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Cavaillé M, Martin G, Poignet B, Chapron T, Dureau P, Metge F, Caputo G. Intraocular foreign bodies in children: A retrospective case series. J Fr Ophtalmol 2024; 47:104188. [PMID: 38636198 DOI: 10.1016/j.jfo.2024.104188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/21/2023] [Accepted: 12/15/2023] [Indexed: 04/20/2024]
Abstract
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.
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Affiliation(s)
- M Cavaillé
- Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France.
| | - G Martin
- Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France
| | - B Poignet
- Ophthalmology Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - T Chapron
- Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France
| | - P Dureau
- Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France
| | - F Metge
- Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France
| | - G Caputo
- Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France
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Maheshwari M, Ho ML, Bosemani T, Dahmoush H, Fredrick D, Guimaraes CV, Gulko E, Jaimes C, Joseph MM, Kaplan SL, Miyamoto RC, Nadel HR, Partap S, Pfeifer CM, Pruthi S. ACR Appropriateness Criteria® Orbital Imaging and Vision Loss-Child. J Am Coll Radiol 2024; 21:S219-S236. [PMID: 38823946 DOI: 10.1016/j.jacr.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Orbital disorders in children consist of varied pathologies affecting the orbits, orbital contents, visual pathway, and innervation of the extraocular or intraocular muscles. The underlying etiology of these disorders may be traumatic or nontraumatic. Presumed location of the lesion along with the additional findings, such as eye pain, swelling, exophthalmos/enophthalmos, erythema, conjunctival vascular dilatation, intraocular pressure, etc, help in determining if imaging is needed, modality of choice, and extent of coverage (orbits and/or head). Occasionally, clinical signs and symptoms may be nonspecific, and, in these cases, diagnostic imaging studies play a key role in depicting the nature and extent of the injury or disease. In this document, various clinical scenarios are discussed by which a child may present with an orbital or vision abnormality. Imaging studies that might be most appropriate (based on the best available evidence or expert consensus) in these clinical scenarios are also discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Mai-Lan Ho
- Panel Vice Chair, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Hisham Dahmoush
- Lucile Packard Children's Hospital at Stanford, Stanford, California
| | - Douglas Fredrick
- Oregon Health & Science University-Casey Eye Institute, Portland, Oregon; American Academy of Pediatrics
| | | | - Edwin Gulko
- Westchester Medical Center, Valhalla, New York
| | - Camilo Jaimes
- Massachusetts General Hospital, Boston, Massachusetts
| | - Madeline M Joseph
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida; American College of Emergency Physicians
| | - Summer L Kaplan
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Committee on Emergency Radiology-GSER
| | - R Christopher Miyamoto
- Peyton Manning Children's Hospital at Ascension St. Vincent, Indianapolis, Indiana; American Academy of Otolaryngology-Head and Neck Surgery
| | - Helen R Nadel
- Lucile Packard Children's Hospital at Stanford, Stanford, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Sonia Partap
- Stanford University, Stanford, California; American Academy of Pediatrics
| | | | - Sumit Pruthi
- Specialty Chair, Vanderbilt Children's Hospital, Nashville, Tennessee
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Lu Y, Armstrong GW. Prognostic Factors for Visual Outcomes in Open Globe Injury. Int Ophthalmol Clin 2024; 64:175-185. [PMID: 38525990 DOI: 10.1097/iio.0000000000000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
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Grover AK. Ophthalmic trauma: Are we doing enough? Indian J Ophthalmol 2023; 71:3581-3583. [PMID: 37991286 PMCID: PMC10788738 DOI: 10.4103/ijo.ijo_2860_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Affiliation(s)
- Ashok K Grover
- Department of Ophthalmology, Sir Gangaram Hospital, Rajinder Nagar, New Delhi, India
- Chairman, Vision Eye Centres, Siri Fort Road and West Patel Nagar, New Delhi, India E-mail:
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Aksu-Ceylan N, Turgay Özbilen K, Karakiraz A. Characteristics of pediatric open globe injuries in preschool-aged and school-aged children. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:559-564. [PMID: 36368410 DOI: 10.1016/j.jcjo.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/30/2022] [Accepted: 10/15/2022] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Nihan Aksu-Ceylan
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Kemal Turgay Özbilen
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Arzu Karakiraz
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Vanathi M. Current perspectives on ocular trauma. Indian J Ophthalmol 2023; 71:3579-3580. [PMID: 37991285 PMCID: PMC10788749 DOI: 10.4103/ijo.ijo_2991_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Affiliation(s)
- Murugesan Vanathi
- Cornea & Ocular Surface, Cataract & Refractive Services, Dr R P Centre for Ophthalmic Sciences, All India Instittute of Medical Sciences, New Delhi, India E-mail:
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Pirhan D, Subasi S, Musaoğlu BK, Alparslan B, Karabaş L. The relationship between computed tomography findings and ocular trauma and pediatric ocular trauma scores in pediatric globe injuries: Does imaging have prognostic and diagnostic value? ULUS TRAVMA ACIL CER 2023; 29:1280-1287. [PMID: 37889035 PMCID: PMC10771248 DOI: 10.14744/tjtes.2023.72470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/27/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The aim of this study is to assess the relationship between computed tomography (CT) findings in open globe injuries (OGIs) in pediatric patients and the pediatric ocular trauma score (POTS) and OTS in pediatric ocular trauma. METHODS In 34 pediatric patients with OGI, CT findings were categorized into nine main categories: Scleral irregularity, lens dislocation, abnormal vitreous density, choroid-retinal layer thickening, preseptal thickness increase, intraocular foreign body and air, vitreous hemorrhage, retinal detachment, and perforation. The relationship between different types and numbers of CT findings and the POTS and OTS was evaluated. RESULTS The mean age of trauma was 6.6±3.1. Of the patients, 9 (26.5%) were female and 25 (73.5%) were male. The most com-mon CT findings are scleral irregularity and increased preseptal thickness (47.1%). In univariate analysis, a P<0.05 was found between 16 patients with 1 or less CT findings (median POTS value 80 [71.25-90.0]) and 11 patients with 2 or 3 CT findings (median POTS value 60 [15-70]). A P<0.05 was found between 16 patients with 1 or less CT findings (median POTS value 80 [71.25-90.0]) and 7 patients with 4 or more CT findings (median POTS value 45 [25-80]). A P > 0.05 was found between 11 patients with 2 or 3 CT findings (median POTS value 60 [15-70]) and 7 patients with 4 or more CT findings (median POTS value 45 [25-80]). No significant difference was found between the number of CT findings and OTS stages. While POTS was significant (P<0.05) in patients with ab-normal vitreous density (median 45 [30-69.6]), OTS value was not significant (P>0.05). There was no significant difference between POTS and OTS in other CT findings. CONCLUSION The number of CT findings may assist in predicting POTS and, consequently, estimating visual prognosis in pediatric patients with OGI. In emergency situations where, sufficient clinical data are unavailable, the objective findings from CT may help in assessing the severity of ocular trauma and potentially predicting long-term visual outcomes.
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Affiliation(s)
- Dilara Pirhan
- Department of Ophthalmology, Kocaeli University, School of Medicine, Kocaeli, Türkiye
| | - Sevgi Subasi
- Department of Ophthalmology, Kocaeli University, School of Medicine, Kocaeli, Türkiye
| | - Büşra Kurt Musaoğlu
- Department of Ophthalmology, Kocaeli University, School of Medicine, Kocaeli, Türkiye
| | - Burcu Alparslan
- Department of Radiology, Kocaeli University, School of Medicine, Kocaeli, Türkiye
| | - Levent Karabaş
- Department of Ophthalmology, Kocaeli University, School of Medicine, Kocaeli, Türkiye
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Speidel AJ, Wolf A, Peraud A, Schuler-Ortoli M, Parlak M. [Orbital impalement injury in childhood: the importance of imaging and interdisciplinary treatment]. DIE OPHTHALMOLOGIE 2023; 120:860-862. [PMID: 36074169 DOI: 10.1007/s00347-022-01724-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/01/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Affiliation(s)
- A J Speidel
- Klinik für Augenheilkunde, Universitätsklinik Ulm, Ulm, Deutschland.
- Universitätsaugenklinik Ulm, Prittwitzstr. 43, 89075, Ulm, Deutschland.
| | - A Wolf
- Klinik für Augenheilkunde, Universitätsklinik Ulm, Ulm, Deutschland
| | - A Peraud
- Klinik für Neurochirurgie, Sektion pädiatrische Neurochirurgie, Universitätsklinik Ulm, Ulm, Deutschland
| | - M Schuler-Ortoli
- Klinik für Neurochirurgie, Sektion pädiatrische Neurochirurgie, Universitätsklinik Ulm, Ulm, Deutschland
| | - M Parlak
- Klinik für Augenheilkunde, Universitätsklinik Ulm, Ulm, Deutschland
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Chen V, Pharr C, Junn S, Kraus CL, Fliotsos M, Park HJ, Alexander JL, Woreta F, Carey GB, Levin MR. Baltimore pediatric ocular trauma study: Health disparities and outcomes in pediatric and adolescent open globe trauma. Injury 2023; 54:533-539. [PMID: 36384857 DOI: 10.1016/j.injury.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 10/11/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
Abstract
Purpose Children represent approximately one-third of patients with serious ocular injuries. Our study evaluates associations between race and socioeconomic status in presentation and outcomes of pediatric and adolescent traumatic open globe injuries. Methods We conducted a retrospective chart review of traumatic open globe injuries in pediatric and adolescent patients presenting to Johns Hopkins Hospital and University of Maryland Medical Center between 2006 and 2020. Variables assessed included age, gender, parent-identified race, median household income, mechanism of injury, initial and final visual acuity (VA), and length of follow-up. Results Eighty patients ranging from 4 months to 17.7 years (mean 9.3 years) presented with traumatic open globe injury. Identifications were 28 White (35%), 38 Black (48%), and 5 Hispanic (6%). Initial presenting and final VA, pediatric ocular trauma score (POTS), and length of follow-up did not differ significantly among race, gender, or income. Black patients had higher rates of blunt trauma (odds ratio (OR) 3.81; 95% confidence interval (CI) 0.95-15.24, p = 0.07), uveal prolapse (OR 3.58; 95% CI 1.03-12.43; p = 0.049), and enucleation (OR 10.55; 95% CI 1.26-88.31). Hispanic patients presented at a younger age of 2.8 years mean age vs. 9.9 years (p = 0.004) for others. Conclusion Visual outcomes following traumatic open globe injury were independent of race, gender, or income. However, blunt trauma, uveal prolapse, and enucleation rates were higher in Black patients, and ocular trauma occurred at a younger age in Hispanic patients.
