.5%, respectively. Although all the patients underwent vitrectomy combined with silicone oil tamponade, the final visual outcomes were no better than counting fingers.

CONCLUSIONS

Although S. pneumoniae was the most prevalent organism in general, the dominant species varied between different age groups. The commonly used antibiotics, cefuroxime and fluoroquinolone, showed higher antibiotic susceptibility. Despite prompt treatment, the visual outcomes of paediatric post-traumatic endophthalmitis in preschool children were poor.

Epidemiology, Etiologies, and Complications of Playtime Open Globe Injuries in Children

PURPOSE

To study the epidemiology, etiologies, and complications of playtime open globe injuries in children at the Assiut University Hospital, Egypt.

METHODS

This prospective cross-sectional study enrolled children with open globe injury who were admitted to Assiut University Hospital during a 6-month period (January to July 2016). All causes of trauma that occurred during playtime (at home, outside home, at the club, or at school) were recorded and analyzed.

RESULTS

Eighty-one children (age = 18 years and younger; mean ± standard deviation age = 8.35 ± 4.84 years) were admitted with open globe injury, and 32 of them (39.51%) sustained ocular trauma during playtime. The majority of children were boys (n = 23, 71.88%). The causes of trauma during playtime were: playing with sharp objects (n = 11; 34.38%), playing with a wooden stick (n = 7; 21.88%), falling on the ground (n = 5; 15.63%), trauma by a stone (n = 2; 6.25%), trauma during running (n = 1; 3.13%), playing with a plastic toy (n = 1; 3.13%), and unknown causes (n = 5; 15.63%). The sites of globe perforation were corneal (n = 23; 71.88%), corneoscleral (n = 8; 25%), and scleral (n = 1; 3.13%).

CONCLUSIONS

Playtime trauma that causes open globe injury and visual disability is avoidable and constituted approximately half of the open globe injuries in this study population. Corneal involvement occurred in almost all open globe injuries. Parental supervision for children during playtime is crucial to injury prevention. Children should avoid playing with sharp, dangerous objects and desist from playing or running on unsafe ground. [J Pediatr Ophthalmol Strabismus. 2021;58(6):385-389.].

Pediatric ocular trauma with pars plana vitrectomy in Southwest of China: clinical characteristics and outcomes

AIM

To investigate the clinical characteristics and predictive factors of pediatric ocular trauma patients with vitrectomy.

METHODS

Pediatric ocular trauma patients (aged 14y or younger) who received vitrectomy in Southwest Hospital between January 2007 and December 2017 were reviewed retrospectively. Age, gender, mechanism of injury, final visual acuity (VA), and prognostic factors were analyzed.

RESULTS

A total of 139 eyes in 139 pediatric patients were included in the study. The mean age was 7.4±3.7 years old and the male-to-female ratio was 5:1. There were 104 (74.8%) open globe injuries and 35 (25.2%) closed globe injuries. The top one traumatic eye injuries were penetrating injuries occur through sharp metal objects (43.9%). After vitrectomy, 116 patients had favorable anatomic outcome at the last follow-up, and 30 eyes (21.6%) achieved VA of 20/200 or better. Following univariate analysis, we found zone III injuries (P=0.021), poor initial VA (P=0.005), endophthalmitis (P=0.024), and recurrent retinal detachment (P<0.001) were poor prognostic factors for pediatric ocular trauma. After Logistic regression analysis, the poor initial VA (odds ratio: 8.276, 95%CI: 1.597-42.897, P=0.012) and recurrent retinal detachment (odds ratio: 6.455, 95%CI: 2.372-17.562, P<0.001) were significantly correlated with unfavorable vision outcome in pediatric ocular trauma.

CONCLUSION

The treatment of vitrectomy for severe ocular trauma results in favorable anatomic outcomes, but VA improvement is not as good as anatomic outcomes. Initial VA and recurrent retinal detachment are the independent prognostic indicators for unfavorable visual outcome of severe pediatric ocular trauma.

Surgical management and outcomes of pediatric open globe injuries requiring vitrectomy

PURPOSE

To describe surgical management and establish visual outcomes of open globe injury (OGI) in pediatric patients requiring vitrectomy.

METHODS

Forty-eight eyes of 48 pediatric patients underwent vitrectomy for OGI with secondary vitreoretinal complications in the eye center of Jilin University were included. Characteristics of patients, details of ocular examination and operation, presenting and final visual acuity were recorded.

RESULTS

Presenting visual acuity less than 20/400 was found in 44 eyes (91.7%), which included no light perception (NLP) in four eyes. At last visit, there was no eyes with visual acuity of NLP, and 19 eyes (39.6%) had a vision recovery to 20/400 or better. Mechanisms of injury, intraocular contents prolapse, presence of hyphema, intraocular foreign body, vitreous hemorrhage, retinal detachment, and total time from injury to PPV > 2 weeks were significant predictors of visual prognosis. Logistic regression analysis showed that hyphema was a significant predictive factor for poor visual outcome.

CONCLUSION

Visual acuity was improved in most of the patients with OGI in this study. Hyphema is an important presenting ocular sign in estimating the post-vitrectomy visual outcome for OGI in children. Proper timing of vitrectomy is suggested, and in this study patients may benefit more with early vitrectomy as less proliferative vitreoretinopathy (PVR) was found together with a better visual acuity.

