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Epidemiological Characteristics of Pediatric Ocular Trauma in China: A Multicenter Retrospective Hospital-Based Study. J Ophthalmol 2022; 2022:4847027. [PMID: 35847351 PMCID: PMC9279087 DOI: 10.1155/2022/4847027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose The objective of the study was to obtain the incidence characteristics of pediatric ocular trauma in mainland China and provide some feasible suggestions of prevention. Methods The patients with pediatric ocular injuries, who were (≤14) hospitalized between January 1, 2019, and December 31, 2020, were included. Patient demographics (age and sex), injury natural characteristics (causes, site, and types), geographic location, and interval of hospital admission were analyzed. Results A total of 13525 cases were identified, and 1973 (14.6%) occurred in children (male accounts 70.9%) with a mean (SD) age of 6.5 (3.4) years. Cases among minors in 2020 dropped by 8.3% compared to 2019, while the former vulnerability to eye injuries has been shifted from the outdoors to home (51.4%, 1015/1973). The main causes of injury are flying objects (31.9%), traffic injury (23.5%), and blunt injury (21.8%), which lead to the main types of injury such as penetrating injury (48.3%), rupture of the globe (18.1%), and contusion trauma (13.1%). If the VA after injury is above CF, the VA after discharge is more likely to be above CF (OR 18.3, 11.9–28.1; p < 0.001). Similarly, age (OR 2.0, 1.3–3.1; p=0.001) and intraocular pressure after injury (OR 0.9, 0.9–1.0; p=0.009) also affect the intraocular pressure at discharge. Conclusions In mainland China, the main injury types are penetrating injury and rupture of the globe with home being the most dangerous place. Prevention strategies should focus on parents' education and protective measures indoors. Visual acuity after injury can be used as a predictor of visual acuity after treatment.
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Zhu WENTING, Tian J, Lu X, Gao X, Wei J, Yuan G, Zhang J. INCIDENCE AND RISK FACTORS OF POSTOPERATIVE ENDOPHTHALMITIS AFTER PRIMARY SURGICAL REPAIR COMBINED WITH INTRAOCULAR FOREIGN BODY REMOVAL. Retina 2022; 42:1144-1150. [PMID: 35594077 PMCID: PMC9112954 DOI: 10.1097/iae.0000000000003440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the incidence and risk factors of postoperative endophthalmitis after primary surgical repair and intraocular foreign body (IOFB) removal within 24 hours of injury. METHODS The records of all patients treated surgically for open globe injury and IOFB removal at the Eye Hospital of Shandong First Medical University between January 1, 2015, and June 30, 2020, were retrospectively reviewed. Variables included time from injury to operation, cause of injury, details of surgical repair, and follow-up. The incidence and risk factors of endophthalmitis after IOFB removal were studied. RESULTS During 5 years, 99 patients with IOFB were reviewed. Of these, 19 patients were diagnosed with endophthalmitis on admission, and 5 were suspected of having endophthalmitis during operation. Fifty-four cases had no clinical signs of endophthalmitis on admission and during operation and were treated with operation within 24 hours after the injury. Two patients (2 of 54; 3.70%) developed endophthalmitis after IOFB removal, and the causative agent in both cases was Bacillus cereus. CONCLUSION The incidence of infectious endophthalmitis after primary surgical repair combined with IOFB removal (≤24 hours) was 3.70% in patients who received a series of standard treatments, and B. cereus infection might be a risk factor.
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Affiliation(s)
- WENTING Zhu
- Eye Hospital of Shandong First Medical University, Jinan, Shandong, China;
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China; and
| | - Jingyi Tian
- Eye Hospital of Shandong First Medical University, Jinan, Shandong, China;
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China.
| | - Xiuhai Lu
- Eye Hospital of Shandong First Medical University, Jinan, Shandong, China;
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China; and
| | - Xiang Gao
- Eye Hospital of Shandong First Medical University, Jinan, Shandong, China;
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China.
| | - Jianmin Wei
- Eye Hospital of Shandong First Medical University, Jinan, Shandong, China;
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China.
| | - Gongqiang Yuan
- Eye Hospital of Shandong First Medical University, Jinan, Shandong, China;
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China.
| | - Jingjing Zhang
- Eye Hospital of Shandong First Medical University, Jinan, Shandong, China;
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China; and
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China.