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Affiliation(s)
- Victoria Chen
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Courtney Pharr
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Sue Junn
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Courtney L Kraus
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, United States
| | - Michael Fliotsos
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, United States
| | - Hee-Jung Park
- Virginia Mason Medical Center, Seattle, WA, United States
| | - Janet L Alexander
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Fasika Woreta
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, United States
| | - Gregory B Carey
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Moran R Levin
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, United States.
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Porapaktham T, Choovuthayakorn J, Nanegrungsunk O, Phinyo P, Tanasombatkul K, Watanachai N, Kunavisarut P, Chaikitmongkol V, Patikulsila D. Open Globe Injury in a Tertiary Hospital of Northern Thailand: No Vision Survival and Ocular Trauma Score. Clin Ophthalmol 2023; 17:365-373. [PMID: 36721667 PMCID: PMC9884457 DOI: 10.2147/opth.s401643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Purpose To determine characteristics and factors associated with no vision survival (included no light perception, enucleation, and evisceration) following open globe injury (OGI) and to correlate the proportion of final vision to predictive values of ocular trauma score (OTS). Patients and Methods The medical records of consecutive patients diagnosed as OGI between January 2015 and December 2020 were retrospectively reviewed. Data collected included demographics, mechanisms and modes of injuries, ophthalmic presentations, managements, and visual outcomes at the final visit. Results Three hundred and seventy-one patients with a mean (standard deviation, SD) age of 44.0 (17.4) years were included. Male with workplace injury was the most frequent scenario. High-velocity metallic objects were the predominant causative materials. Following treatments, fifty-six eyes (14.9%) obtained no vision survival. Factors associated with no vision survival following OGI were low presenting vision, globe perforation, larger wound, presence of relative afferent pupillary defect, retinal detachment, and vitreous hemorrhage. Compared to OTS predictive values, eyes in OTS categories 1 and 2 had a lower proportion of no vision survival. Conclusion This study identified the importance of workplace injuries. Overall, there were comparable final visions between OTS and this study. However, a reduced proportion of no vision survival among severely injured eyes signifies the challenges of OGI management.
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Affiliation(s)
- Tuangprot Porapaktham
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Janejit Choovuthayakorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Correspondence: Janejit Choovuthayakorn, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, 110 Intavaroros Road, Maung, Chiang Mai, 50200, Thailand, Tel +66 53 935512, Fax +66 53 936121, Email
| | - Onnisa Nanegrungsunk
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Musculoskeletal Science and Translational Research (MSTR), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Krittai Tanasombatkul
- Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nawat Watanachai
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Voraporn Chaikitmongkol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Direk Patikulsila
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Prognosis of Open Globe Injuries at a Tertiary Referral Center: The Modified Florida Ocular Trauma Score. Am J Ophthalmol 2022; 244:152-165. [PMID: 36007553 DOI: 10.1016/j.ajo.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To analyze vision outcomes after open globe injury and propose modifications to the ocular trauma score to offer more specific vision prognoses. DESIGN Validity and reliability analysis. METHODS Patients presenting to the University of Florida with a new open globe injury from October 2015 to January 2021 with subsequent follow-up were included in the study. Demographics, ophthalmic history, trauma details, timeline, imaging, operative findings, and ocular examinations were collected from the medical record. Z tests, χ2 test, Fisher exact test, receiver operating characteristic curve, and ordinal correlation were used. A weighted logistic model was optimized to predict vision outcomes. Measured outcomes included the best-corrected visual acuity, Ocular Trauma Score category, and performance of vision prognosis scores. RESULTS A total of 162 eyes were identified from chart review. Eighty percent of the Ocular Trauma Score categories were accurate. Only the absence of orbital fractures was associated with a significant weight in the logistic model, which produced more accurate prognoses for 59 patients, and less accurate prognoses for 30 patients compared to the Ocular Trauma Score. Kendall Tau-B was 0.639 for the logistic model and 0.582 for the Ocular Trauma Score. CONCLUSIONS The Ocular Trauma Score accurately estimates vision prognosis after open globe injury. We propose inclusion of orbital fracture status in our Modified Florida Ocular Trauma Score. This addended score is more correlated with final vision outcome and provides more specific prognoses for severe open globe injuries. Prospective, multicenter validation is needed to refine and confirm the use of this new scoring system.
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PİRHAN D, SUBASİ S, DEMİRCİ KUCUK K. Pediatrik Hastalarda Oküler Travmaların Etiyolojik Özellikleri ve Görsel Sonuçları. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.30934/kusbed.1150458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Amaç: Açık glob yaralanması (AGY) nedeni ile acil kliniğimize başvuran, tedavi ve takibi yapılan 60 pediatrik olgunun demografik özelliklerini ve prognozu etkileyen faktörleri araştırmak.
Yöntem: Kliniğimizde 2010-2021 yılları arasında AGY nedeni ile ameliyat edilip, en az bir yıl takip yapılmış olan 16 yaş ve altı 69 olgunun dosya kayıtları retrospektif olarak incelendi. Kayıtlardan AGY’nin tipi, oluş nedeni, eşlik eden muayene bulguları, hastaneye başvuru zamanı ile ilk ve son görme keskinlikleri (GK), ek cerrahileri kaydedildi.
Bulgular: Olguların ortalama yaşı 11±5 yıl idi. %17,4’si kız %82,6’sı erkek idi. AGY’nin şekli en sık korneal kesi, en sık etiyolojik nedeni kesici ve delici aletler (%65,1) oluşturmakta idi. Olguların %87 sinde sadece bölge 1, %40,6 sında bölge 2, %13 ünde bölge 3 etkilenmişti. Olguların %37,7 sinde relatif afferent pupil defekti (RAPD) vardı. %5,8’i rüptür, %8,7’si retina dekolmanı, %2,9’u endoftalmi, %4,3’ü perforan yaralanma idi. Olguların başvuru anında %7’sinde GK değerlendirilemezken, %60’ında 0.1 ve daha altında, %25,7’sinde 0.1-0,6. %4,3’ünde ise 0.6’dan daha iyi GK’ya sahipti. Olguların takiplerinde 6. ayda ise %2,9’ unda GK değerlendirilemezken (inop), %11,4’ ünde 0.1 ve daha altında, %25,7’sinde 0.1-0.6 ve %60’ında ise 0.6’dan daha iyi GK’ya sahipti. Oküler travma skoru (OTS) 74±16, pediatrik oküler travma skoru (POTS) 64±19 idi. OTS başlangıçtaki GK ile orta derecede ilişkili (r=0,687, p<0,001), takipteki GK ile orta derecede ilişkili (r=0,611, p<0,001) idi. Pediatrik oküler travma skorunun korelasyon değerleri ise daha düşük bulundu (başlangıç GK ile r=0,574, p<0,001).
Sonuç: Pediatrik AGY’de görsel prognozu tahmin edebilmek için RAPD değerlendirilemediğinde bile OTS güvenilir bir araçtır.
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Affiliation(s)
- Dilara PİRHAN
- KOCAELİ ÜNİVERSİTESİ, TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, GÖZ HASTALIKLARI ANABİLİM DALI
| | - Sevgi SUBASİ
- KOCAELİ ÜNİVERSİTESİ, TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, GÖZ HASTALIKLARI ANABİLİM DALI
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Junn S, Pharr C, Chen V, Williams K, Alexander J, Park HJ, Kraus C, Levin MR. Sensorimotor Outcomes in Pediatric Patients With Ocular Trauma in Baltimore. J Pediatr Ophthalmol Strabismus 2022; 59:303-309. [PMID: 35192378 DOI: 10.3928/01913913-20220126-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate sensorimotor outcomes following traumatic open globe injuries in the pediatric population. METHODS A retrospective cohort of 80 pediatric patients aged 0.4 to 17.7 years (mean age: 9.3 years, median age: 8.3 years) presenting with traumatic open globe injury to the Johns Hopkins and University of Maryland Medical Centers was evaluated between January 2006 and January 2020. Parameters included the mechanism of injury, length of time of visual deprivation, initial and final visual acuity, additional eye pathologies, and demographic factors such as age and sex. RESULTS Among children with more than 6 months of follow-up, 77.4% developed poor stereopsis and 50% developed strabismus. Children who developed strabismus had a lower Pediatric Ocular Trauma Score (POTS), indicating greater severity of injury, than children who did not develop strabismus (P = .005, chi-square test). A higher POTS, indicating less severe ocular injury, significantly correlated to a better stereoacuity (P = .001, chi-square test). CONCLUSIONS The findings indicate that strabismus and poor stereopsis are common in pediatric open globe injuries, occurring in more than half of children with pediatric open globe trauma. These outcomes are associated with poor presenting visual acuity, more severe ocular trauma, and a lower presenting POTS. [J Pediatr Ophthalmol & Strabismus. 2022;59(5):303-309.].