Etiology, microbiological isolates, and antibiotic susceptibilities in culture-proven pediatric endophthalmitis: a 9-year review

Purpose

To analyze the etiology, microbiological isolates, and antibiotic susceptibilities of endophthalmitis in pediatric patients.

Methods

Patients aged < 18 years with culture-positive endophthalmitis in Zhongshan Ophthalmic Center between January 2010 and December 2018 were included retrospectively.

Results

A total of 127 patients (127 eyes) were included, and 108 (85%) had posttraumatic endophthalmitis. Streptococcus (21.4%), coagulase-negative Staphylococcus (14.5%), Aspergillus (6.9%), and Bacillus cereus (5.3%) were the common organisms. The proportion of Streptococcus decreased with age (40.0% in 0–3 years, 16.3% in 4–12 years, and 6.3% in 13–17 years), while coagulase-negative Staphylococcus increased from 5.7% to 18.8%. Overall, fluoroquinolones achieved the highest antibiotic susceptibility rate (> 95%), while the susceptibility of isolated bacteria to tobramycin and cefazolin was only 60.2% and 59.4%, respectively. The susceptibility rates of Gram-positive cocci to cephalosporins were nearly 90%. For Gram-negative bacilli, susceptibility to neomycin was 91.3%.

Conclusion

Trauma was the main etiology for pediatric endophthalmitis. Although Streptococcus was the most prevalent organism in general, the dominant pathogen varied with age, which merits clinical attention. Fluoroquinolones showed the highest antibiotic efficacy; however, commonly used antibiotics tobramycin and cefazolin showed relatively low antibiotic susceptibility. Thus, antibiotic resistance in pediatric populations merits clinical attention.

Application of pediatric ocular trauma score in pediatric open globe injuries

AIM

To evaluate the predictive value of pediatric penetrating ocular trauma score (POTS) on the visual outcome in children with open globe injury.

METHODS

A retrospective study in 90 children (60 males and 30 females) aged 1-15y (average, 7.48±2.86y) with penetrating ocular trauma was performed. Each patient's POTS was calculated. The effects of POTS on final visual acuity (FVA) were examined. Correlation between factors affecting POTS and the FVA was established.

RESULTS

All patients presented with single-eye trauma. The follow-up time was 3-21mo (average, 10.23±3.54mo). Among the 90 cases of penetrating wounds, 71 eyes (78.89%) were injured in Zone I (wound involvement limited to the cornea, including the corneoscleral limbus), 17 eyes (18.89%) were injured in Zone II (wound involving the sclera and no more posterior than 5 mm from the corneoscleral limbus), and 2 eyes (2.22%) were injured in Zone III (wound involvement posterior to the anterior 5 mm of the sclera). Analysis of POTS and FVA showed important correlation between them (r=0.414, P=0.000). Initial visual acuity (P=0.00), age (P=0.02), injury location (P=0.002), traumatic cataract (P=0.00), vitreous hemorrhage (P=0.027), retinal detachment (P=0.003), and endophthalmitis (P=0.03) were found to be statistically significant factors for the FVA outcome.

CONCLUSION

Ocular trauma presents serious consequences and poor prognosis in children. The POTS may be a reliable prognostic tool in children with open globe injury.

Epidemiology and prognostic factors of open globe injuries in a Tunisian pediatric population

INTRODUCTION

Childhood ocular trauma is a preventable cause of visual impairment and blindness worldwide. The purpose of our study was to determine demographic, etiologic, and clinical characteristics, visual outcome, and factors affecting visual prognosis in children with open globe injuries (OGI) and to analyze the predictive value of ocular trauma scoring systems for OGI in children.

METHODS

We conducted a retrospective study enrolling 120 pediatric patients hospitalized for OGI from January 2010 to March 2017. Age, gender, date of trauma, time between trauma and presentation, place and circumstances of injury, etiology, visual acuity (VA), wound location and type of injury based on the Birmingham Eye Trauma Terminology, and the clinical signs were recorded. We recorded the number of surgical procedures performed, complications and visual outcomes.

RESULTS

The mean age was 7.38 years. In all, 62.5% of the patients were male, and 37.5% were female. The gender ratio was observed to decrease with increasing age. The mean time interval between injury and consultation was 22.80±42.68hours. Injuries usually occurred at home (80%) followed by playgrounds and sports venues (8.3%), the street (6.7%) and school (5%). All of the OGI's were accidental, and the main context was play (70%). The most common traumas were penetrating injury (60.8%) and metal (30%) objects. Penetrating trauma accounted for 68.3% of cases, followed by rupture (27.5%) and intraocular foreign body (IOFB) (7.5%). Initial VA was<1/10 in 59.2% of cases, and the point of entry was the cornea in 65.8% of cases. Final VA was<1/10 in 39.69% of all cases. FVA was significantly correlated with BCVA prior to the surgery, mechanism of the trauma, wound location and size, and other associated lesions. The Ocular Trauma Score (OTS) and the Pediatric Ocular Trauma Score (POTS) were significantly correlated with final VA.

CONCLUSION

OGI's in children occurs most frequently in school-age boys. Prognosis is determined by presenting visual acuity, trauma score, and wound severity and location.

Surgical management of pediatric eye injuries

BACKGROUND:

Eye injury is a leading cause of unilateral childhood blindness. The purpose of this research was to study the management and visual outcome of pediatric eye injuries necessitating hospitalization and surgical repair.

