Abstract
Purpose: :
Past studies have examined prognostic predictors of ruptured globe injuries in adult patients. This study was conducted to analyze pediatric cases of ruptured globe injuries and determine what factors were predictive of visual outcome.
Methods: :
Following a retrospective review of over 200 medical records involving ruptured globe injury that were seen at the Institute of Ophthalmology and Visual Science at New Jersey Medical School, a series of 41 pediatric patients (41 eyes) ages 1 to 17 were identified. Data extracted from each record included location and size of injury, initial and final visual acuity, and lens involvement. The Ocular Trauma Classification system was used to group the injuries such that Zone I was defined as a full thickness wound isolated to the cornea, Zone II to involve the sclera between the limbus and 5mm posterior to the limbus (involving the lens), and Zone III posterior to Zone II.
Results: :
All identified patients underwent repair of ruptured globe injury. 75% of final visual acuities were 20/100 or better with injuries in Zone I vs. 44% in Zone II and III. Without involvement of the visual axis, defined the injury being 3 mm or less from the center, initial visual acuity was better than 20/100 in 33% of patients with injuries outside of the visual axis compared to 13% of patients with injuries inside the visual axis. Final acuities 20/100 or better were seen in 70% of patients with injuries outside the visual axis and 52% of patients with injuries involving the visual axis. Involvement of the lens was also associated with a worse initial and final visual acuities, as initial visual acuity was 20/100 or better in 33% of patients without lens involvement compared to 0% of patients with lens involvement. Considering final visual acuity, 83% without lens involvement were able to see 20/100 or better vs. 40% with lens involvement. Of note, prior to cataract surgery, visual acuity was worse than counting fingers in 96% of patients while afterwards, acuities were noted to be 20/100 or better in 96% of those patients.
Conclusions: :
Location of the wound, involvement of the visual axis, and involvement of the lens were identified as important predictive factors in pediatric ruptured globe injuries. Visual acuities were significantly better with a more anterior location of wound (Zone I vs. Zones II and III). Involvement of the visual axis was associated with a worse visual outcome. Although lens involvement was associated with a poor prognosis, cataract surgery in these patients made a significant improvement in their visual outcome.
Keywords: trauma • clinical (human) or epidemiologic studies: outcomes/complications