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14
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Irawati Y, Ardiani LS, Gondhowiardjo TD, Hoskin AK. Predictive value and applicability of ocular trauma scores and pediatric ocular trauma scores in pediatric globe injuries. Int J Ophthalmol 2022; 15:1352-1356. [PMID: 36017051 DOI: 10.18240/ijo.2022.08.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/26/2022] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the predictive value and applicability of Ocular Trauma Score (OTS) and Pediatric Ocular Trauma Score (POTS) for closed and open globe injuries in the pediatric group. METHODS A retrospective study of closed and open globe injuries in children age of 0-18-year-old between 2012-2019 was conducted. Medical records were collected, and injuries were classified using Birmingham Eye Trauma Terminology System (BETTS). The predictive value and applicability of both OTS and POTS to final visual acuity (VA) were analyzed. RESULTS Of 84 patients, 59 (70.2%) presented with closed globe injuries (CGI) and 25 (29.8%) with open globe injuries (OGI). The mean of initial VA was 0.832±0.904 logMAR. OTS and POTS was calculated. Initial VA (P<0.001) and traumatic cataract (P<0.001) were significantly associated with visual outcome, followed by organic/unclean wound (P=0.001), delay of surgery (P=0.001), iris prolapse (P=0.003), and globe rupture (P=0.008). A strong correlation between OTS and POTS and final VA (r=-0.798, P<0.001; r=-0.612, P<0.001) was found. OTS was more applicable in all age group of pediatric and in contrast to POTS, it was designed for 0-15 years old. POTS requires eleven parameters and OTS six parameters. Even though initial VA was not available, we could still calculate into POTS equation. CONCLUSION OTS and POTS are highly predictive prognostic tools for final VA in CGI and OGI's in children.
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Affiliation(s)
- Yunia Irawati
- Division of Plastic and Reconstructive Surgery, Department of Ophthalmology, Faculty of Medicine, University of Indonesia, dr. Cipto Mangunkusumo Hospital, Jalan Kimia No.8, Jakarta 10430, Indonesia.,JEC Eye Hospitals and Clinics, Jalan Cik Ditiro 46, Menteng, Jakarta 10310, Indonesia
| | - Lily Silva Ardiani
- JEC Eye Hospitals and Clinics, Jalan Cik Ditiro 46, Menteng, Jakarta 10310, Indonesia
| | | | - Annette K Hoskin
- Save Sight Institute, The University of Sydney, Sydney, South Block, Sydney Eye Hospital, 8 Macquarie Street, Sydney NSW 2000, Australia.,Lions Eye Institute, Department of Ophthalmology, The University of Western Australia, 2 Verdun Street, Nedlands WA 6009, Australia
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15
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Zhou Y, DiSclafani M, Jeang L, Shah AA. Open Globe Injuries: Review of Evaluation, Management, and Surgical Pearls. Clin Ophthalmol 2022; 16:2545-2559. [PMID: 35983163 PMCID: PMC9379121 DOI: 10.2147/opth.s372011] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yujia Zhou
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL, USA
- Correspondence: Yujia Zhou, Department of Ophthalmology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32608, USA, Tel +1 305 342-9166, Email
| | - Mark DiSclafani
- Department of Ophthalmology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Lauren Jeang
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Ankit A Shah
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL, USA
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16
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Shah S, Shah M, Gunay R, Kataria A, Makhloga S, Vaghela M. New model for the prediction of visual outcomes in young children with mechanical ocular conditions and comparison with other models. Indian J Ophthalmol 2022; 70:3045-3049. [PMID: 35918970 DOI: 10.4103/ijo.ijo_3144_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose Herein, we compared the efficacy among the Ocular Trauma Score (OTS), Toddlers Ocular Trauma Score (TOTS), and Pediatric Ocular Trauma Score (POTS) for prognosis prediction in Indian children who had mechanical ocular conditions causing traumatic cataract. Methods This prospective, interventional study recruited consecutive children undergoing operation for traumatic cataracts caused by mechanical eye injuries at Drashti Netralaya. The following details were obtained from their medical files: the circumstance and time of injuries, penetrating injury type, initial and final visual acuity (VA), time of operation, and associated eye diseases. Specific variables were employed to determine the OTS, TOTS, and POTS. For all patients, the final and predicted VA determined using all scores were compared using Fischer's exact test. Accuracy, specificity, and sensitivity were evaluated for all the scores by using the area under receiver operating characteristic curve. Results We enrolled 124 eyes. Patients' mean value for age was 4.6 ± 1.29 years; 44 (35.41%) and 74 (64.5%) were female and male patients, respectively. Visual outcomes significantly improved after operation, and the outcomes did not differ between closed- and open-globe injuries (P = 0.162). The actual and predicted VA did not exhibit a statistically significant difference among the three scores. TOTS and POTS were more suitable for evaluating low-risk injuries, whereas the OTS could more efficiently examine high-risk cases. Conclusion TOTS and POTS were more accurate than the OTS in VA prediction after operation in toddlers with traumatic cataracts caused by mechanical globe injury. TOTS and POTS were more suitable for evaluating low-risk injuries, whereas the OTS could more efficiently examine high-risk cases. All the examined scores can be helpful in estimating VA following treatment.
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Affiliation(s)
- Shreya Shah
- Vitreo Retina, Drashti Netralaya, Dahod, Gujarat, India
| | - Mehul Shah
- Vitreo Retina, Drashti Netralaya, Dahod, Gujarat, India
| | - Ruhi Gunay
- Vitreo Retina, Drashti Netralaya, Dahod, Gujarat, India
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Hoskin AK, Fliotsos MJ, Rousselot A, Ng SMS, Justin GA, Blanch R, Colyer MH, Shukla B, Natarajan S, Kuhn F, Sundar G, Woreta FA, Watson SL, Agrawal R. Globe and Adnexal Trauma Terminology Survey. JAMA Ophthalmol 2022; 140:819-826. [PMID: 35862061 DOI: 10.1001/jamaophthalmol.2022.2594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Ocular trauma terminology should be periodically updated to enable comprehensive capturing and monitoring of ocular trauma in clinical and research settings. Objective To update terminology for globe and adnexal trauma. Design, Setting, and Participants A 2-round modified Delphi survey was conducted from January 1 to July 31, 2021, using an expert panel, including 69 ophthalmologists identified through their membership in ophthalmology (globe and adnexal trauma) societies. Consensus was defined as at least 67% expert agreement. A steering committee developed questions after identifying gaps in the current terminology via a targeted literature review. Round 1 sought consensus on existing and newly proposed terminology, and round 2 focused on unresolved questions from round 1. Experts included ophthalmologists who had managed, on average, 52 globe or adnexal trauma cases throughout their careers and/or published a total of 5 or more globe or adnexal trauma-related peer-reviewed articles. Main Outcomes and Measures Expert consensus on ocular and adnexal terms. Results A total of 69 experts participated in and completed round 1 of the survey. All 69 participants who completed round 1 were asked to complete round 2, and 58 responses were received. Consensus was reached for 18 of 25 questions (72%) in round 1 and 4 of 7 questions (57%) in round 2. Existing Birmingham Eye Trauma Terminology system terminology achieved consensus of 84% (58 of 69 experts) in round 1 and 97% (56 of 58 experts) in round 2. Experts agreed on the need for further refinement of the definition of zones of injury (55 of 69 [80%]), as the zone affected can have a substantial effect on visual and functional outcomes. There was consensus that the mechanism of injury (52 of 69 [75%]) and status of the lacrimal canaliculi (54 of 69 [78%]), nasolacrimal ducts (48 of 69 [69%]), lens (46 of 58 [80%]), retina (42 of 58 [73%]), and central and paracentral cornea (47 of 58 [81%]) be included in the revised terminology. Conclusions and Relevance There was consensus (defined as at least 67% expert agreement) on continued use of the existing Birmingham Eye Trauma Terminology system definitions and that additional terms are required to update the current ocular trauma terminology.