MATERIALS AND METHODS:

This is a retrospective study of children having eye injury that needed surgical repair over the period of 2012 and 2017. Demographic data, place of occurrence, activity at the time of injury, place and cause of injury, presenting signs, surgical interventions, visual acuity (VA) before and after surgery, and causes for vision limitations were studied.

RESULTS:

Thirty-nine eyes of children were surgically treated. The mean (range) age of the patients was 3 years (1–15 years). Nearly 61.5% were males. Almost 80% of injuries occurred at home and while playing (71.8%). Trauma with sharp objects (35.8%) was the most common cause of injury. Majority presented to the hospital in <6 h (89%), mainly with eye pain (95%). Corneal laceration (53.8%), traumatic cataract (15.3%), and foreign body (15.3%) were the most common clinical findings. Twenty-one (53.8%) eyes sustained open-globe injuries. Fifteen percent had vision of 20/200 or worse at follow-up. The VA improved significantly at follow-up (P < 0.05). The major cause of vision limitation was the cornea (33%).

CONCLUSIONS:

Eye injury is a major cause of vision loss in children. Despite early presentation to our hospital and prompt interventions, significant number of our pediatric patients sustained limited VA in ruptured globe injuries.

The cereus matter of Bacillus endophthalmitis

Bacillus cereus (B. cereus) endophthalmitis is a devastating intraocular infection primarily associated with post-traumatic injuries. The majority of these infections result in substantial vision loss, if not loss of the eye itself, within 12-48 h. Multifactorial mechanisms that lead to the innate intraocular inflammatory response during this disease include the combination of robust bacterial replication, migration of the organism throughout the eye, and toxin production by the organism. Therefore, the window of therapeutic intervention in B. cereus endophthalmitis is quite narrow compared to that of other pathogens which cause this disease. Understanding the interaction of bacterial and host factors is critical in understanding the disease and formulating more rational therapeutics for salvaging vision. In this review, we will discuss clinical and research findings related to B. cereus endophthalmitis in terms of the organism's virulence and inflammogenic potential, and strategies for improving of current therapeutic regimens for this blinding disease.

Intraocular foreign body injury in children: clinical characteristics and factors associated with endophthalmitis

Background/Aims

To analyse the clinical characteristics of intraocular foreign body (IOFB) injury in children and evaluate factors associated with endophthalmitis development.

Methods

Patients aged <18 years with IOFB attending Zhongshan Ophthalmic Center between January 2003 and July 2016 were included retrospectively. Demographic features, clinical characteristics and factors associated with endophthalmitis development were analysed.

Results

Consecutive subjects (n=484, 484 eyes) were included: mean age 10.12±4.54 years, 86.4% male. Fireworks (28.5%) were the most common cause of injury. Injury of uncertain cause (17.5%), fireworks (36.7%) and metal splatter (31.7%) accounted for most injuries in the 0–3, 4–12 and 13–17 years age groups, respectively. Plant branches (16.7%) and fireworks (31.1%) were the most common causes of injuries in females and males, respectively. Endophthalmitis occurred in 116 patients (24.0%), with metallic IOFB (OR=0.338, p=0.001), intraocular haemorrhage (OR=0.100, p<0.001) and uveal tissue prolapse (OR=0.206, p<0.001) conferring lower risk, while zone II wound (OR=4.336, p<0.001) and traumatic lens rupture (OR=2.567, p=0.028) were associated with higher risk.

Conclusion

Clinical characteristics of children with IOFB injury differ from those of adults. Fireworks are the most common cause of injury, indicating a ban on children igniting fireworks should be advocated. Safety education and protective measures should vary by age and sex. Endophthalmitis is associated with zone II wound, traumatic lens rupture, IOFB material, intraocular haemorrhage and uveal tissue prolapse, which has clinical relevance.

A survey of incidental ocular trauma by pencil and pen

AIM

To determine characteristic features of ocular trauma resulted from self-trauma by writing instruments among pediatric population.

METHODS

Thirty-six children who suffered from self-inflicted ocular trauma with a writing instrument were included in this prospective cross-sectional study.

RESULTS

The mean age was 5.6±2.7y with male: female ratio of 1.77. The right eye was involved two times more than the left eye. The superomedial (55.5%) and inferomedial (30.6%) quadrants were the most common sites of injury. The leading culprit was colored pencils (44.4%). During surgical exploration, no foreign body (FB) was found in 25 (69.4%) patients while an FB was found in 11 (30.5%) patients. Brain injury was present in two patients (5.6%) and only in superomedial quadrant injuries. Zone 1 was the most common site for ocular trauma associated with penetrating injury. The mean ocular trauma score (OTS) in penetrating injuries was 3.8±1.2. The best corrected visual acuity (BCVA) was 0.3±0.6 upon admittance and 0.08±0.21 after one year. The final BCVA was significantly correlated with the entrance site, better final BCVA was found in nasal entrance site (P<0.05).

CONCLUSION

The ophthalmologists should keep a high index of suspicion to rule out penetrating eye injuries related to writing instruments in a young uncooperative child. Brain injury is a life-threatening event that should be ruled out by appropriate imaging. Medial canthal area as the most common site needs an especial attention in writing instrument injuries.

An Uncommon Meridional Globe Rupture due to Blunt Eye Trauma

Open globe injury (OGI) is a severe form of eye trauma. It is an important cause of monocular blindness worldwide. Ruptures from blunt trauma are most common at the sites where the sclera is thinnest, at the insertions of the extraocular muscles, and at the limbus. Most often, rupture is equatorial. We present a unique case of open globe injury due to blunt ocular trauma from a thrown rock that resulted in a meridional rupture of the eye. The pertinent literature is reviewed.

