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S. Lesniak, A. M. Bauza, J. Son, S. Guo, R. Wagner, M. A. Zarbin, N. Bhagat; Pediatric Traumatic Open Globe Injuries. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4881.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the epidemiology, characteristics, and outcomes of pediatric traumatic open globe injuries; and to compare the observed final visual acuity (VA) to the ocular trauma score (OTS) expected visual acuity.
Retrospective chart review of 103 pediatric eyes with traumatic open globes that presented to University Hospital, Newark between 1997-2008. Eighty-nine records were complete enough to be included in the study. Complete set of OTS variables was available in 50 eyes.
Of 89 cases included in the study, 65 (73%) were male. The average age was 9.7 years. The mean follow-up was 22.6 months. The most common causes of trauma were accidents (79%), violence (10%) and motor vehicle accidents (9%). Penetrating ocular injury was the most common type of injury classification (53%), followed by blunt rupture (36%). Zone 1 injuries represented 49% of cases, zone 2 28%, and zone 3 21%. Ninety-seven percent of patients received IV antibiotics. The most common antibiotic regimen was ceftazidime and vancomycin. No patients at follow-up developed endophthalmitis. The average presenting and final visual acuities were 1.927 and 1.401 logMAR respectively. Lens trauma was noted in 49% of cases. Lensectomy was performed in 34% of cases. Vitreous hemorrhage (VH) was noted in 33% of cases. Twenty-eight patients (31%) were diagnosed with a retinal detachment (RD) within 6 months of presentation. Pars plana vitrectomy (PPV) was performed in 24 patients (27%) for RD or VH. Overall, retinal attachment was achieved in 15 of 24 eyes (63%). Enucleations were performed in 10% of cases; all were NLP eyes. The final visual acuities were not statistically different from visual acuities predicted by OTS. This was true for the analysis of the combined set including all patients (p > 0.05), as well as the analysis of subsets consisting of ages 0-9 and 10-19 (p > 0.05).
The visual prognosis in pediatric open globe injury is poor; only 30% achieved 20/60 or better VA. The zone of injury may correlate with poor final VA, risk of RD, subsequent need for a PPV, and enucleation. The OTS predicted final VA correlated well with the observed final VA in our study.
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