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Affiliation(s)
| | - Michael J Fliotsos
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrés Rousselot
- Consultorios Oftalmológicos Benisek Ascarza, Buenos Aires, Argentina
| | | | - Grant A Justin
- Duke Eye Centre, Duke University Hospital, Durham, North Carolina
| | - Richard Blanch
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom.,Department of Ophthalmology, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom.,Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Marcus H Colyer
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Bhartendu Shukla
- Department of Ophthalmology, Gajra Raja Medical College, Gwalior, India.,Regional Institute of Ophthalmology, Bhopal, India.,Ratan Jyoti Netralaya Ophthalmic Institute, Gwalior, India
| | | | - Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, Alabama.,Department of Ophthalmology, University of Pécs Medical School, Pécs, Hungary
| | - Gangadhara Sundar
- Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Hospital of Singapore, Singapore.,Department of Pediatrics, National University Hospital of Singapore, Singapore
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Singapore, Singapore.,Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Duke National University of Singapore Medical School, Singapore, Singapore Eye Research Institute, Singapore
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Cohen E, Antman G, Katzburg E, Cohen N, Varssano D, Glatz MM, Dotan G. A modified pediatric ocular trauma score for predicting visual outcome post open globe injury. Graefes Arch Clin Exp Ophthalmol 2022; 260:3711-3718. [PMID: 35729409 DOI: 10.1007/s00417-022-05723-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/21/2022] [Accepted: 05/27/2022] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Eyal Cohen
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 64239, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gal Antman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Ophthalmology Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Etti Katzburg
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 64239, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Neta Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Emergency Medicine, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - David Varssano
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 64239, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marlene M Glatz
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Gad Dotan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Ophthalmology Unit, Schneider Children's Medical Center, Petah Tikva, Israel
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Günaydın NT, Oral AYA. Pediatric traumatic cataracts: 10-year experience of a tertiary referral center. BMC Ophthalmol 2022; 22:199. [PMID: 35501774 PMCID: PMC9063203 DOI: 10.1186/s12886-022-02427-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/26/2022] [Indexed: 11/22/2022] Open
Abstract
Background This study aimed to evaluate the factors influencing final visual acuity in pediatric traumatic cataracts. Methods Data of patients who presented with traumatic cataracts were reviewed retrospectively. We evaluated age at trauma; gender, trauma type, cause, and zone; duration between the time of trauma and cataract surgery; surgical method used; time, location, and type of intraocular lens (IOL) implantation; initial and final best corrected visual acuity (BCVA); amblyopia rate; and complications. Results In all, 61 eyes of 59 patients aged < 16 years with cataracts after trauma were included. The mean age of the children was 7.2 ± 3.9 years. Primary IOL implantation was performed in 70.9% of eyes. The BCVA was 0.7 LogMAR or better in 5.9% of the 49 eyes in which the visual acuity could be measured at the time of trauma and in 69.1% of 55 eyes in which it could be measured after treatment. Evaluation of factors potentially influencing the final visual acuity revealed that eyes that had undergone posterior capsulotomy (PC) and anterior vitrectomy (AV) during cataract surgery had significantly better final visual acuity compared with eyes that did not undergo these procedures. Conclusions In children with posttraumatic cataracts, final visual acuity was not affected by patient age and gender; trauma type, cause, and zone; duration between the time of trauma and cataract surgery; surgical method used; and time, location, and type of intraocular lens (IOL) implantation. Improvements in the final BCVA could be seen only by PC + AV combined with lens aspiration with or without IOL implantation. However, this approach of amblyopia treatment needs to be confirmed by more comprehensive and prospective studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02427-6.
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Affiliation(s)
- Nesrin Tutaş Günaydın
- Department of Ophthalmology, University of Health Sciences, Dr. Lütfi Kırdar Kartal City Hospital, Denizer Cad. No:1, 34865, Cevizli, 34100, İstanbul, Turkey.
| | - Ayşe Yeşim Aydın Oral
- Department of Ophthalmology, Afyonkarahisar University of Health Sciences, 03200, Afyonkarahisar, Turkey
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20
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Surgical Antimicrobial Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Eye Surgery: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:antibiotics11050561. [PMID: 35625205 PMCID: PMC9137626 DOI: 10.3390/antibiotics11050561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 01/25/2023] Open
Abstract
Ocular surgery encompasses a wide range of procedures, including surgery of the tear ducts, eyelid, cornea and conjunctiva, lens, ocular muscle, and vitreoretinal and iris surgery. Operations are also performed for the removal of tumors, repairs of ocular trauma and, finally, corneal transplantation. Antibiotic prophylaxis for the prevention of surgical site infections (SSIs) in ocular surgery is a complex field in which shared lines of action are absent. In light of the scarcity of shared evidence in the use of ocular antimicrobial prophylaxis for the pediatric population, this consensus document aims to provide clinicians with a series of recommendations on antimicrobial prophylaxis for patients of neonatal and pediatric age undergoing eye surgery. The following scenarios are considered: (1) intraocular surgery; (2) extraocular surgery; (3) ocular trauma; (4) ocular neoplasm; (5) ocular surface transplantations; (6) corneal grafts. This work has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies and represents, in our opinion, the most complete and up-to-date collection of recommendations regarding clinical actions in the peri-operative environment in eye surgery. The application of uniform and shared protocols aims to improve surgical practice, through the standardization of procedures, with a consequent reduction of SSIs, also limiting the phenomenon of antimicrobial resistance.
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21
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Silva-Filho GV, Morgan-Kanada AM, Kasahara N. Predictive values of the Pediatric Penetrating Ocular Trauma Score and the Toddler/Infant Ocular Trauma Score in Brazilian children with open globe injury. Clin Exp Emerg Med 2022; 9:41-46. [PMID: 35354234 PMCID: PMC8995519 DOI: 10.15441/ceem.21.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study compared the prognostic value of the Pediatric Penetrating Ocular Trauma Score (POTS) with the Toddler/Infant Ocular Trauma Score (TOTS) in a cohort of Brazilian children with open-globe injuries.Methods This retrospective, observational case series included consecutive children with open-globe injuries seen at the Santa Casa de Sao Paulo Eye Emergency Service. The medical records of all patients were reviewed for data analysis, including the circumstance and time of injury, type of penetrating injury, initial and final visual acuity (VA), time of surgery, and associated eye diseases. The test characteristics of POTS and TOTS for VA were calculated and compared by the McNemar test.Results Thirty patients were included. The mean age was 3.9 ± 1.6 years; 20 were male patients and 10 were female patients. Most wounds were limited to the anterior segment (93.3%). The sensitivity for the POTS was higher than that of the TOTS (100%; 95% confidence interval [CI], 75.3–100 vs. 61.5%; 95% CI, 31.6–86.1; P = 0.014). The specificity was not significantly different (14.3%; 95% CI, 0.4–57.8 vs. 0%; 95% CI, 0–41.0; P = 0.563). The accuracy for the POTS was higher than the TOTS (70.0%; 95% CI, 45.7–88.1 vs. 40.0%; 95% CI, 19.1–63.9; P = 0.001).Conclusion In this cohort of Brazilian children with open-globe injuries, the POTS had better accuracy than did the TOTS in predicting VA after treatment.
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22
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Dursun Ö, Özer Ö, Vatansever M, Dinç E, Oktay Ö, Örekici Temel G. Comparison of Two Scoring Systems in Pediatric Open Globe Injuries. J Craniofac Surg 2022; 33:e105-e107. [PMID: 34260448 DOI: 10.1097/scs.0000000000007935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this study is to determine the demographic characteristics of pediatric open globe injuries, evaluate the ocular trauma scores (OTS), and predict the visual outcomes. METHODS All patients with pediatric open globe injuries who applied to Department of Ophthalmology, Faculty of Medicine, Mersin University between January 2018 and December 2019 were included in this study. Age, gender, type of injury, time of admission, time to surgery, OTS, and pediatric ocular trauma score (POTS) were calculated for each patient. The relation between these findings and final visual acuity (VA) after 12 months of follow-up was examined. RESULTS Forty-two eyes of 41 patients were included in this study. The most common injuries observed were sharp objects such as knives (23.8%) and stones (23.8%). The wound locations were zone I in 36 patients (85.7%) and zone II in 6 patients (14.3%). The most common concomitant eye pathologies were iris prolapse in 37 (88.1%) and hyphema in 29 (69.1%). The mean original OTS was 77.21 and the mean POTS was 46.78. Association between OTS/POTS and final VA was very good (Kendall Tau-b = 0.665, P < 0.001, Kendall Tau-b = 0.505, P < 0.001, respectively). The level of agreement between the predicted VA for OTS and that for POTS was almost perfect (kappa = 0.8726). CONCLUSIONS This study shows that the original OTS is still the gold standard in pediatric cases.
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Affiliation(s)
- Özer Dursun
- Faculty of Medicine, Department of Ophthalmology, Mersin University, Mersin
| | - Ömer Özer
- Faculty of Medicine, Department of Ophthalmology, Mersin University, Mersin
| | - Mustafa Vatansever
- Faculty of Medicine, Department of Ophthalmology, Mersin University, Mersin
| | - Erdem Dinç
- Faculty of Medicine, Department of Ophthalmology, Mersin University, Mersin
| | - Özgün Oktay
- Kilis State Hospital, Ophthalmology Clinic, Kilis
| | - Gülhan Örekici Temel
- Faculty of Medicine, Department of Biostatistics, Mersin University, Mersin, Turkey
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Abstract
OBJECTIVES Open globe injuries (OGIs) in children can be visually devastating traumas and are a common cause of unilateral blindness in children. Three commonly used ocular trauma scores (Ocular Trauma Score [OTS], Pediatric Penetrating Ocular Trauma Score [POTS], and Toddler/Infant Ocular Trauma Score [TOTS]) can be used to help predict visual outcomes in ocular injuries. Each has strengths and weaknesses, but these scores have not been studied extensively in the pediatric population. METHODS The medical records of all pediatric patients presenting at a single institution with OGIs from 2011 to 2016 were retrospectively reviewed. Initial clinical presentation and subsequent examinations were reviewed. The 3 trauma scoring systems were applied to patient data to determine the effectiveness at predicting final visual acuity (VA). RESULTS A total of 15 patients met inclusion criteria. The mean age at presentation was 6.97 years. Seven of 15 (47%) of the patients had a final VA of 20/40 or better. The OTS was applied to 8 of 15 patients, as the OTS requires initial VA, which could not be obtained in 7 patients. The POTS and TOTS were applied to all 15 patients. The POTS, TOTS, and OTS were all significantly correlated to final VA. Incidence of relative afferent pupillary defect and more posterior zone of injury were correlated with poorer visual outcomes. CONCLUSIONS All 3 available ocular trauma scores were effective at predicting final VA in our cohort of pediatric patients with OGIs even outside of the age ranges for which they have been created. Of all the factors included in the scores, relative afferent pupillary defect and zone of injury were most closely correlated with poor final VA.