Pediatric Infectious Endophthalmitis: A 271-case Retrospective Study at a Single Center in China

Background:

Pediatric infectious endophthalmitis is a serious sight-threatening disease for children. The purpose of this study was to investigate the etiology, microbiological spectrum, and visual outcomes of infectious endophthalmitis in children at a single institution in China.

Methods:

It is a retrospective study of the medical records of all patients under 14 years of age with histories of infectious endophthalmitis, treated at a single institution from January 1, 2009 to January 1, 2015. The clinical characteristics, etiology, microbiological spectrum, and management, as well as the visual outcomes, were analyzed. The Kappa test and Chi-square test were used in the statistical evaluation.

Results:

A total of 271 children were identified, with a mean age of 5.61 ± 2.93 years (range 5 months to 14 years). Ocular trauma (94.8%) and previous ocular surgery (3.0%) were the most common etiologies. Overall, 147 (54.2%) cases had positive cultures, and 176 organisms were isolated from these patients. A single species was isolated in 120 (81.6%) cases, with multiple organisms in 27 (18.4%) cases, and the most commonly identified organisms were coagulase-negative Staphylococcus and Streptococcus species, comprising 29.5% and 26.8% of the isolates, respectively. Moreover, of 176 isolates, 142 (80.8%) were Gram-positive organisms, 23 (13.0%) were Gram-negative organisms, and 11 (6.2%) were fungi. The final visual outcomes were 20/200 or better in 66 (24.4%) eyes, counting fingers to 20/200 in 34 (12.5%), hand motions in 30 (11.1%), light perception in 33 (12.2%), no light perception in 32 (11.8%), and 9 (3.3%) eyes were enucleated or eviscerated. The visual outcomes were not available in 67 (24.7%) patients.

Conclusions:

Penetrating ocular trauma is the most frequent cause of pediatric endophthalmitis in China. Streptococcus and Staphylococcus species are the most commonly identified organisms in exogenous pediatric endophthalmitis whereas Fusarium species are commonly seen in endogenous endophthalmitis. In this research, in spite of aggressive management with antibiotics and vitrectomy, the visual prognosis was found to be generally poor.

A Possible Regression Equation for Predicting Visual Outcomes after Surgical Repair of Open Globe Injuries

Background. To analyze the effects of factors other than the ocular trauma score parameters on visual outcomes in open globe injuries. Methods. Open globe injuries primarily repaired in our hospital were reviewed. The number of surgeries, performance of pars plana vitrectomy (PPV), lens status, affected tissues (corneal, scleral, or corneoscleral), intravitreal hemorrhage, intraocular foreign body, glaucoma, anterior segment inflammation, loss of iris tissue, cutting of any prolapsed vitreous in the primary surgery, penetrating injury, and the time interval between the trauma and repair were the thirteen variables evaluated using linear regression analysis. Results. In total, 131 eyes with a mean follow-up of 16.1 ± 4.7 (12–36) months and a mean age of 33.8 ± 22.2 (4–88) years were included. The regression coefficients were 0.502, 0.960, 0.831, −0.385, and −0.506 for the performance of PPV, aphakia after the initial trauma, loss of iris tissue, penetrating injury, and cutting of any prolapsed vitreous in the primary surgery, respectively (P < 0.05 for these variables). Conclusions. The performance of PPV, aphakia after the initial trauma, and loss of iris tissue were associated with poor visual outcomes, whereas cutting any prolapsed vitreous in the primary repair and penetrating-type injury were associated with better visual outcomes.

Posttraumatic Endophthalmitis in children: Epidemiology, Diagnosis, Management, and Prognosis

Pediatric posttraumatic endophthalmitis presents with great complexities and challenges arising due to delayed presentation, difficulty in eliciting an accurate history, or trauma with unusual and highly contaminated objects. The possibility of initial misdiagnosis as panuveitis, metastatic endophthalmitis, and masquerade syndrome is also very high, which results not only in several unwarranted investigations being performed, but also a delay in the initiation of treatment. The standard treatment remains primary repair of the wound, intravitreal therapy with broad spectrum antibiotics, and parsplana vitrectomy. Despite appropriate intervention, visual outcome in children with posttraumatic endophthalmitis is dampened by additional factors like poor compliance with postoperative instructions and high risk of amblyopia. Hence, it is important to recognize that posttraumatic endophthalmitis in children differs from that in adults in several ways. We made a very tailored effort to review the published literature pertaining to posttraumatic endophthalmitis in children and herein present the results of our search.