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The clinical features and the factors affecting visual prognosis in pediatric open-globe ınjuries. Int Ophthalmol 2022; 42:3589-3600. [PMID: 35579769 DOI: 10.1007/s10792-022-02359-6] [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: 04/15/2021] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate clinical features and factors affecting visual prognosis after pediatric open-globe injuries. METHODS Retrospective study of 223 children with open-globe injury was conducted. Children with final logMAR visual acuity (LVA) > 0.70 were determined as poor-vision group (group 1, n = 108) and those with final LVA ≤ 0.70 as good-vision group (group 2, n = 115). Demographic characteristics (age, gender, and damaged eye), time between trauma and surgery, ocular trauma score (OTS), follow-up time, injury size, initial and final visual acuity levels, injury type (penetrating injury, globe rupture, perforating injury, and intraocular foreign body injury), injury localization (zone 1 = within the corneal and/or limbal area, zone 2 = within the scleral area extending 5 mm back from the limbus, and zone 3 = within the area posterior to zone 2), injury cause [metal objects (fork, knife, needle), broken glass, blunt objects (ball, punch), pen-pencil, and unidentified objects], and accompanying ocular findings of the groups were detected, and comparisons were done. Additionally, effects of age, time between trauma and surgery, OTS, injury size, follow-up time, initial LVA, injury type, and injury zone on final LVA were analyzed in both groups. RESULTS Mean age was 9.1 ± 2.0 years. There were 151 males and 72 females. Compared to group 1, group 2 had better initial and final visions (1.21 ± 0.26 vs 0.60 ± 0.28, p < 0.001 for initial LVA; 1.00 ± 0.32 vs 0.30 ± 0.13, p < 0.001 for final LVA), greater OTS (1.72 ± 0.53 vs 3.73 ± 0.61, p = 0.025), and smaller injury size (10.4 ± 3.5 vs 5.8 ± 2.4 mm, p = 0.002). Globe rupture (p = 0.015) and relative afferent pupillary defect (RAPD) (p = 0.037) were higher in group 1, while penetrating injury (p = 0.044), zone 1 involvement (p = 0.038), and metal object injury (p = 0.041) were higher in group 2. Based on multivariate analysis, the presences of globe rupture (p = 0.024) and RAPD (p = 0.035), the involvement without zone 1 (p = 0.042), and the injury without metal object (fork, knife, needle) (p = 0.046) were associated with poor final vision. Final LVA (for group 1 and group 2) was negatively correlated with OTS (r = - 0.398, p = 0.037; r = - 0.369, p = 0.040), while positively correlated with injury size (r = 0.412, p = 0.031; r = 0.318, p = 0.046) and initial LVA (r = 0.335, p = 0.043; r = 0.402, p = 0.034). CONCLUSION In our study, poor prognostic factors affecting final vision were low OTS, poor initial vision, the presences of globe rupture and RAPD, the large injury size, the involvement without zone 1, and the injury without metal object (fork, knife, needle).