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Affiliation(s)
- Carleigh N Bruce
- From the University of Florida College of Medicine; Departments of
| | | | - Baiming Zou
- Biostatistics, University of Florida, Gainesville, FL
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BOZALİ E, YALINBAŞ YETER D, APA AS, VURAL ÖZEÇ A, ERDOĞAN H. Pediatric Open Globe Injury in a University-Based Tertiary Hospital in the Anatolian Region. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.1014872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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.
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Moustaine MO, Nassaf O, Hassani Idrissi M, Sandali H. [Bilateral manual enucleation: Challenges in the management of this rare, barbaric form of battery]. J Fr Ophtalmol 2022; 45:e137-e139. [PMID: 34973819 DOI: 10.1016/j.jfo.2021.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 10/19/2022]
Affiliation(s)
- M O Moustaine
- Service d'ophtalmologie, faculté de médecine et de pharmacie d'Agadir, université Ibn Zohr, CHU Souss Massa CHR Hassan II, Agadir, Maroc.
| | - O Nassaf
- Service d'ophtalmologie, faculté de médecine et de pharmacie d'Agadir, université Ibn Zohr, CHU Souss Massa CHR Hassan II, Agadir, Maroc
| | - M Hassani Idrissi
- Service d'ophtalmologie, faculté de médecine et de pharmacie d'Agadir, université Ibn Zohr, CHU Souss Massa CHR Hassan II, Agadir, Maroc
| | - H Sandali
- Service de psychiatrie,faculté de médecine et de pharmacie d'Agadir, université Ibn Zohr, CHU Souss Massa CHR Hassan II, Agadir, Maroc
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Placide J, Ip CS, Le BHA, Ali SF, Ghergherehchi LM. An Update on the Management of Traumatic Pediatric Open Globe Repair: Prognostication and Complication Management. Int Ophthalmol Clin 2022; 62:203-218. [PMID: 34965235 DOI: 10.1097/iio.0000000000000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dulz S, Dimopoulos V, Katz T, Kromer R, Bigdon E, Spitzer MS, Skevas C. Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury. Int J Ophthalmol 2021; 14:1589-1594. [PMID: 34667737 DOI: 10.18240/ijo.2021.10.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To elucidate the question of whether the ocular trauma score (OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment (RD) in patients with open globe injury (OGI). METHODS A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI. RESULTS Totally 102 patients with traumatic OGI with a minimum of 12mo follow-up and a median age at of 48.6y (range: 3-104y) were identified. Final best corrected visual acuity (BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score I (P<0.0001) or II (P<0.0001) revealed a significantly worse BCVA at last follow up when compared to the cohort with an OTS score >III. OGI associated RD was observed in 36/102 patients (35.3%), whereas post traumatic RD (defined as RD following 14d after OGI) occurred in 37 patients (36.3%). OGI associated RD did not correlate with the OTS and the zone of injury (P=0.193), yet post traumatic RD correlated significantly with zone III injuries (P=0.013). CONCLUSION The study shows a significant association between lower OTS score and zone III injury with lower final BCVA and a higher number of surgeries, but only zone III could be significantly associated with a higher rate of RD.
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Affiliation(s)
- Simon Dulz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Vasilis Dimopoulos
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | | | - Robert Kromer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Eileen Bigdon
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Martin Stephan Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Christos Skevas
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
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Liu Y, Hoskin AK, Watson SL. Epidemiology, aetiology and outcome of paediatric ocular trauma in Sydney. J Paediatr Child Health 2021; 57:1479-1484. [PMID: 33913216 DOI: 10.1111/jpc.15531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/28/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
AIM Report epidemiology, aetiology and outcomes of eye injuries in children 0-16 years treated at quaternary referral and paediatric hospitals in Sydney, Australia. METHODS A retrospective review of cases January 2009 to December 2015 using hospital diagnostic and International Classification of Diseases, 10th Revision codes. Medical records confirmed open globe injury (OGI) or closed globe injury (CGI) diagnosis and demographic, injury mechanism, ocular and best-corrected visual acuities (BCVA) before and after treatment. RESULTS A total of 295 patients, 298 eyes were included (96 OGIs, 202 CGIs.) Injuries were commonest in males (72%) with OGI peaks in 3-5-, and CGI, 12-14-year-old males. A projectile was the commonest mechanism (106, 36%) then being struck (101, 34%). Commonest agents were sporting equipment (13%), toys (10%) and sticks (10%). Another child was involved in 32.9% OGI and 27.6% CGI. Initial BCVA was a good predictor of final BCVA. Poor prognostic factors included lens injury, vitreous haemorrhage and relative afferent pupillary defect. Final BCVA 6/12 or better was achieved in 69% cases, including 40% of OGIs and 85% of CGIs. Enucleation and evisceration rates were both 1% (n = 3). CONCLUSION Paediatric ocular trauma most commonly occurred in males from projectiles or being struck, with injuries commonly occurring from sporting equipment, toys and sticks. Vision was poorer with open than closed globe injuries.
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Affiliation(s)
- Ying Liu
- Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Save Sight Institute, Sydney, New South Wales, Australia.,St George Hospital, Kogarah, New South Wales, Australia
| | - Annette K Hoskin
- Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Save Sight Institute, Sydney, New South Wales, Australia.,Genetics and Epidemiology, Lions Eye Institute, Perth, Western Australia, Australia.,Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Stephanie L Watson
- Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Save Sight Institute, Sydney, New South Wales, Australia.,Sydney Eye Hospital, Sydney, New South Wales, Australia.,Sydney Children's Hospital, Sydney, New South Wales, Australia
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Gao YZ, Zhang YF, Zhang M, Xu HY, Jin XR. Clinical characteristics and prognostic factors for visual outcome in 669 patients with intraocular foreign bodies. Int J Ophthalmol 2021; 14:759-765. [PMID: 34012893 DOI: 10.18240/ijo.2021.05.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/06/2020] [Indexed: 02/08/2023] Open
Abstract
AIM To describe the clinical characteristics and analyze prognostic factors that influence visual outcome in 669 patients with intraocular foreign bodies (IOFBs). METHODS Medical records of 669 patients with IOFBs from West China Hospital were reviewed. Best corrected visual acuity (BCVA) values were recorded using standard Snellen acuity chart and were converted to logarithm of the minimum angle of resolution (logMAR) scale for statistical analysis. The visual outcome was defined by the final BCVA (excellent visual outcome: final BCVA of 20/40 or better; poor visual outcome: final BCVA less than 20/200). Statistical analysis of collected data was performed using IBM SPSS Statistics version 23. A 2-tailed P value of less than 0.05 was considered statistically significant throughout the study. RESULTS The average age ranged from 1 to 79 years old (mean age, 34.8±12.7 SD) and the majority of patients were men (626, 93.6%). The major cause of ocular injury was hammering (383, 57.2%). Almost all the patients (97.8%) underwent surgeries (97.8%) and the average time interval between injury and surgery was 26.4±322.3d (0-7300), while 327 patients received surgeries within 24h (48.9%) and 590 patients received surgeries within seven days (88.2%) after IOFBs injury. The poor BCVA was associated with older age (P=0.013), larger IOFBs size (P<0.001), presence of complications (P<0.001) and worse presenting BCVA (P<0.001). On the contrary, younger age (P=0.005), smaller IOFBs size (P<0.001), absence of complications (P<0.001) and better presenting BCVA (P<0.001) were considered to relate to excellent BCVA. CONCLUSION Multiple prognostic factors may influence the final visual outcome, including age, size of IOFBs, complications and presenting BCVA. Meanwhile, further education and promotion on eye protection should be taken for the improvement on self-protection and self-health awareness.
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Affiliation(s)
- Yu-Zhu Gao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yi-Fan Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ming Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Han-Yue Xu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xu-Rui Jin
- Duke Global Health Research Institute, 310 Trent Drive, Durham, NC 27710, Box 905119, Durham, NC 27708, USA
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Zhuang X, Jiang R, Xu G, Sun Z. Pediatric open globe injury in left-behind children treated by pars plana vitrectomy in China. Transl Pediatr 2021; 10:1346-1354. [PMID: 34189093 PMCID: PMC8192994 DOI: 10.21037/tp-21-162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND To analyze the clinical features of pediatric open globe injury (OGI) in left-behind children (LBC) and in non-left-behind children (non-LBC) prospectively. METHODS Patients diagnosed with OGI were included and divided into 2 groups: LBC and non-LBC. A complete ophthalmological examination was performed. Primary wound repair was completed within 8 hours from initial administration. Pars plana vitrectomy (PPV) was subsequently performed for retained intraocular foreign body (IOFB), endophthalmitis, retinal detachment, or non-clearing vitreous hemorrhage. RESULTS A total of 96 patients (4 to 15 years old) were recruited, including 54 LBC and 42 non-LBC. Rupture of the eyeball (P<0.001), endophthalmitis (P<0.001), primary hospitalization time (PHT) over 24 hours (PHT >24 h) (P=0.016), traumatic cataract (P=0.013), vitreous hemorrhage (P=0.040), numbers of surgeries (P<0.001), and lower OTS scores and grades (P<0.001) predisposed patients to poorer final visual acuity (VA). Compared with non-LBC, LBC were significantly younger (P<0.001), had lower OTS scores (P=0.020), had longer PHT (P<0.001), and worse baseline (P=0.011) and final VA (P<0.001). The 3 most common injury sources were pencils (20 cases, 20.8%), knives (11 cases, 11.5%), and iron wire (7 cases, 7.3%). Pencils were the major injury source for IOFB (14 cases, 53.8%). LBC were significantly more likely to be injured by instruments which should be routinely kept away from children (P=0.009). CONCLUSIONS The prognosis of pediatric OGI was worse in LBC than in non-LBC. It is necessary to improve the guardianship of LBC. Many tragedies may be avoided if adult instruments are properly stored and if children are educated to properly use writing devices.