Clinical characteristics and prognostic factors of scleral rupture due to blunt ocular trauma

PurposeTo describe and identify ocular and wound characteristics, and prognostic factors associated with final visual acuity (VA) in patients with scleral rupture due to blunt ocular trauma.MethodsThe medical records of 61 patients with globe rupture due to blunt ocular trauma who underwent primary repair were reviewed retrospectively. The data recorded included demographic characteristics, initial and final VA, ocular signs, wound characteristics, and surgeries. Initial VA, ocular signs, wound characteristics, and surgeries were analyzed to determine the association with the final VA.ResultsForty three women and 18 men with a mean age of 43.6±23.5 years were included in the study. The locations of scleral wounds were mostly in the superonasal quadrant (41.0%) and zone 2 (75.4%). In eyes with hyphema (P=0.009), vitreous hemorrhage (P=0.001), and retinal detachment (P=0.004), final VA was statistically worse than eyes without these signs. A moderate positive correlation was found between the initial and final VA (P<0.001). Final VA was statistically worse in eyes with horizontal midline wounds than in eyes with vertical midline wounds (P=0.002). A moderate negative correlation was found between scleral wound length and final VA (P<0.001). Patients who underwent cataract surgery had statistically better final VA (P=0.002).ConclusionsScleral rupture was detected mostly in females, superonasal quadrant and zone 2. Poor final VA was significantly associated with poor initial VA, longer wound length, horizontal midline wound, presence of hyphema, vitreous hemorrhage and retinal detachment at presentation, and cataract surgery not performed during follow-up period. Scleral ruptures have different demographic, ocular and wound characteristics than other open globe injuries.

An Important Cause of Blindness in Children: Open Globe Injuries

Objective. Our aim was to present and evaluate the predictive factors of visual impairment and blindness according to WHO criteria in pediatric open globe injuries. Methods. The medical records of 94 patients younger than 18 years who underwent primary repair surgery were reviewed retrospectively. The initial and final visual acuity, anterior and posterior segment findings, and zone of injury were noted. The patients were classified as blindness in one eye or visual impairment in one eye. Results. Of 412 patients who presented with open globe injury, 94 (23%) were under 18 years old. Fifty-four (16 females, 38 males) children were included. The mean age of the children was 7.1 ± 4.1 years. According to WHO criteria, 19 of 54 patients (35%) had unilateral blindness and 8 had unilateral visual impairment (15%). There was no significant relationship between final visual acuity and gender and injured eye. In visually impaired and blind patients, presence of preoperative hyphema, retinal detachment, and zone 2 and zone 3 injuries was significantly higher. Conclusion. Presence of hyphema and zone 2 and zone 3 injuries and retinal detachment may end up with visual impairment and/or blindness in children.

Pediatric open globe injury: A review of the literature

Open globe injury (OGI) is a severe form of eye trauma estimated at 2-3.8/100,000 in the United States. Most pediatric cases occur at home and are the result of sharp object penetration. The aim of this article is to review the epidemiology, diagnosis, management, and prognosis of this condition by conducting a systematic literature search with inclusion of all case series on pediatric OGI published between 1996 and 2015. Diagnosis of OGI is based on patient history and clinical examination supplemented with imaging, especially computed tomography when indicated. Few prospective studies exist for the management of OGI in pediatric patients, but adult recommendations are often followed with success. The main goals of surgical management are to repair the open globe and remove intraocular foreign bodies. Systemic antibiotics are recommended as medical prophylaxis against globe infection, or endophthalmitis. Other complications are similar to those seen in adults, with the added focus of amblyopia therapy in children. Severe vision decline is most likely due to traumatic cataracts. The ocular trauma score, a system devised to predict final visual acuity (VA) in adults, has proven to be of prognostic value in pediatric OGI as well. Factors indicating poor visual prognosis are young age, poor initial VA, posterior eye involvement, long wound length, globe rupture, lens involvement, vitreous hemorrhage, retinal detachment, and endophthalmitis. A thorough understanding of OGI and the key differences in epidemiology, diagnosis, management, and prognosis between adults and children is critical to timely prevention of posttraumatic vision loss early in life.

Point-of-service, quantitative analysis of ascorbic acid in aqueous humor for evaluating anterior globe integrity

Limited training, high cost, and low equipment mobility leads to inaccuracies in decision making and is concerning with serious ocular injuries such as suspected ruptured globe or post-operative infections. Here, we present a novel point-of-service (POS) quantitative ascorbic acid (AA) assay with use of the OcuCheck Biosensor. The present work describes the development and clinical testing of the paper-based biosensor that measures the changes in electrical resistance of the enzyme-plated interdigitated electrodes to quantify the level of AA present in ocular fluid. We have demonstrated the proof-of-concept of the biosensor testing 16 clinical samples collected from aqueous humor of patients undergoing therapeutic anterior chamber paracentesis. Comparing with gold standard colorimetric assay for AA concentration, OcuCheck showed accuracy of >80%, sensitivity of >88% and specificity of >71%. At present, there are no FDA-approved POS tests that can directly measures AA concentration levels in ocular fluid. We envisage that the device can be realized as a handheld, battery powered instrument that will have high impact on glaucoma care and point-of-care diagnostics of penetrating ocular globe injuries.

Characteristics of Open Globe Injuries in Preschool Children

PURPOSE

To evaluate the demographic, etiologic, and clinical characteristics of open globe injuries in preschool children.

METHODS

The medical files of preschool children who had an operation for an open globe injury from January 2003 to January 2013 were retrospectively analyzed. The patients' demographics and injury characteristics were recorded.

RESULTS

The study consisted of 44 preschool children with an open globe injury. The mean age was 4.38 ± 1.39 years. Most of the injuries occurred in boys (32/44). All patients were followed up for at least 3 months (mean, 8.47 ± 6.38 months; range, 3-24 months). The mean time between injury and operation was 10.40 ± 5.94 hours. Injuries happened most frequently at home (45.4%), and the most common cause of injury was kitchen items (25%). The final visual acuity could be evaluated only in 21 patients, and 90.4% of them had residual vision deficit.

CONCLUSIONS

Because open globe injuries occur most frequently at home or in the immediate surroundings of the house, higher awareness of parents and child care providers is extremely important to prevent these injuries in preschool children.

