Pediatric ocular trauma with pars plana vitrectomy in Southwest of China: clinical characteristics and outcomes

Abstract

AIM: To investigate the clinical characteristics and predictive factors of pediatric ocular trauma patients with vitrectomy. METHODS: Pediatric ocular trauma patients (aged 14y or younger) who received vitrectomy in Southwest Hospital between January 2007 and December 2017 were reviewed retrospectively. Age, gender, mechanism of injury, final visual acuity (VA), and prognostic factors were analyzed. RESULTS: A total of 139 eyes in 139 pediatric patients were included in the study. The mean age was 7.4±3.7 years old and the male-to-female ratio was 5:1. There were 104 (74.8%) open globe injuries and 35 (25.2%) closed globe injuries. The top one traumatic eye injuries were penetrating injuries occur through sharp metal objects (43.9%). After vitrectomy, 116 patients had favorable anatomic outcome at the last follow-up, and 30 eyes (21.6%) achieved VA of 20/200 or better. Following univariate analysis, we found zone III injuries (P=0.021), poor initial VA (P=0.005), endophthalmitis (P=0.024), and recurrent retinal detachment (P<0.001) were poor prognostic factors for pediatric ocular trauma. After Logistic regression analysis, the poor initial VA (odds ratio: 8.276, 95%CI: 1.597-42.897, P=0.012) and recurrent retinal detachment (odds ratio: 6.455, 95%CI: 2.372-17.562, P<0.001) were significantly correlated with unfavorable vision outcome in pediatric ocular trauma. CONCLUSION: The treatment of vitrectomy for severe ocular trauma results in favorable anatomic outcomes, but VA improvement is not as good as anatomic outcomes. Initial VA and recurrent retinal detachment are the independent prognostic indicators for unfavorable visual outcome of severe pediatric ocular trauma.

A Comparative Analysis of Traumatic Retinal Detachment After Open and Closed Globe Injuries in Children

“…In this study, baseline BCVA was the best predictor of the final BCVA, which is consistent with previous studies. 9,11,12 Higher final BCVA was also seen, as in previous studies, [9][10][11] in the absence of PVR and older age. Prospective studies with defined success criteria are needed to assess potential outcome improvements.…”

“…Despite being rare, traumatic RD resulting from open (OGI) or closed globe injuries (CGIs) is a challenging condition for retinal surgeons to address, in many cases carrying an unfavorable visual prognosis. [1][2][3][4][5][6][7][8][9][10][11][12] Open globe injury involves a full-thickness injury of the eye, often caused by sharp objects or high-velocity projectiles, leading to retinal tears or breaks. 10,[13][14][15][16][17] By contrast, CGI, often caused by a blunt impact such as sports-related injuries, falls, or physical assault, can also induce traumatic RD through indirect mechanical forces and vitreoretinal traction.…”

“…Despite being rare, traumatic RD resulting from open (OGI) or closed globe injuries (CGIs) is a challenging condition for retinal surgeons to address, in many cases carrying an unfavorable visual prognosis. 1–12…”

Predicting visual acuity with machine learning in treated ocular trauma patients

“…Owing to the complexity and diversity of ocular trauma and the great difference in posttreatment recovery, clinicians and forensic doctors often pay great attention to the recovery of post-traumatic visual acuity (VA). To better understand visual recovery after surgery or trauma, many researchers have investigated the relationship between macular [3][4] , retinal [5][6] , and vireteal [7] injuries caused by diseases or trauma. Hou et al [8] found that macular injury involving the fovea or a thin optic nerve fiber layer results in severe vision loss.…”