Traumatic cataracts in children: Visual outcome

Validation of a modified Birmingham Eye Trauma Terminology classification for mechanical eye injuries

Introduction

Criticisms have been levelled at the widely accepted Birmingham Eye Trauma Terminology (BETT) classification of mechanical ocular trauma, as it is not specific enough. Alternative modifications to the BETT have been proposed and this study aimed to assess these newer classifications.

Methods

A prospective cohort study of all patients presenting to the outpatient department between January 2005 and December 2014, who were examined and categorised based on the BETT. Cases which did not comply with the BETT system were placed in additional categories, and documented for each type of injury.

Results

A total of 4721 eyes suffered mechanical injuries and 1060 (22.4%) could not be classified with BETT, including 368 globe injuries (7%) associated with orbital/ocular adnexa injury; 692 eyes (14.6%) with ocular surface foreign body (OSFB) or ocular wall foreign body (IWFB). There were 77 eyes (1.6%) with contusion, 9 eyes (0.19%) with lamellar laceration-associated OSFB or OWFB, 29 eyes (0.6%) with globe rupture-associated OSFB, OWFB or intraocular foreign body (IOFB) and 60 eyes (1.4%) with laceration-associated OSFB or OWFB.

Conclusion

The BETT needs modification to be fully applicable to the wide range of ocular trauma seen across the world.

Pediatric ocular trauma score as a prognostic tool in the management of pediatric traumatic cataracts

OBJECTIVE

To introduce and validate the pediatric ocular trauma score (POTS) - a mathematical model to predict visual outcome trauma in children with traumatic cataract METHODS: In this retrospective cohort study, medical records of consecutive children with traumatic cataracts aged 18 and below were retrieved and analysed. Data collected included age, gender, visual acuity, anterior segment and posterior segment findings, nature of surgery, treatment for amblyopia, follow-up, and final outcome was recorded on a precoded data information sheet. POTS was derived based on the ocular trauma score (OTS), adjusting for age of patient and location of the injury. Visual outcome was predicted using the OTS and the POTS and using receiver operating characteristic (ROC) curves.

RESULTS

POTS predicted outcomes were more accurate compared to that of OTS (p = 0.014).

CONCLUSION

POTS is a more sensitive and specific score with more accurate predicted outcomes compared to OTS, and is a viable tool to predict visual outcomes of pediatric ocular trauma with traumatic cataract.