Clinical features and outcomes of vitrectomy in pediatric ocular injuries-eye injury vitrectomy study

Context:

Severe pediatric ocular injury remains a frequent and difficult problem. Vitrectomy is a major technique that has been used to manage severely damaged eyes. However, limited follow-up studies exist currently.

Aims:

To evaluate the clinical features and predictive factors of visual and anatomic outcomes in Eye Injury Vitrectomy Study (EIVS).

Settings and Design:

Retrospective, consecutive, interventional case series.

Materials and Methods:

Reviewing and analyzing records of children, aged 15 years or younger, who had undergone vitrectomy for eye injuries in EIVS database between January 1997 and December 2009.

Statistical analysis used:

Descriptive analyses and multiple Logistic regressions were employed for all variables using SPSS software (version 17.0, SPSS Inc.).

Results:

Eighty-seven children (89 eyes) with more than 6 months follow-up and complete records identified in EIVS were included in this study. Average follow-up was 12.7 months. The mean age was 9.4 ± 3.8 years. Seventy-seven eyes (86.5%) had open globe injuries, and 12 (13.5%) had closed globe injuries. Seventeen eyes (19.3%) presented with endophthalmitis. Seventy-five eyes (88.2%) presented with visual acuity of 4/200 or worse; however, 42 eyes (47.7%) achieved 4/200 or better vision with anatomical restoration after vitrectomy. Multiple analysis showed that choroidal damage, large scleral wound, and endophthalmitis were significantly associated with unfavorable outcome, the OR values were 16.7 (95% CI: 2.7-102.4, P = 0.002), 10.9 (95% CI: 1.7-71.6, P = 0.013), and 6.6 (95% CI: 1.0-42.4, P = 0.048), respectively.

Conclusions:

Vitrectomy intervention resulted in favorable visual and anatomic outcomes in almost half of the injured eyes. Choroidal damage, large scleral wound, and endophthalmitis were the prognostic indicators of unfavorable outcome.

Two kinds of ocular trauma score for paediatric traumatic cataract in penetrating eye injuries

PURPOSE

To compare the ocular trauma score (OTS) and the paediatric penetrating ocular trauma score (POTS) as prognostic model for visual outcome in paediatric traumatic cataract cases after penetrating eye injuries.

METHODS

All children younger than 16 years with unilateral traumatic cataract following penetrating trauma between 2007 and 2012 were retrospectively reviewed. Univariate chi-square analysis was conducted to identify the variables associated with profound visual loss. The area under the receiver-operating characteristic curves (AUROC) was used to assess the predictive ability of the two models.

RESULTS

The study group comprised 65 boys and 37 girls. The variables associated with profound visual loss were: a relative afferent papillary defect (RAPD) (P<0.001), poor initial vision (P=0.01), vitreous haemorrhage (P<0.001), retinal detachment (P<0.001), posterior penetrating site (P<0.001), hyphema (P<0.001), no intraocular len implantation (P<0.001) and endophthalmitis (P=0.001). OTS could not be calculated in 21 patients (20.6%) without clinical data on initial visual acuity and RAPD. For the patients with complete clinical data, POTS was similar to OTS in predicting poor vision (AUROC 0.904 vs 0.924) and in predicting good vision (AUROC 0.766 vs 0.736). For all the samples, POTS was a robust predictor of poor vision (AUROC 0.910) and had a moderate ability to predict good vision (AUROC 0.764).

CONCLUSION

OTS has high ability to predict visual outcome for paediatric traumatic cataract following penetrating ocular trauma. POTS is also a reliable prognostic model for very young child without initial vision or RAPD, but is only for penetrating eye injuries.

Prognostic Factors for Open Globe Injuries and Correlation of Ocular Trauma Score in Tianjin, China

Purpose. To investigate prognostic factors that influence the final visual acuity (VA) and to correlate the ocular trauma score (OTS) with the final VA in open globe injuries. Methods. A retrospective review of 298 patients with open globe injuries admitted to Tianjin Medical University General Hospital was carried out from January 1, 2010, till December 31, 2014. Prognostic factors influencing the final VA in patients with open globe injuries and the correlation between OTS and the final VA were examined. Results. Three hundred and fourteen eyes from 298 patients with open globe injuries were analyzed. Males had a higher rate of open globe injury than females (83.56% versus 16.44%). Mean age was 45.46 ± 17.48 years (5–95 years). In a univariate analysis, prognostic factors influencing the final VA included initial VA, relative afferent papillary defect (RAPD), vitreous hemorrhage, lens injury, endophthalmitis, hyphema, retinal detachment, and the zone of injury. In a multiple logistic regression analysis, initial VA, RAPD, and the zone of injury were considered to be independent risk factors. The OTS correlated with final VA (r = 0.988, p = 0.000). Conclusion. In our study, the most important prognostic factors influencing the final VA were initial VA, RAPD, and the zone of injury. The OTS was of great importance for patients and ophthalmologists.

