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Abdelhalim Awidi, Courtney Kraus; Outcomes following pediatric ocular trauma. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2303.
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Pediatric ocular trauma represents a major concern for ophthalmologists. Delays in presentation, incomplete exams, inaccurate visual acuity (VA) results, and amblyopia can limit achieving full visual recovery in pediatric eye trauma. We performed a retrospective clinical study to describe the demographics and causes of eye trauma. A pediatric ocular trauma score (POTS) developed by Sii et al was used to classify injuries and predict VA outcomes. Sii F et al. The UK Pediatric Ocular Trauma Study 1, Clinical Ophthal. 2017;11:449-52.
A retrospective chart review of 10 years of pediatric globe trauma was performed. Analysis was focused on mechanisms of injury and VA outcomes. Complex factors that may worsen outcomes were recorded. The POTS was used to assign Group 1-5 to each case. Group 1 was poorest prognosis, Group 5 best. Association between Group and final VA was examined.
53 children met eligibility criteria (35 male, 18 female). VA was obtained in 36 children at presentation and averaged 20/300. Average age not able to provide presenting VA was 2.8 yrs. Final VA was obtained in 40 children and was 20/80. Average VA for children with injury during the amblyogenic age range was 20/200; for older children it was 20/60.9 of 53 children presented to the ER >24 hours after initial injury. 3 cases of endophthalmitis occurred, all presenting >24 hours after injury.23 patients were injured at home, 9 on the street, 5 at school, and 5 during sports activities. Most common objects of injury were dogs (9), knives/sharp objects (9), and BB guns (4). Six injuries were penetrating with/without intraocular foreign body; 14 were defined as ruptured globe trauma.Using POTS, 9 patients were in Group 1; 6/9 had VA of count fingers (CF) or worse. In Group 2, 2/9 patients had VA of CF or worse. In Group 4, 6/10 children had VA of 20/30 or better. Of the 3 patients in Group 5, 2 had VA 20/30 or better.
The chance of vision loss in a child following ocular trauma is high. Unlike in adults, initial VA is not as easily obtained or accurate in this population. Many ocular trauma scores give inital VA greater weight in outcome prediction models, which unfairly penalizes pediatric patients. Using the POTS developed by Sii et al, we were able to validate its grouping system and found excellent correlation with VA outcomes, which may prove crucial in guiding care and treatment algorithms.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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