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Affiliation(s)
- Xiaonan Zhuang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Rui Jiang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Zhongcui Sun
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
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Ocular trauma in the pediatric emergency departments, characteristics and risk factors of immediate sequelae. An Pediatr (Barc) 2021. [DOI: 10.1016/j.anpede.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Pfister T, Bohnak C, Patel S. Wood-Related Open-Globe Injuries. JOURNAL OF VITREORETINAL DISEASES 2021; 5:7-14. [PMID: 37009584 PMCID: PMC9976041 DOI: 10.1177/2474126420946624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This work evaluates the clinical characteristics, visual outcomes, and complications of patients treated for open-globe injuries (OGIs) caused by wooden objects. Methods: A retrospective review of medical records was conducted on patients presenting to a tertiary trauma center with an OGI between January 2005 and December 2017. Medical records were isolated for wounds caused by wooden objects. Patient demographics were recorded, with presenting visual acuity (VA), physical examination findings, and wound characteristics. After primary globe repair, secondary complications, need for additional surgery, and visual outcomes were noted until final examination. Main outcome measures were final VA and secondary complications. The Ocular Trauma Score (OTS) was computed and assessed for clinical relevance related to visual outcomes. Results: Thirty-two patients met the inclusion criteria, with 15 (47%) being injured by plant material. Thirty of the patients were men (94%). A large portion of patients presented with hand motion or worse vision (48%), and there were high rates of hyphema (59%), vitreous hemorrhage (31%), retinal detachment (28%), and endophthalmitis (9%). Two patients eventually required enucleation. At last follow-up, 19 patients achieved 20/100 VA or better (59.4%), which correlated with their OTS ( P < .001). Conclusions: Despite the high clinical severity of wood OGIs, the potential for visual recovery remains high. The OTS appropriately assesses the severity of injuries and the likely prognosis in this cohort of patients.
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Affiliation(s)
- Tyler Pfister
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Carisa Bohnak
- Vanderbilt University Medical Center, Department of Ophthalmology, Nashville, TN, USA
| | - Shriji Patel
- Vanderbilt University Medical Center, Department of Ophthalmology, Nashville, TN, USA
- Vanderbilt Eye Institute, Nashville, TN, USA
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Abraham EG, Motilewa OO. Profile of Ocular Injury among Paediatric Patients in a Tertiary Institution in Uyo, Nigeria: An 18 Months Review. Niger Med J 2021; 62:8-13. [PMID: 38504790 PMCID: PMC10903290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/10/2020] [Indexed: 03/21/2024] Open
Abstract
Background Ocular injury is one of the known causes of acquired blindness in children. The epidemiological data of childhood ocular injury vary from region to region, and also with sex and age.Methodology: Clinic records of pediatric ocular trauma patients (0-18 years) were reviewed for 18 months. Information on sociodemographics, causes of trauma, mechanism of trauma, place of injury, and type of injury were extracted. Data obtained were analyzed using STATA version 12. Results Sixty patients aged 0.5-18 years, mean age was 9 years ± 4.73 visited the hospital on account of eye injury formed the study population. Males were 37 (61.7%) and females 23 (38.3%) in a ratio of 1.6:1. The most common age group for ocular trauma was 6-10 years 24 (40.0%). Closed globe injuries were the most common type 48 (80%), home 45 (71.7%) was the most common location where injury occurred, the conjunctiva was the most commonly affected structure 21 (35%) and the most common offending object used was stick 9 (15.0%). Conclusion Paediatric eye injury has age-specific pattern, occurred more commonly in males, mainly of the closed globe variety and occurred mostly at the home setting.
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Affiliation(s)
- Emem Godwin Abraham
- Department of Ophthalmology, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Olugbemi O. Motilewa
- Department of Community Health, University of Uyo Teaching Hospital, Uyo, Nigeria
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35
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Jacobson A, Liles N, Besirli CG, Bohnsack BL. Predictors of visual outcomes in pediatric open globe injuries. J AAPOS 2020; 24:360.e1-360.e8. [PMID: 33271286 DOI: 10.1016/j.jaapos.2020.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/28/2020] [Accepted: 08/02/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Adam Jacobson
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI; Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Nathan Liles
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI; Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Cagri G Besirli
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI; Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Brenda L Bohnsack
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI; Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
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Meena S, Rakheja V, Sahu S, Rathore P. Traumatic avulsion of the globe with optic nerve transection: an unusual presentation. BMJ Case Rep 2020; 13:13/10/e233148. [PMID: 33122220 DOI: 10.1136/bcr-2019-233148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Complete globe extrusion, whether traumatic or spontaneous, is a rare clinical entity and if associated with optic nerve avulsion, it has a worse visual outcome, though repositioning of the globe may be attempted. We report a case of road traffic accident, wherein the patient presented with an extrusion of the globe, along with a complete transection of the optic nerve, about 4 cm from the optic nerve head, with only a residual attachment to the orbital rim via the unsevered lateral conjunctival flap, where the enucleation was completed and the conjunctiva was sutured.
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Affiliation(s)
- Seema Meena
- Ophthalmology, All India Institute of Medical Sciences Jodphur, Jodhpur, India
| | - Vaishali Rakheja
- Ophthalmology, All India Institute of Medical Sciences Jodphur, Jodhpur, India
| | - Sulabh Sahu
- Ophthalmology, All India Institute of Medical Sciences Jodphur, Jodhpur, India
| | - Priyanka Rathore
- Ophthalmology, All India Institute of Medical Sciences Jodphur, Jodhpur, India
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Pahor D, Gracner T. Comparison of the Ocular Trauma Score and Pediatric Ocular Trauma Score as Two Prognostic Models in Pediatric Open Globe Injuries. Klin Monbl Augenheilkd 2020; 238:67-72. [PMID: 33036059 DOI: 10.1055/a-1194-5104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To compare the ocular trauma score (OTS) and the pediatric ocular trauma score (POTS) as prognostic models of visual outcome after open globe injury in children during a period of 19 years. PATIENTS AND METHODS A retrospective study of 36 open globe injuries in 36 patients younger than 18 years was conducted from January 2000 to January 2019. For each case, OTS and POTS points were calculated. RESULTS Significant differences were observed in our patients using the two models regarding categories 1 to 4. One third of the cases were in categories 1 and 2 using the OTS model, and nearly 60% using the POTS model. Nearly 60% of our patients were in categories 3 and 4 using the OTS model and 30.6% using the POTS model. In category 5, no difference was observed between the two models. The comparison of distribution of the percentage of final visual acuity between OTS and POTS model in each category revealed a significant difference in category 1 in final visual acuity 20/40 or more (25 vs. 50%) as well as in final visual acuity 20/20 (0 vs. 30%). In category 2, final visual acuity was not significantly different in 20/40 or more between the two models; however, there was a significant difference in final visual acuity 20/20 - 12.5% in the OTS model and 45.5% in the POTS model. In category 3, significant differences were revealed between the two models. Using the OTS model, final visual acuity 20/40 or more was observed in more than 60% and using POTS model in 100%; final visual acuity 20/20 was observed in 36.3% using OTS model and in 50% using POTS model. In category 4 and 5, no differences were observed between OTS and POTS models. CONCLUSION Our study did not confirm the benefit of POTS. The distribution of our cases among OTS categories demonstrated a significant difference between the two models with more cases distributed in lower categories in POTS group. In the POTS group, the prognosis for final visual acuity was significantly better in the first three categories than in the OTS group, probably as a result of a lower calculation for POTS points. In our opinion, the OTS model is easier to use, has a higher prognostic accuracy, and should be further used in counselling of paediatric cases.
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Affiliation(s)
- Dusica Pahor
- Department of Ophthalmology, University Clinical Centre Maribor, Slovenia.,Department of Ophthalmology, Faculty of Medicine, University of Maribor, Slovenia
| | - Tomaz Gracner
- Department of Ophthalmology, University Clinical Centre Maribor, Slovenia
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García Mancebo J, Ferrero García-Loygorri C, Romero AI, Vázquez López P. [Ocular trauma in the Pediatric Emergency Departments, characteristics and risk factors of immediate sequelae]. An Pediatr (Barc) 2020; 94:161-172. [PMID: 32912750 DOI: 10.1016/j.anpedi.2020.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/15/2020] [Accepted: 07/10/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study assesses the clinical characteristics and epidemiology of children with eye trauma presenting to the Emergency Department in Spain and analyze the risk factors associated with immediate sequelae. METHODS A multicentric prospective case series study conducted during 24 months of patients presenting to the Pediatric Emergency Departments in five hospitals collaborating with the Spanish Pediatric Emergency Research Group. Data were collected from October 2016 through September 2018, including all patients up to the age of 16 years old presenting to the Emergency Department with an ocular trauma. All injuries were classified by Birmingham Eye Trauma Terminology. RESULTS A total of 242,134 visits to the Emergency Departments took place during the study period, being 1,007 ocular traumas (0.42%; IC 95% 0.40-0.45) and 858 were included in the study. Most commonly, injuries occurred while playing (54.7%), except in the 15 or more-age group, in which sports activities were more common (23.1%). The place of the trauma varied depending on the age group, being home (34.7%) and schools or sports areas (34.3%) the most recurrent. Blunt objects were the most frequent mechanism of trauma (48.6%). Most of the injuries were classified as closed globe (85.5%), mainly contusions (52.7%). Fifty-eight patients (6.8%) presented with immediate sequelae, being the impairment of visual acuity the most common (70.7%). The risk factors associated with immediate sequelae were the 10 or more-age group, the preexisting refractive errors, the open globe injuries and the injuries with blunt objects. CONCLUSIONS Ocular trauma is a frequent chief complaint in the Pediatric Emergency Departments in Spain. Increasing awareness of the serious nature of ocular injuries and the study of the risk factors will help to develop a comprehensive plan for educating both parents and children to minimize preventable eye injuries sequelae.