Vitreous hemorrhage in pediatric age group

Purpose. To identify and study causes of vitreous hemorrhage (VH) in pediatric age group and to investigate factors predicting visual and anatomical outcomes. Procedure. A retrospective review of patients aged 16 years or less with the diagnosis of vitreous hemorrhage from January 2005 until December 2010. Results. A total number of 230 patients (240 eyes) were identified. Traumatic vitreous hemorrhage accounted for 82.5%. In cases of accidental trauma, final visual acuity of 20/200 was significantly associated with visual acuity of ≥20/200 at presentation and the absence of retinal detachment at last follow-up. Patients with nontraumatic vitreous hemorrhage were significantly younger with higher rates of enucleation/evisceration/exenteration and retinal detachment at last follow-up compared to traumatic cases. Conclusion. Trauma is the most common cause of VH in pediatric age group. In this group, initial visual acuity was the most important predictor for visual outcome, and the presence of retinal detachment is a negative predictor for final good visual outcome. The outcome is significantly worse in nontraumatic cases compared to traumatic cases.

Outcome of conjunctival flap repair for corneal defects with and without an acellular submucosa implant in 73 canine eyes

OBJECTIVE

To report and compare the success rate of a conjunctival pedicle flap (CPF) alone vs. a CPF with an underlying acellular submucosa implant for the repair of deep or perforating corneal wounds in dogs.

PROCEDURES

Records of 69 dogs (73 eyes) receiving a CPF with or without an acellular submucosa implant between 2004 and 2012 were reviewed. Successful outcome was defined as a comfortable eye with vision at the last post-operative evaluation. Age, breed, underlying corneal disease, surgical time, lesion characteristics, topical therapies, and postoperative complications were investigated.

RESULTS

Groups consisted of dogs that had a CPF alone (n = 37) and dogs that had a CPF plus an acellular submucosa implant (n = 36). Age, lesion size, surgical time, and time to discontinuation of topical anti-proteolytic medications was not significant between groups. Topical antibiotic use was terminated 13 days sooner (P ≤ 0.01) in dogs with an acellular submucosa implant. The combined success rate of all corneal wounds was 93% with success rate of corneal perforations, descemetoceles, and deep stromal wounds being 89%, 95%, and 100%, respectively. There was no difference in overall success rate between groups. Increasing age was associated with a negative outcome (P ≤ 0.01). Lesion size, presence of a corneal perforation, and concurrent keratoconjunctivitis sicca was not associated with a negative outcome.

CONCLUSIONS

A comparable success rate is achieved for deep or perforating corneal wounds stabilized with a CPF alone vs. a CPF plus acellular submucosa. Glaucoma, persistent uveitis, and cataract formation were not reported as post-operative complications in this study population.

Determination of visual prognosis in children with open globe injuries

AIMS

To determine the predictive factors of visual outcomes in children with open globe injury and to give guidance to reduce the incidence of open globe injury.

METHODS

One hundred and forty eyes of 137 consecutive open globe injury patients, who were treated at the Eye Center of Second Bethune Hospital affiliated with Jilin University between August 2005 and August 2012, were retrospectively analyzed. Data recorded included demographic characteristics, causes of injury, location and extent of injury, presenting visual acuity, detailed ocular anterior and posterior segment evaluations, details of primary and subsequent surgeries, and postoperative complications and outcomes. The follow-up data included the most recent best-corrected visual acuity, complications, and the duration of follow-up.

RESULTS

Of the 137 patients, there were 116 (84.7%) boys and 21 (15.3%) girls. Their ages ranged between 3 and 17 years old (mean=11.57±4.19 years old). Sixty (43.8%) children had a right eye injury, whereas 74 (54.0%) had a left eye injury. Only three (2.2%) children suffered bilateral eye injury. Living utensils, industrial tools, and fireworks contributed to the most common causes of open globe injury. Eighty-one (59.1%) had sharp force injuries, 23 (16.8%) had blunt injuries, and 33 (24.1%) had missile injuries.

CONCLUSIONS

Unfavorable visual outcomes were related to a younger age at presentation, poor presenting visual acuity, injuries caused by blunt or missile objects, posterior wound location, hyphema, vitreous hemorrhage, and surgical intervention of pars plana vitrectomy.

Pediatric infectious endophthalmitis: a review

Infectious endophthalmitis is a rare but severe complication of septecemia, intraocular surgeries, or penetrating eye trauma. The etiology, prognosis, and management of pediatric endophthalmitis resulting from exogenous and endogenous infections are reviewed. Open-globe trauma and glaucoma surgery are the most frequent causes of endophthalmitis in children, whereas endogenous infection is the least common cause. Streptococcus and Staphylococcus species are common bacterial agents in both posttraumatic and postoperative pediatric endophthalmitis, whereas Candida albicans is a commonly reported organism in endogenous endophthalmitis. Additionally, Streptococcus pneumoniae and Haemophilus influenzae appear more likely as pathogens in children than in adults. The clinical manifestations and outcome usually correlate with the virulence of the infecting organism. The visual prognosis of endophthalmitis is generally poor.

Characteristics and outcomes of pediatric open globe injury

To describe the epidemiology, mechanism of injury, and final visual and anatomical outcomes of pediatric patients with open globe injury. The medical records of patients aged ≤ 16 years diagnosed with open globe injury between January 2006 and December 2010 were retrospectively reviewed. Forty-nine pediatric patients were diagnosed with open globe injury during the study period. Forty-one of the 49 patients (83.7 %) were male. The mean age of the patients was 9.3 ± 4.6 years, with 49 % of the injuries occurring in patients between the ages of 11 and 16 years. Ocular penetration was the most common type of injury (63.3 %), occurring most frequently in the cornea (63.3 %). Wooden objects were the most common cause of injury. Following surgical intervention, 40.8 % of the patients obtained a final visual acuity (VA) of ≥ 6/60. Pars plana vitrectomy was performed in 51 % of cases, with only 36 % of these patients having a final VA of ≥ 6/60. The presence of retinal detachment was the only statistically significant factor (odds ratio 0.05, p < 0.001) that affected VA improvement of more than one line. Corneal penetration was frequently observed in pediatric patients with ocular trauma. Pediatric patients with a retinal detachment were significantly more likely to have a poor final visual outcome than open globe patients whose retina remained attached. Despite prompt surgical intervention, useful vision was preserved in less than half of the patients requiring pars plana vitrectomy.

