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Anterior Segment Organ Culture Platform for Tracking Open Globe Injuries and Therapeutic Performance
Published on: August 25, 2021
Traumatic open globe injury in young pediatric patients: characterization of a novel prognostic score
Sarah P Read1, Kara M Cavuoto1
1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Insights
A new algorithm predicts visual outcomes in children with open globe injuries, avoiding difficult-to-assess visual acuity. This tool aids prognosis for young patients with eye trauma.
Area of Science:
- Ophthalmology
- Pediatric Trauma
- Medical Algorithms
Background:
- Open globe injury is a leading cause of acquired monocular blindness in children.
- Assessing visual acuity and pupillary response in young children is challenging, limiting current prognostic tools.
- This study focuses on children aged 0-6 years to develop a tailored predictive algorithm.
Purpose of the Study:
- To analyze features of open globe injuries in young children (0-6 years).
- To develop a novel algorithm for predicting visual outcomes in this pediatric population.
- To create a prognostic tool independent of presenting visual acuity.
Main Methods:
- Retrospective review of medical records for patients aged 0-6 years with open globe injury (2000-2013).
- Analysis of epidemiological data, physical examination findings, and interventions.
- Development of a prognostic algorithm based on identified risk factors.
Main Results:
- Glass was the most frequent cause of injury in 28 included patients.
- Common findings included uveal prolapse (93%), choroidal detachment (39%), and hyphema (32%).
- A novel algorithm achieved 81% sensitivity and 92% specificity in predicting visual outcomes, identifying cataract and wound length (>6 mm) as negative predictors.
Conclusions:
- Pediatric open globe injuries (0-6 years) have unique risk factors impacting visual prognosis.
- The developed algorithm does not rely on visual acuity, offering a valuable tool for prognosis in very young children.
- This novel score can aid clinicians in managing pediatric eye trauma and predicting outcomes.
Background:
Open globe injury is a common cause of monocular blindness in children. Current formulas to predict outcomes of open globe injury often rely heavily on visual acuity and presence of an afferent pupillary defect, examination elements that are difficult to assess in young children. We aimed to analyze the features of open globe injuries in children aged 0-6 years to facilitate development of a novel algorithm for predicting visual outcomes in this age group.
Methods:
The medical records of patients 0-6 years of age presenting at a single institution with open globe injury from 2000 to 2013 were retrospectively reviewed. Epidemiology, physical examination, and intervention data were used to develop a prognostic algorithm.
Results:
A total of 28 patients were included. Mean age at presentation was 4.2 years (range, 1.9-6.7). Glass was the most common mechanism of injury. Associated findings included uveal prolapse (93%), choroidal detachment (39%), hyphema (32%), and retinal detachment (11%). In addition to primary repair, 43% patients required a lensectomy, and 7% underwent surgery to repair retinal detachment. Complicating cataract (P < 0.005) and a wound >6 mm (P < 0.05) were associated with a final visual acuity worse than 20/40. A novel algorithm for predicting visual outcome was devised with a sensitivity of 81% and a specificity of 92%.
Conclusions:
Patients 0-6 years of age with open globe injuries present unique risk factors for poor outcome. The trauma score generated by our algorithm is not reliant on presenting visual acuity and may be useful in predicting prognosis in very young children.
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