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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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Qin ZX, He Y, Xu YF, Yu T, Liu Y, Wu N. Pediatric ocular trauma with pars plana vitrectomy in Southwest of China: clinical characteristics and outcomes. Int J Ophthalmol 2021; 14:1321-1326. [PMID: 34540606 DOI: 10.18240/ijo.2021.09.05] [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: 11/14/2020] [Accepted: 02/19/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the clinical characteristics and predictive factors of pediatric ocular trauma patients with vitrectomy. METHODS Pediatric ocular trauma patients (aged 14y or younger) who received vitrectomy in Southwest Hospital between January 2007 and December 2017 were reviewed retrospectively. Age, gender, mechanism of injury, final visual acuity (VA), and prognostic factors were analyzed. RESULTS A total of 139 eyes in 139 pediatric patients were included in the study. The mean age was 7.4±3.7 years old and the male-to-female ratio was 5:1. There were 104 (74.8%) open globe injuries and 35 (25.2%) closed globe injuries. The top one traumatic eye injuries were penetrating injuries occur through sharp metal objects (43.9%). After vitrectomy, 116 patients had favorable anatomic outcome at the last follow-up, and 30 eyes (21.6%) achieved VA of 20/200 or better. Following univariate analysis, we found zone III injuries (P=0.021), poor initial VA (P=0.005), endophthalmitis (P=0.024), and recurrent retinal detachment (P<0.001) were poor prognostic factors for pediatric ocular trauma. After Logistic regression analysis, the poor initial VA (odds ratio: 8.276, 95%CI: 1.597-42.897, P=0.012) and recurrent retinal detachment (odds ratio: 6.455, 95%CI: 2.372-17.562, P<0.001) were significantly correlated with unfavorable vision outcome in pediatric ocular trauma. CONCLUSION The treatment of vitrectomy for severe ocular trauma results in favorable anatomic outcomes, but VA improvement is not as good as anatomic outcomes. Initial VA and recurrent retinal detachment are the independent prognostic indicators for unfavorable visual outcome of severe pediatric ocular trauma.
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Affiliation(s)
- Zuo-Xin Qin
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Yan He
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Yu-Fei Xu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Tao Yu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Yong Liu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Nan Wu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
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Liu X, Wang L, Yang F, Xie J, Zhao J, Liu Z, Su G, Yang L. Surgical management and outcomes of pediatric open globe injuries requiring vitrectomy. Eur J Ophthalmol 2021; 32:546-552. [PMID: 33706579 DOI: 10.1177/11206721211000648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe surgical management and establish visual outcomes of open globe injury (OGI) in pediatric patients requiring vitrectomy. METHODS Forty-eight eyes of 48 pediatric patients underwent vitrectomy for OGI with secondary vitreoretinal complications in the eye center of Jilin University were included. Characteristics of patients, details of ocular examination and operation, presenting and final visual acuity were recorded. RESULTS Presenting visual acuity less than 20/400 was found in 44 eyes (91.7%), which included no light perception (NLP) in four eyes. At last visit, there was no eyes with visual acuity of NLP, and 19 eyes (39.6%) had a vision recovery to 20/400 or better. Mechanisms of injury, intraocular contents prolapse, presence of hyphema, intraocular foreign body, vitreous hemorrhage, retinal detachment, and total time from injury to PPV > 2 weeks were significant predictors of visual prognosis. Logistic regression analysis showed that hyphema was a significant predictive factor for poor visual outcome. CONCLUSION Visual acuity was improved in most of the patients with OGI in this study. Hyphema is an important presenting ocular sign in estimating the post-vitrectomy visual outcome for OGI in children. Proper timing of vitrectomy is suggested, and in this study patients may benefit more with early vitrectomy as less proliferative vitreoretinopathy (PVR) was found together with a better visual acuity.