Epidemiological and clinical features of paediatric open globe injuries in southwestern Turkey

AIM

To evaluate the epidemiologic, anatomic, and clinical features of open globe injuries in children.

METHODS

The medical files of patients under the age of 16 who had been operated for an open globe injury at Akdeniz University Hospital's Department of Ophthalmology were retrospectively evaluated.

RESULTS

A total of 90 patients were evaluated in this study. Among these patients, 26 (28.9%) were female and 64 (71.1%) were male. The mean age of the patients was 7.7±4.2 years. The male/female ratio was observed to increase with increasing age (P=0.006, r=7.48). Injuries were most likely to occur in spring and autumn (P=0.028). The time interval between the injury and the surgical repair was 9.36±27.4h. Forty (44.4%) of the injuries occurred in the home, 27 (30%) occurred in the yard, and 21 (23.3%) happened while playing in the street. The most common causes of injury were sharp metal objects (P<0.001). Injury to the cornea occurred in 47 (52.2%) of the patients (P<0.001). The most common complication to occur was cataract formation. Additional operations were necessary for 37 (41.1%) of the patients. The final visual acuity was correlated with both the initial visual acuity of the wounded eye prior to surgery and the length of the wound (P<0.001, r=0.502 and P<0.001, r=-0.442, respectively).

CONCLUSION

Open globe injuries that are suffered in childhood generally occur either at home, in the yard, or on the street, with sharp metal objects being the most common cause of injury. The initial visual acuity and the length of the wound are the most important determinants of the final visual acuity.

Proliferative vitreoretinopathy after eye injuries: an overexpression of growth factors and cytokines leading to a retinal keloid

Eye injury is a significant disabling worldwide health problem. Proliferative Vitreoretinopathy (PVR) is a common complication that develops in up to 40–60% of patients with an open-globe injury. Our knowledge about the pathogenesis of PVR has improved in the last decades. It seems that the introduction of immune cells into the vitreous, like in penetrating ocular trauma, triggers the production of growth factors and cytokines that come in contact with intra-retinal cells, like Müller cells and RPE cells. Growth factors and cytokines drive the cellular responses leading to PVR's development. Knowledge of the pathobiological and pathophysiological mechanisms involved in posttraumatic PVR is increasing the possibilities of management, and it is hoped that in the future our treatment strategies will evolve, in particular adopting a multidrug approach, and become even more effective in vision recovery. This paper reviews the current literature and clinical trial data on the pathogenesis of PVR and its correlation with ocular trauma and describes the biochemical/molecular events that will be fundamental for the development of novel treatment strategies. This literature review included PubMed articles published from 1979 through 2013. Only studies written in English were included.

Prediction of visual outcomes after open globe injury in children: a 17-year Canadian experience

PURPOSE

To analyze the predictive value of ocular trauma scoring systems for open globe injury in children, to determine risk factors for poor visual outcome, and to assess circumstances under which trauma occurs.

METHODS

The medical records of patients <18 years of age who presented with open globe injuries from January 1992 to December 2009 were examined retrospectively. Information recorded included demographic profile; date, time, and place of injury; cause and extent of injury; complications; and final best-corrected visual acuity. Injuries were classified by Ocular Trauma Classification Group guidelines.

RESULTS

A total of 131 patients were included. Final best-corrected visual acuity was ≥20/40 in 74 patients (56.5%) after mean follow-up of 24.8 months. Injuries occurred more commonly in boys (98/131), and 45% of injuries occurred in children aged ≤5 years (P = 0.001). Injuries were more common indoors (P = 0.003), in the afternoon (P < 0.001), and on Saturdays and Mondays (P = 0.004). Multiple regression analysis identified risk factors for final best-corrected visual acuity <20/40: age <5 years, injuries with retrolimbal involvement, wound length >5 mm, globe rupture, vitreous hemorrhage, and retinal detachment (P < 0.05).

CONCLUSIONS

Visual outcomes after pediatric open globe injury in this study compare favorably to results reported previously. Knowledge of weekly fluctuations in occurrence may help guide development of prevention strategies. Age <5 years is an independent risk factor for a poorer outcome. The ocular trauma score is useful in assessing prognosis after pediatric open globe injury.

An overview of penetrating ocular trauma with retained intraocular foreign body

Penetrating trauma is one of the common causes of ocular morbidity world wide. Violation of the globe integrity, also known as a ruptured globe is an ocular emergency that universally threatens vision. Prompt recognition and management is prudent. Here we report a case of a 26-year-old-female, university teacher, who presented with pain and sudden loss of vision in the left eye of 2 h duration subsequent to a test tube blast in the chemical laboratory. Examinations revealed a ruptured globe with vitreous haemorrhage and an intraocular glass foreign body in the left eye. Primary repair was done with good post operative visual recovery. We report this case to emphasize that protective measures should be taken to prevent such eye traumas.