Purpose Data regarding ocular foreign body (FB) in the pediatric population is sparse. The purpose of this study is to describe the demographic features and the outcomes of pediatric non-penetrating ocular FB. Methods The charts of all children with non-penetrating ocular FB who presented at a tertiary medical center between 2011 and 2018 were retrospectively reviewed. Data analyzed included demographics, ocular FB site, the need for general anesthesia, or sedation for FB removal and clinical outcomes. Results Three hundred and fifty-two children (58.8% boys) with a mean age of 7.7 ± 3.7 years were included. Two hundred and fifty-one (71.3%) children presented on the same day of injury. Patients with developmental delay presented more often with restlessness than patients without developmental delay (p < 0.0001). One hundred and forty-six (41.5%) of FBs were found on the conjunctiva, 128 (36.4%) under the eyelid, and 62 (17.6%) on the cornea. In 19 (4.5%) cases, general anesthesia or sedation was required for FB removal. A multivariate analysis identified young age (OR 0.976, 95% CI 0.961-0.992, p = 0.003), corneal FB (OR 50.84, 95% CI 10.08-256.37, p < 0.0001), and developmental delay (OR 18.56, 95% CI 1.22-283.45, p = 0.036), as significant predictors for the need of general anesthesia or sedation. Among patients with corneal FB, in two (3.2%) cases, the corneal FB was complicated by infectious keratitis, resulting in mild corneal scar. Conclusion The rate of general anesthesia for non-penetrating ocular FB removal in children is low. Children presenting with non-penetrating ocular FB have good prognosis without long-term complications.
To analyze functional and anatomical response patterns to dexamethasone (DEX) implant in diabetic macular edema (DME), to describe proportion of responders and non-responders, and to propose a new DME grading system. Retrospective, multicenter, observational cohort study. Naïve and non-naïve DME patients were treated with DEX, with visual acuity (VA) ≥ 0.2 logMAR and central subfield thickness (CST) of ≥ 300 µm. Functional and anatomical responses were graded after 2 and 4 months, and categorized as early and stable improvement, early and progressive improvement, pendular response, delayed improvement, and persistent non-response. 417 eyes were included (175 treatment naïve eyes). Compared to non-naïve eyes, naïve eyes showed a very good functional response (VA gain ≥ 10 letters) more frequently after 2 and 4 months (56% and 57% [naïve] vs. 33% and 28% [non-naïve], p < 0.001). A VA gain < 5 letters (non-response) after 2 and 4 months was seen in 18% and 16% of naïve eyes, and in 49% and 53% of non-naïve eyes (p < 0.001). A lack of anatomical response was rare in both groups, but more frequently in non-naïve eyes (12% vs. 4%, p = 0.003). Functionally and anatomically, naïve eyes showed most frequently an early and stable improvement (functionally: 77/175 44%; anatomically: 123/175 eyes, 70%). Most non-naïve eyes experienced no significant improvement functionally (97/242 eyes, 40%), despite a mostly early and stable improvement anatomical response pattern (102/242 eyes, 42%). Functional but not anatomical response patterns were influenced by baseline VA. Naïve and non-naïve eyes show different functional and anatomical response patterns to DEX implant. Functional non-responders are rare in naïve eyes, whereas anatomical non-response is unusual in both groups.
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