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Affiliation(s)
- Xin Liu
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Lufei Wang
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Fengjuan Yang
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jia'nan Xie
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jinsong Zhao
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Zaoxia Liu
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Guanfang Su
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Longfei Yang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, Changchun, Jilin, China
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Hoskin AK, Watson SL, Mackey DA, Agrawal R, Keay L. Eye injury registries - A systematic review. Injury 2019; 50:1839-1846. [PMID: 31378543 DOI: 10.1016/j.injury.2019.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/18/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Registries are integral to monitoring, surveying, treating, preventing and prognosticating trauma. The quantity and quality of data must justify a change or intervention in treatment and/or preventive strategies and must be collected while balancing the cost and time invested in the registry. This review documents the quality, completeness and operational and funding models for ocular trauma registries worldwide. METHODS The databases CENTRAL, MEDLINE, EMBASE and Informit Health Collection were searched using key word and mesh terms for: "Eye injury, "Ocular trauma", "Eye injury prevention", "Eye protection", "Registry". To find relevant unpublished articles and theses, clinicaltrials.gov, Trip, MedNar and Google Scholar were searched using the key words "eye injury" OR "ocular trauma" AND "registry*". No date or language restrictions were applied. The quality of registry data was assessed against published measures including design, operation and data quality. RESULTS The electronic search retrieved 528 distinct published articles; 61 articles were assessed for eligibility. Of the 61 articles identified, 28 were eligible to be included in the review, with cross-referencing identifying a further 7 articles. The source of most articles on ocular trauma registries was the United States, followed by Germany and China. Patient follow-up was conducted in 31 studies, with 6 months being the most frequently reported period. Issues with data quality included incomplete data such as presence or absence of eye protection and initial visual acuity. Attrition bias was controlled by the United States Eye Injury Register with follow-up. Patients without follow-up data were removed for some studies and this may have introduced bias. CONCLUSION National, state and hospital-based ocular trauma registries have contributed significantly to our understanding of ocular trauma. The United States has the most frequently cited and well-resourced ocular trauma registries. It is anticipated that this review will guide the development of future registries for ocular trauma in order to inform evidence-based prevention strategies and, ultimately, improve visual outcomes. We recommend the development of a consensus guidelines for international ocular trauma registry that includes mechanism and context of injury and visual outcomes, to permit international comparison that can be implemented at low cost with secure data capture.
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Affiliation(s)
- Annette K Hoskin
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia; Lions Eye Institute. Nedlands, Western Australia, Australia; Department of Ophthalmology, University of Western Australian, Nedlands, Western Australia, Australia.
| | - Stephanie L Watson
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
| | - David A Mackey
- Lions Eye Institute. Nedlands, Western Australia, Australia; Department of Ophthalmology, University of Western Australian, Nedlands, Western Australia, Australia
| | | | - Lisa Keay
- The School of Optometry and Vision Science, UNSW, Sydney, New South Wales, Australia; The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
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Han L, Cho YL, Ma Z, Zhao X, Chang X. Clinical histopathology of intrachoroidal splitting in open-globe injury: A retrospective case series of four patients. Taiwan J Ophthalmol 2018; 8:36-41. [PMID: 29675348 PMCID: PMC5890583 DOI: 10.4103/tjo.tjo_61_17] [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] [Indexed: 12/02/2022] Open
Abstract
PURPOSE: The purpose of this study is to observe the characteristics of intrachoroidal splitting (ICS) associated with choroidal detachment due to open-globe injury. METHODS: A retrospective, observational case series study of four eyes diagnosed with choroidal detachment exhibited ICS. The in vivo pathologic changes of the ICS were recorded during surgery. Four specimens were obtained from the inner part of the ICS region. One specimen was stained with hematoxylin and eosin; one specimen was examined under scanning electron microscopy, and the other two specimens were examined under transmission electron microscopy. RESULTS: All four patients presented with vortex vein rupture associated with large-scaled mid-peripheral ICS. The histopathologic observations indicated that ICS occurred between the medium-sized and large-sized choroidal vessel layers. Large vascular indentations and medium-sized choroidal vessels were observed on the inner part of the split interface. Postoperative outcomes of the four patients were poor. Vision in all four patients was no light perception before or after surgery. Three eyes became atrophic with silicon oil tamponade and band keratopathy, one eye was eventually enucleated for cosmetic reason. CONCLUSION: Intrachoroidal tissue has the potential to split during trauma. The outcome of ICS with choroidal detachment in open-globe injury was poor.