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Affiliation(s)
- Julia García Mancebo
- Servicio de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | | | - Ana Isabel Romero
- Servicio de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Paula Vázquez López
- Servicio de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
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- Servicio de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
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Xue C, Yang LC, Kong YC. Application of pediatric ocular trauma score in pediatric open globe injuries. Int J Ophthalmol 2020; 13:1097-1101. [PMID: 32685398 DOI: 10.18240/ijo.2020.07.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/08/2019] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Chao Xue
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute; Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300020, China
| | - Li-Chun Yang
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute; Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300020, China
| | - Yi-Chun Kong
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute; Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300020, China.,Tianjin NanKai Hospital, Tianjin Medical University NanKai Hospital, Nankai University Affiliated Nankai Hospital, Tianjin 300100, China
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Kafali HY, Biler ED, Palamar M, Ozbaran B. Ocular injuries, attention deficit and hyperactivity disorder, and maternal anxiety/depression levels: Is there a link? Chin J Traumatol 2020; 23:71-77. [PMID: 32201230 PMCID: PMC7156958 DOI: 10.1016/j.cjtee.2019.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/25/2020] [Accepted: 02/18/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Given the increased risk of accidents in patients with attention deficit and hyperactivity disorder (ADHD) or maternal anxiety/depression, we aimed to investigate the frequency of the two diseases in children with penetrating eye injury (PEI). METHODS Altogether 79 children, 39 with PEIs and 40 healthy individuals (control group), aged 5-15 years, underwent a complete ophthalmologic examination. Afterwards, schedule for affective disorders and schizophrenia for school-aged children was conducted to assess the psychiatric diagnosis of all children. Turgay diagnostic and statistical manual of mental disorders (DSM-IV)-based child and adolescent behavior disorders screening and rating scale (T-DSM-IV-S) was filled by parents to evaluate the severity of ADHD symptoms. The depression and anxiety levels of mothers of each group were evaluated by two self-report measures: the Beck depression scale and the state-trait anxiety inventory (STAI), respectively. Data were analyzed by IBM SPSS version 22.0. The Chi-square and Fisher's exact test were used to determine whether there is a significant difference between qualitative variables while independent sample t and Mann-Whitney U tests to compare quantitative variables. RESULTS The only diagnostic difference was a significantly higher frequency of ADHD among patients with PEIs (48.7% in PEI vs. 17.5% in control group, χ2 = 7.359, p = 0.007). The total scores of the T-DSM-IV-S (attention subscale U = 418.000, p = 0.006; hyperactivity subscale U = 472.000, p = 0.022) and maternal state-trait anxiety inventory (maternal STAI-state U = 243.000, p = 0.003; maternal STAI-trait U = 298.000, p = 0.021) were significantly higher in the PEI group than in control group. In logistic regression, children with PEI had a tendency to have a 3.5-fold increased risk for ADHD (OR = 3.538, CI = 0.960-13.039, p = 0.058). CONCLUSION ADHD was detected almost 1 in 2 children with PEIs. Besides, the maternal anxiety level was significantly higher in the PEI group than in the control group. This association should be further explored via a future prospective longitudinal study. Since a proper treatment of ADHD in children and anxiety treatment in mothers may prevent vision loss following PEIs in children.
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Affiliation(s)
- Helin Yilmaz Kafali
- Department of Child and Adolescent Psychiatry, Ankara City Hospital, Ministry of Health, Ankara, Turkey,Corresponding author.
| | | | - Melis Palamar
- Department of Ophthalmology, Ege University School of Medicine, Izmir, Turkey
| | - Burcu Ozbaran
- Department of Child and Adolescent Psychiatry, Ege University School of Medicine, Izmir, Turkey
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Jain K, Jain A, Patil J, Gadiya T. Amblyopia therapy in children with penetrating corneal injuries. Taiwan J Ophthalmol 2020; 10:29-31. [PMID: 32309121 PMCID: PMC7158934 DOI: 10.4103/tjo.tjo_13_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/01/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND: The role of part-time occlusion therapy in children with penetrating ocular injuries has not been studied. The aim of the study is to analyze the role of part-time occlusion therapy in children with penetrating ocular trauma following surgical intervention. MATERIALS AND METHODS: This is a retrospective case series with a median follow-up of 17 months (range: 3–105 months). The study was carried out at a tertiary referral center. Consecutive children with penetrating corneal tear injury who underwent surgical intervention were included in the study. These patients were subjected to part-time occlusion, and those with good compliance and follow-up were included in the study. The role of part-time occlusion therapy in children with ocular trauma is studied. RESULTS: There were 26 patients included in the study of which 23 were male and 3 were female, with a median age at presentation of 5 years (range: 1–11 years). The vision following surgical intervention at 6 weeks was 0.85 logMAR units (range: 0.3–2.8). Final median visual acuity was 0.48 logMAR units (range: 0–2). Paired t-test done for improvement in visual outcome before and after amblyopia therapy was statistically significant (P = 0.007). CONCLUSION: Amblyopia therapy shows promising results for patients following penetrating intraocular injury despite corneal scar in the visual axis in our group. A study on larger population is indicated.
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Ababneh LT, Mohidat H, Abdelnabi H, Kana'an MF, Tashtush NA, El-Mulki OS, Aleshawi AJ. Hospital-Based Ocular Trauma: Factors, Treatment, And Impact Outcome. Clin Ophthalmol 2019; 13:2119-2126. [PMID: 31802841 PMCID: PMC6827522 DOI: 10.2147/opth.s223379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/09/2019] [Indexed: 11/23/2022] Open
Abstract
Background Specific morbidities as blindness is a serious complication that commonly results from patients with ocular traumas and can significantly impair the patient's social and occupational abilities. This study is conducted due to the current lack of data on ocular injuries in developing countries and places near war regions and aims to investigate and evaluate the impact of ocular trauma. Material and methods After Institutional Review Board approval was obtained, we retrospectively identified 112 patients who were admitted due to eye trauma from January 2015 until October 2018. Information about demographics, diagnostic modalities, prognostic impact, and treatment interventions were retrieved, analyzed. Results One-hundred and twelve patients were included in the study. The majority of patients were males. The mean age for patients was 22.2. Road traffic accident (RTA) constituted the most common cause of trauma (60.7%). Gunshots and blast injuries were observed in 12.5% of patients. Workplace injuries were infrequent (8.1%). The gunshot was significantly associated with injury to two or more eyeball structures while the RTA was significantly related to one eyeball structure injury. RTA was associated with intact globe while gunshot was significantly associated with ruptured globes. The mean duration of admission was 8.1 days. Associated truncal injury is the most important independent factor affecting the duration of admission. Conclusion Majority of trauma cases occurred in young males involved in RTAs. The location of Jordan near the Syrian war increases the appearance of gunshot ocular trauma in specific and ocular trauma in general. Educating the public is essential if we wish to prevent eye injuries.
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Affiliation(s)
- Laila T Ababneh
- Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Hasan Mohidat
- Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Heba Abdelnabi
- Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Mohammed F Kana'an
- Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Nour A Tashtush
- Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Omar S El-Mulki
- Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
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A comparison of ocular trauma scores in a pediatric population. BMC Res Notes 2019; 12:569. [PMID: 31511037 PMCID: PMC6737673 DOI: 10.1186/s13104-019-4602-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/03/2019] [Indexed: 12/01/2022] Open
Abstract
Objective Pediatric ocular trauma represents a major concern for ophthalmologists. Delays in presentation, incomplete exams, inaccurate visual acuity (VA) results, and amblyopia can limit accurately predicting final visual outcomes in pediatric eye trauma. We performed a retrospective clinical study to describe the demographics and causes of eye trauma. We also compared 2 ocular trauma scoring systems, one specifically designed for pediatric trauma, to classify injuries and determine which better predicted VA outcomes. A retrospective chart review of 3 years of pediatric globe trauma was performed. Analysis was focused on mechanisms of injury and VA outcomes. Complex factors that may worsen outcomes were recorded. Ocular trauma score (OTS) and pediatric ocular trauma score (POTS) were used to assign Groups 1–5 to each case. Group 1 was poorest prognosis, Group 5 best. Association between Group and final VA was examined. Accuracy of the two systems was compared. Results 23 children met eligibility criteria (13 male). Initial VA averaged 20/200 (range no light perception (NLP)—20/20). Final VA was 20/150 (range no light perception (NLP)—20/20). Objects of injury were sharp metallic household objects (7), miscellaneous (4), toys (3), BB pellets (2), stick/wood (2), pencil/pen (1).
