Prognostic factors of poor final visual acuity after repair of open globe injuries in a pediatric population in Mexico.

Abstract

Purpose : Ocular trauma is a leading cause of acquired monocular blindness in children and constitutes 20-50% of ocular injury emergency admissions. Late complications on these patients can lead to severe visual impairment. The aim of this prospective study is to identify the most important risk factors for final functional vision in children with open globe injuries (OGI), and to compare the predictive value for final vision using the ocular trauma score (OTS) and the pediatric penetrating ocular trauma score (POTS).

Methods : Sixty-six unilateral open-globe injuries in children 18 years or younger treated in our institution between 2013 and 2017 were included. OTS and POTS variables were obtained at presentation; the raw scores and its category conversion were also determined. Final best corrected visual acuity (BCVA) was captured at 3-month follow-up or the last documented visit if follow-up was lost. BCVA better than 1 LogMAR was defined as final functional vision (FFV) and worse than 1 LogMAR as final non-functional vision (FNFV).

Results : We evaluated mostly male patients (51), with a mean age of 10.16±5.3 years. The most frequent injury mechanism was trauma with metallic objects (20.3%), followed by organic materials (17.2%) and glass bottles (9.4%). Sixty-five percent were penetrating injuries, 27% globe ruptures, 6% perforating injuries and 3% intraocular foreign bodies. Two primary enucleations were performed, and where excluded from further analysis. A higher proportion of penetrating injuries (74.4% vs 43.8%, P =0.035) and a lower proportion of globe ruptures (16.3% vs 50.0%, P =0.016) were classified in the FFV group. A higher proportion of zone 1 injuries were in the FFV group compared to the FNFV group (65.1% vs 26.7%, P =0.037). Better initial BCVA showed statistical significance in the FFV group compared to the FNFV group (2.62±1.38 vs 1.50±1.16 LogMAR, P =0.014). We observed a significant negative correlation between final BCVA and the raw OTS score (R=-0.502, P=<0.001) and the raw POTS score (R=-0.320, P=0.034). A significant negative correlation between final BCVA (LogMAR) and the OTS category score (R=-0.486, P =<0.001) was noted.

Conclusions : Better initial BCVA, penetrating injuries, and zone 1 injuries were related to final functional vision. Higher OTS and POTS raw scores, and OTS category score where correlated with a better final BCVA.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.