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Affiliation(s)
- Liang Han
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yen-Ling Cho
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Zhizhong Ma
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Xinrong Zhao
- Peking University Health and Science Center, Beijing, China
| | - Xin Chang
- Peking University Health and Science Center, Beijing, China
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Jin W, Xu Y, Wang W, Xing Y, Yang A. Efficacy and Safety of 23-Gauge Pars Plana Vitrectomy/Silicone Oil Tamponade Combination for Treatment of Pediatric Post-Traumatic Endophthalmitis. Curr Eye Res 2017; 42:1143-1148. [PMID: 28441071 DOI: 10.1080/02713683.2017.1297460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To determine (i) the etiology, epidemiology, mechanism of injury, and risk factors associated with open globe injuries (OGIs) in children and (ii) visual outcomes of pediatric patients with post-traumatic endophthalmitis following 23-gauge pars plana vitrectomy (PPV) combined with silicone oil tamponade (SOT). METHODS A total of 107 consecutive patients, <15 years of age, who had been diagnosed with post-traumatic endophthalmitis between September 2009 and October 2015, were included in this 6-year retrospective study. All patients had undergone a combined PPV and SOT procedure. We reviewed records and analyzed several parameters, including age, gender, wound anatomy, intraocular foreign body characteristics, best-corrected visual acuity (BCVA), and anatomic re-attachment of the vitreous. Visual acuity (VA) was evaluated by comparing the Ocular Trauma Scores (OTS) system with BCVA (as assessed by Fisher's exact test). RESULTS Patients included 70 (65.42%) boys and 37 (34.58%) girls (mean, 7.84 ± 2.31 years). Mean follow-up time was 13.31 ± 3.15 months. Zone-1 injuries accounted for 15 of 107 (14.02%) cases, while Zones-2 and -3 accounted for 69 of 107 (64.49%), and 23 of 107 (21.50%) cases, respectively. Lens trauma was noted in 53 of 107 (49.53%) eyes. Our analysis showed that the 6-month BCVA, as assessed by OTS, differed significantly between groups OTS-1 (p = 0.001) and OTS-2 (p = 0.012). No significant difference was observed in group OST-3 (p = 1.000). Total retinal attachment was achieved in 99 of 107 eyes (92.52%). CONCLUSIONS Following combined PPV/SOT for post-traumatic endophthalmitis, VAs were not only favorable, but also often better than those predicted by OTS. Increased awareness of the very serious nature of endophthalmitis is expected to help in the development of a comprehensive strategy designed to educate both parents and children, and to minimize the number of preventable pediatric OGIs.
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Affiliation(s)
- Wei Jin
- a Eye Center of Renmin Hospital, Wuhan University , Wuhan , Hubei Province , People's Republic of China
| | - Yaopeng Xu
- b Department of Urology , Wuhan General Hospital of Guangzhou Military Command , Wuhan , Hubei Province , People's Republic of China
| | - Wenjun Wang
- a Eye Center of Renmin Hospital, Wuhan University , Wuhan , Hubei Province , People's Republic of China
| | - Yiqiao Xing
- a Eye Center of Renmin Hospital, Wuhan University , Wuhan , Hubei Province , People's Republic of China
| | - Anhuai Yang
- a Eye Center of Renmin Hospital, Wuhan University , Wuhan , Hubei Province , People's Republic of China
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Zhang M, Xu GZ, Jiang R, Ni YQ, Wang KY, Gu RP, Ding XY. Pediatric Infectious Endophthalmitis: A 271-case Retrospective Study at a Single Center in China. Chin Med J (Engl) 2017; 129:2936-2943. [PMID: 27958225 PMCID: PMC5198528 DOI: 10.4103/0366-6999.195473] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Pediatric infectious endophthalmitis is a serious sight-threatening disease for children. The purpose of this study was to investigate the etiology, microbiological spectrum, and visual outcomes of infectious endophthalmitis in children at a single institution in China. Methods: It is a retrospective study of the medical records of all patients under 14 years of age with histories