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Dai C, Wu J, Chen C, Wu X. Interactions of thymic stromal lymphopoietin with TLR2 and TLR4 regulate anti-fungal innate immunity in Aspergillus fumigatus-induced corneal infection. Exp Eye Res 2019; 182:19-29. [PMID: 30853520 DOI: 10.1016/j.exer.2019.02.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 12/13/2022]
Abstract
Thymic stromal lymphopoietin (TSLP) is an interleukin 7 (IL-7)-like four helix bundle cytokine that plays diverse roles in the regulation of immune responses. In fungal infection, pattern recognition receptors (PRRs), including the cell surface Toll-like receptors (TLRs) and cytoplasmic NOD-like receptors, recognize pathogen-associated molecular patterns to initiate downstream signal cascades to active immune responses. Our previous studies reported that, in vitro human cornea epithelium cells represented a novel target of TSLP and that TSLP/TSLPR/STAT5 signaling played an important role in the response to Aspergillus fumigatus challenge. TSLP downstream signaling molecules upregulated TLR2 and MyD88/NF kappa B-p65 signaling. This phenomenon suggested that TSLP had an impact on PRRs in antifungal immunity. In mouse fungal keratitis induced by A. fumigatus, TSLP was mainly expressed in the epithelium as well as in some infiltrated immune cells in a time-dependent manner. Exogenous TSLP with Aspergillus led to severe keratitis and worse corneal recovery with higher levels of TLR2, TLR4, IL-6, and IL-8 as well as increased neutrophil infiltration. By contrast, when TSLP was suppressed by siRNA, fungal keratitis was mild with higher levels of antimicrobial peptides such as human beta-defensin (hBD9). Taken together, our data revealed an unreported function of TSLP in mediating an anti-fungal inflammatory response and serving as a target to control tissue injury and infection in A. fumigatus keratitis.
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Affiliation(s)
- Chenyang Dai
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, PR China; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jiayin Wu
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, PR China
| | - Chen Chen
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, PR China; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xinyi Wu
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, PR China.
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Maurya RP, Srivastav T, Singh VP, Mishra CP, Al-Mujaini A. The epidemiology of ocular trauma in Northern India: A teaching hospital study. Oman J Ophthalmol 2019; 12:78-83. [PMID: 31198291 PMCID: PMC6561041 DOI: 10.4103/ojo.ojo_149_2018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
AIM: The aim was to determine the epidemiology of ocular trauma in a large teaching hospital in northern India over 4 years from 2010 to 2014. MATERIALS AND METHODS: This prospective, hospital-based, observational study was conducted at the Ophthalmology and Emergency Outpatient Departments of S. S. Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from March 2012 to February 2016. Detailed history was taken with special consideration to time, place and session of trauma, mode of injury, and type and nature of traumatic agent. All patients were thoroughly examined as per the standard clinical procedures to identify the type, extent, and severity of injury and impact on ocular structure and vision. Follow-up period was 6 months. Statistical analysis was based on age, sex, residence, marital status, occupation, per capita income, type of trauma and nature of damage, etc. RESULTS: Out of 402 patients, 293 (72.9%) were male and 109 (27.1%) were female. Overall male-to-female sex ratio was 2.7:1. Patients were aged between 2 and 70 years (mean: 26.48 ± 15.88, median: 23 years). The most vulnerable age group was 6–15 years (24.38%) followed by 16–25 years (23.88%). Maximum patients belonged to rural background (61.94%). The extent of ocular trauma was 3.93% (95% confidence interval: 3.23–4.63). Majority of participants were single (78.11%) and rest were married. About 112 (27.9%) participants were illiterate and 24.4% had primary education only. One hundred and eighty-eight (46.8%) participants belonged to lower and lower middle socioeconomic status. The cases were clustered in Rs. 1000–5000 per capita income. Most of the injuries occurred in summer season (46.18%) and in afternoon between 12.00 and 17.59 h (48.8%). Majority of trauma occurred away from home (66.20%) mainly on street (28.6%) and playground (9.2%). The most common injury was nonoccupational (82.3%) including sports related (23.9%) and road traffic accident (23.6%). Mechanical injuries were accounted for 89.3% of all eye injuries, and most common source was wooden object (24.9%) followed by metallic objects (20.9%). Traumatic agents were blunt and sharp in 56% and 17% of cases, respectively. Majority of traumatic agents were solid (82.1%). Seven percent of victims were drowsy during trauma and 98.4% of participants were not using any protective device at the time of injury. In 60.7% of cases, time elapsed between injury and treatment was between 1 and 24 h. Around 44.5% had isolated ocular trauma and rest 55.5% were polytrauma cases. Three hundred and sixty-eight (91.5%) participants had unilateral involvement and 8.5% had bilateral involvement. Almost 52.8% had injuries of adnexa and 32.8% had globe injuries. More than half of the study participants had ≥3 ocular structure involvement. After 6 months, 14.8% of the right eyes and 25.5% of the left eyes showed poor outcome. CONCLUSION: This study highlights epidemiology of ocular trauma in northern India. Mass health education and awareness about risk of ocular trauma, morbidity caused by delayed presentation, and need to adopt safety or preventive strategies should be focused, especially during travel, playground, and at workplace.
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Affiliation(s)
- Rajendra P Maurya
- Department of Ophthalmology, IMS BHU, Varanasi, Uttar Pradesh, India
| | - Tanmay Srivastav
- Department of Ophthalmology, IMS BHU, Varanasi, Uttar Pradesh, India
| | | | - C P Mishra
- Department of Ophthalmology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultante of Oman
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Qiu H, Fischer NA, Patnaik JL, Jung JL, Singh JK, McCourt EA. Frequency of pediatric traumatic cataract and simultaneous retinal detachment. J AAPOS 2018; 22:429-432. [PMID: 30366052 DOI: 10.1016/j.jaapos.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/05/2018] [Accepted: 08/10/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Traumatic cataract in children is a treatable cause of vision loss. In cases of simultaneous retinal detachment, the prognosis for visual recovery is often poor. The purpose of this study was to investigate risk factors for concurrent retinal detachment in patients with traumatic cataract. METHODS A retrospective review of patients diagnosed with traumatic cataract at Children's Hospital Colorado between 2005 and 2014 was conducted. Demographics, mechanism of injury, and incidence of retinal detachment were recorded. Logistic modeling with generalized estimating equations to account for correlation of eyes within patients was used to analyze associations between potential risk factors and retinal detachment. RESULTS A total of 62 total eyes with traumatic cataract were included: 52 patients presented with unilateral cataract; 5 presented with bilateral cataracts. Mean patient age was 8.4 ± 4.1 years (range, 0-16 years), and 83% of patients were male. A total of 9 eyes (14.5%) had comorbid retinal detachment. Traumatic cataracts caused by self-injurious hitting were more likely to present with simultaneous retinal detachment than those caused by other mechanisms of injury (OR = 24.0; 95% CI, 3.8-153.3; P = 0.0010). CONCLUSIONS Patients with traumatic cataract who display self-injurious behavior are at higher risk for concurrent retinal detachment. These patients can often only be examined under sedation. Ophthalmologists should counsel families of high-risk patients and consider involving retinal specialists in surgical planning.
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Affiliation(s)
- Howe Qiu
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Nathan A Fischer
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer L Jung
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jasleen K Singh
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Emily A McCourt
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado.
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Tabatabaei SA, Soleimani M, Naderan M, Ahmadraji A, Rajabi MB, Jafari H, Safizade M. A survey of incidental ocular trauma by pencil and pen. Int J Ophthalmol 2018; 11:1668-1673. [PMID: 30364156 DOI: 10.18240/ijo.2018.10.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/17/2018] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Seyed Ali Tabatabaei
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Mohammad Soleimani
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Morteza Naderan
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Aliasghar Ahmadraji
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Mohammad Bagher Rajabi
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Hajar Jafari
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Mona Safizade
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
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Aziz M, Patel S. BB Gun–Related Open Globe Injuries. ACTA ACUST UNITED AC 2018; 2:1056-1061. [DOI: 10.1016/j.oret.2018.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/05/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
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Comparative Evaluation of the Prognostic Value Between the Ocular Trauma Score and the Pediatric Penetrating Ocular Trauma Score. J Craniofac Surg 2018; 29:1776-1779. [DOI: 10.1097/scs.0000000000004937] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Pediatric Traumatic Retinal Detachment: Clinical Features, Prognostic Factors, and Surgical Outcomes. J Ophthalmol 2018; 2018:9186237. [PMID: 30046466 PMCID: PMC6036795 DOI: 10.1155/2018/9186237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/25/2018] [Accepted: 05/10/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose We report the clinical characteristics, prognostic factors, and surgical outcomes for 23-gauge pars plana vitrectomy (23-G PPV) in pediatric cases of traumatic retinal detachment (RD). Methods Medical records of pediatric patients who underwent 23-G PPV to treat traumatic retinal detachment were retrospectively reviewed. These patients underwent a follow-up examination at least 1 year following surgery. Associations between various preoperative factors and anatomical and visual outcomes were analyzed. An Ocular Trauma Score (OTS) and a Pediatric Ocular Trauma Score (POTS) were calculated for each patient. Raw scores were converted to their corresponding OTS and POTS categories. Final visual acuities by categories were compared with those in the OTS and POTS studies. Results The mean age of the patients was 9 ± 4 years, and the male-to-female ratio was 4.7 : 1. The mean follow-up time was 23 ± 14 months. Anatomical success was achieved in 72% of the eyes, and functional success (>5/200) was achieved in 37% of the eyes. Functional success was less common among patients with visual acuities less than hand motion, macula-off retinal detachment, proliferative vitreoretinopathy at presentation, and recurrent retinal detachment during follow-up. When we compared the categorical distribution of final visual acuities in all categories, our results were significantly different than those suggested by OTS and POTS. Conclusions Visual outcomes are poorer compared to anatomical outcomes. OTS and POTS do not provide reliable prognostic information if the patient has RD. Presenting visual acuity, the presence of macula-off RD, and PVR are all important predictors of final visual acuity.
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