1
|
Bowe T, Serina A, Armstrong M, Welcher JE, Adebona O, Gore C, Staffa SJ, Zurakowski D, Shah AS. Timing of Ocular Hypertension After Pediatric Closed-Globe Traumatic Hyphema: Implications for Surveillance. Am J Ophthalmol 2022; 233:135-143. [PMID: 33991515 DOI: 10.1016/j.ajo.2021.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the timing of ocular hypertension (OHT) after pediatric closed-globe injury (CGI) and traumatic hyphema. We hypothesize that OHT will occur at different times based on injury characteristics. DESIGN Retrospective, cohort study. METHODS Setting: Single-center, tertiary-care, pediatric hospital. PARTICIPANTS Subjects included patients ≤18 years of age at the time of injury who suffered CGI and traumatic hyphema between 2002 and 2019. Observation Procedure(s): Intraocular pressure and injury demographics were abstracted for every visit after injury. OHT was defined as >21 mm Hg at presentation or after a reading of ≤21 mm Hg at a prior visit. MAIN OUTCOME MEASURES The primary outcome measure was the timing of OHT categorized into 4 periods: presentation, acute (days 1-7), subacute (days 8-28), or late (day >28). Secondary outcome measures were identification of risks factors for OHT by multivariable logistic regression. RESULTS OHT occurred in 119 of the 305 (39%) subject eyes. OHT occurred in 35 patients at presentation, 69 times acutely, 35 times subacutely, and 36 times late. Pupil damage predicted acute-period OHT (P = .004). OHT at presentation predicted subacute period OHT (P = .004). Iridodialysis and cataract predicted late-period OHT (P = .007 and P < .001, respectively). CONCLUSIONS OHT after CGI and traumatic hyphema in pediatric patients is common. Injury demographics predict this complication. Integration of these risk factors with current literature allows proposal of a risk-stratification tool to guide efficient surveillance for OHT.
Collapse
Affiliation(s)
- Theodore Bowe
- From Harvard Medical School (T.B., D.Z., A.S.S.); Department of Ophthalmology, Boston Children's Hospital (T.B., A.S., M.A., J.W., D.Z., A.S.S.); Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital (S.J.S, D.Z.); Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA (T.B., A.S.S.)
| | - Anthony Serina
- Department of Ophthalmology, Boston Children's Hospital (T.B., A.S., M.A., J.W., D.Z., A.S.S.); Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital (S.J.S, D.Z.)
| | - Mikhayla Armstrong
- Department of Ophthalmology, Boston Children's Hospital (T.B., A.S., M.A., J.W., D.Z., A.S.S.); Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital (S.J.S, D.Z.)
| | - Jennifer E Welcher
- Department of Ophthalmology, Boston Children's Hospital (T.B., A.S., M.A., J.W., D.Z., A.S.S.); Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital (S.J.S, D.Z.)
| | - Olumuyiwa Adebona
- Department of Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (O.A.)
| | - Charlotte Gore
- Department of Ophthalmology, University of California Irvine, Irvine, CA, USA (C.G.)
| | - Steven J Staffa
- Department of Ophthalmology, Boston Children's Hospital (T.B., A.S., M.A., J.W., D.Z., A.S.S.); Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital (S.J.S, D.Z.)
| | - David Zurakowski
- From Harvard Medical School (T.B., D.Z., A.S.S.); Department of Ophthalmology, Boston Children's Hospital (T.B., A.S., M.A., J.W., D.Z., A.S.S.); Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital (S.J.S, D.Z.)
| | - Ankoor S Shah
- From Harvard Medical School (T.B., D.Z., A.S.S.); Department of Ophthalmology, Boston Children's Hospital (T.B., A.S., M.A., J.W., D.Z., A.S.S.); Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital (S.J.S, D.Z.); Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA (T.B., A.S.S.).
| |
Collapse
|
2
|
An Uncommon Meridional Globe Rupture due to Blunt Eye Trauma. Case Rep Emerg Med 2018; 2018:1808509. [PMID: 30319823 PMCID: PMC6167593 DOI: 10.1155/2018/1808509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/21/2018] [Accepted: 08/16/2018] [Indexed: 11/18/2022] Open
Abstract
Open globe injury (OGI) is a severe form of eye trauma. It is an important cause of monocular blindness worldwide. Ruptures from blunt trauma are most common at the sites where the sclera is thinnest, at the insertions of the extraocular muscles, and at the limbus. Most often, rupture is equatorial. We present a unique case of open globe injury due to blunt ocular trauma from a thrown rock that resulted in a meridional rupture of the eye. The pertinent literature is reviewed.
