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Anterior Segment Organ Culture Platform for Tracking Open Globe Injuries and Therapeutic Performance
Published on: August 25, 2021
Pediatric open-globe injury in a university-based tertiary hospital
Faisal AlDahash1, Ahmed Mousa1, Priscilla W Gikandi1
1Department of Ophthalmology, King Abdulaziz University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Insights
Pediatric open-globe injuries are most commonly caused by knives and penetrating trauma. Good initial visual acuity and smaller wound size predict better outcomes, while retinal detachment significantly worsens prognosis.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Trauma Care
Background:
- Pediatric open-globe injuries present unique challenges in epidemiology, etiology, and surgical repair.
- Understanding these factors is crucial for optimizing treatment and visual outcomes in young patients.
Purpose of the Study:
- To investigate the epidemiology, causes, and outcomes of pediatric open-globe injuries.
- To identify predictors of good visual outcome and retinal detachment after primary repair.
Main Methods:
- Retrospective review of medical records for patients aged 18 years or younger undergoing primary open-globe repair.
- Analysis of injury types, causative agents, initial presentation, and follow-up data.
Main Results:
- Penetrating injuries (74.4%) were most common, often caused by knives (19.4%).
- Good initial visual acuity, smaller wound size (<10 mm), and absence of iris prolapse predicted better visual outcomes.
- Retinal detachment occurred in 12.7% of cases and was associated with worse final visual outcomes.
Conclusions:
- Penetrating injuries, particularly knife-related, are the leading cause of pediatric open-globe injuries.
- Initial presentation significantly influences visual outcomes.
- Retinal detachment is a critical complication impacting long-term visual prognosis.
Background:
To investigate epidemiology, etiology, and outcomes after repair of pediatric open-globe injury.
Methods:
We retrospectively reviewed medical records of patients ⩽18 years who underwent primary open-globe repair.
Results:
A total of 213 patients were identified. Male-female ratio was 1.44:1. Type of injury was penetration in 157 (74.4%) cases, rupture in 52 (24.4%) cases, and perforation in 2 (0.9%) cases. Knife injuries were the most common cause, affecting 38/196 (19.4%), followed by metallic object in 37/196 (18.9%) patients, glass in 26/196 (13.3%) patients, and pen or pencil in 24/196 (12.8%). Predictors of good visual outcome defined as (⩾20/40) were good initial visual acuity (⩾20/40; p < 0.0001), time from injury to arrival at the emergency room >24 h (p = 0.038), size of wound less than 10 mm (p < 0.0001), absence of iris prolapse (p < 0.0001), deep anterior chamber at presentation (p < 0.0001), absence of hyphema (p = 0.043), intact lens (p < 0.0001), and no retinal detachment during follow-up (p < 0.0001). A total of 27 (12.7%) cases were documented to have retinal detachment at any time during follow-up period. Predictors of retinal detachment were perforation and rupture (p < 0.0001), whereas penetration was not associated with development of retinal detachment, size of the wound ⩾10 mm (p < 0.0001), initial visual acuity ⩽20/200 (p < 0.0001), lens injury (p < 0.0001), and development of endophthalmitis (p < 0.027). Eight (3.7%) eyes had the clinical diagnosis of posttraumatic endophthalmitis.
Conclusions:
The most common type of injury was penetration and the most common tool was knife. Visual outcome was affected by the initial presentation. Retinal detachment was a significant predictor of a worse final visual outcome.
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