of infectious endophthalmitis, treated at a single institution from January 1, 2009 to January 1, 2015. The clinical characteristics, etiology, microbiological spectrum, and management, as well as the visual outcomes, were analyzed. The Kappa test and Chi-square test were used in the statistical evaluation. Results: A total of 271 children were identified, with a mean age of 5.61 ± 2.93 years (range 5 months to 14 years). Ocular trauma (94.8%) and previous ocular surgery (3.0%) were the most common etiologies. Overall, 147 (54.2%) cases had positive cultures, and 176 organisms were isolated from these patients. A single species was isolated in 120 (81.6%) cases, with multiple organisms in 27 (18.4%) cases, and the most commonly identified organisms were coagulase-negative Staphylococcus and Streptococcus species, comprising 29.5% and 26.8% of the isolates, respectively. Moreover, of 176 isolates, 142 (80.8%) were Gram-positive organisms, 23 (13.0%) were Gram-negative organisms, and 11 (6.2%) were fungi. The final visual outcomes were 20/200 or better in 66 (24.4%) eyes, counting fingers to 20/200 in 34 (12.5%), hand motions in 30 (11.1%), light perception in 33 (12.2%), no light perception in 32 (11.8%), and 9 (3.3%) eyes were enucleated or eviscerated. The visual outcomes were not available in 67 (24.7%) patients. Conclusions: Penetrating ocular trauma is the most frequent cause of pediatric endophthalmitis in China. Streptococcus and Staphylococcus species are the most commonly identified organisms in exogenous pediatric endophthalmitis whereas Fusarium species are commonly seen in endogenous endophthalmitis. In this research, in spite of aggressive management with antibiotics and vitrectomy, the visual prognosis was found to be generally poor.
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Affiliation(s)
- Meng Zhang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
| | - Ge-Zhi Xu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
| | - Rui Jiang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
| | - Ying-Qin Ni
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
| | - Ke-Yan Wang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
| | - Rui-Ping Gu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
| | - Xin-Yi Ding
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
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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.
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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
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Feng K, Wang CG, Hu YT, Yao Y, Jiang YR, Shen LJ, Pang XQ, Nie HP, Ma ZZ. Clinical features and prognosis of eyeball rupture: eye injury vitrectomy study. Clin Exp Ophthalmol 2015; 43:629-36. [PMID: 25855007 DOI: 10.1111/ceo.12534] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 03/31/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Kang Feng
- Department of Ophthalmology; Ministry of Education's Key Laboratory of Vision Loss and Restoration; Peking University Third Hospital; Beijing China
| | - Chang-guan Wang
- Department of Ophthalmology; Ministry of Education's Key Laboratory of Vision Loss and Restoration; Peking University Third Hospital; Beijing China
| | - Yun-tao Hu
- Department of Ophthalmology; Ministry of Education's Key Laboratory of Vision Loss and Restoration; Peking University Third Hospital; Beijing China
| | - Yi Yao
- Department of Ophthalmology; Chinese PLA General Hospital; Beijing China
| | - Yan-rong Jiang
- Department of Ophthalmology; Peking University People's Hospital; Beijing China
| | - Li-jun Shen
- Hospital of Optometry and Ophthalmology; Wenzhou Medical College; Zhejiang Province China
| | - Xiu-qin Pang
- Department of Ophthalmology; Tongren Hospital; Capital University of Medical Sciences; Beijing China
| | - Hong-ping Nie
- Department of Ophthalmology; Peking University First Hospital; Beijing China
| | - Zhi-zhong Ma
- Department of Ophthalmology; Ministry of Education's Key Laboratory of Vision Loss and Restoration; Peking University Third Hospital; Beijing China
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