Collapse
|
3
|
Abstract
Open globe injury (OGI) is a severe form of eye trauma estimated at 2-3.8/100,000 in the United States. Most pediatric cases occur at home and are the result of sharp object penetration. The aim of this article is to review the epidemiology, diagnosis, management, and prognosis of this condition by conducting a systematic literature search with inclusion of all case series on pediatric OGI published between 1996 and 2015. Diagnosis of OGI is based on patient history and clinical examination supplemented with imaging, especially computed tomography when indicated. Few prospective studies exist for the management of OGI in pediatric patients, but adult recommendations are often followed with success. The main goals of surgical management are to repair the open globe and remove intraocular foreign bodies. Systemic antibiotics are recommended as medical prophylaxis against globe infection, or endophthalmitis. Other complications are similar to those seen in adults, with the added focus of amblyopia therapy in children. Severe vision decline is most likely due to traumatic cataracts. The ocular trauma score, a system devised to predict final visual acuity (VA) in adults, has proven to be of prognostic value in pediatric OGI as well. Factors indicating poor visual prognosis are young age, poor initial VA, posterior eye involvement, long wound length, globe rupture, lens involvement, vitreous hemorrhage, retinal detachment, and endophthalmitis. A thorough understanding of OGI and the key differences in epidemiology, diagnosis, management, and prognosis between adults and children is critical to timely prevention of posttraumatic vision loss early in life.
Collapse
Affiliation(s)
- Xintong Li
- Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Marco A Zarbin
- Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Neelakshi Bhagat
- Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, NJ, USA
| |
Collapse
|
4
|
Türkoğlu EB, Celik T, Celik E, Ozkan N, Bursalı O, Coşkun SB, Alagoz G. Is topical corticosteroid necessary in traumatic hyphema? J Fr Ophtalmol 2014; 37:613-7. [PMID: 25199483 DOI: 10.1016/j.jfo.2014.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/29/2014] [Accepted: 04/08/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the outcomes in the management of traumatic hyphema treated with topical corticosteroid plus supportive therapy versus only supportive therapy. PATIENTS AND METHODS In this retrospective study, 206 patients were divided into two groups; group I, 98 eyes were treated with topical corticosteroid 12 × 1 and supportive therapy including bed rest, keeping the head elevated (45 degrees), and hydration. In group II, 108 eyes were treated with only supportive therapy. Hyphema size, initial and final visual acuities and intraocular pressure, time to hyphema clearance, and incidence of rebleeding were evaluated. RESULTS The time needed for hyphema resorption in the two groups were 60.25 ± 33.9 and 62.3 ± 28.9 hours respectively (P=0.62). There was no significant difference in rebleeding rate between the topical corticosteroid group (4.01%) and non-steroid group (6.48%) (P=0.67). The initial and final visual acuities were similar in the two groups (P=0.86). In Groups I and II, the average intraocular pressures were 19.7 ± 8.01 and 14.2 ± 10.2 mmHg respectively. The difference between the two groups was statistically significant (P=0.04). CONCLUSION Patients who were treated with topical corticosteroids were no less likely to experience a rebleed or a poor visual outcome than those treated with supportive therapy alone. Supportive therapy alone may be convenient and cost-effective management strategy in uncomplicated traumatic hyphema.
Collapse
Affiliation(s)
- E B Türkoğlu
- Akdeniz University, Department of Ophthalmology, 07100 Antalya, Turkey.
| | - T Celik
- Bolu Gerede State Hospital Department of Ophthalmology, Seviller St., 14900 Gerede-Bolu, Turkey
| | - E Celik
- Sakarya University Training and Research Hospital Department of Ophthalmology, 54180 Sakarya, Turkey
| | - N Ozkan
- Sakarya University Training and Research Hospital Department of Ophthalmology, 54180 Sakarya, Turkey
| | - O Bursalı
- Sakarya University Training and Research Hospital Department of Ophthalmology, 54180 Sakarya, Turkey
| | - S B Coşkun
- Sakarya University Training and Research Hospital Department of Ophthalmology, 54180 Sakarya, Turkey
| | - G Alagoz
- Sakarya University Training and Research Hospital Department of Ophthalmology, 54180 Sakarya, Turkey
| |
Collapse
|