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Epidemiology and Visual Outcome of Pediatric Ocular Trauma in a Major Tertiary Eye Center in Tunisia: A 6-Year
Mohamed Foued Rmili1,2, Ahmed Chebil1,2, Rim Limaiem1,2
1Department B, Hedi Rais Institute of Ophthalmology, Tunis, Tunisia.
Insights
Pediatric ocular trauma in Tunisia predominantly affects young males, with falls and tree branches being common injury causes. Both Ocular Trauma Score (OTS) and Pediatric OTS (POTS) predict visual outcomes, with POTS being advantageous for children.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Public Health
Background:
- Pediatric ocular trauma presents unique challenges in diagnosis and management.
- Understanding the epidemiological profile and risk factors is crucial for prevention and improving visual outcomes in children.
Purpose of the Study:
- To describe the epidemiological characteristics of pediatric ocular trauma in Tunisia.
- To identify clinical factors associated with visual outcomes in pediatric ocular trauma.
- To evaluate the predictive value of the Ocular Trauma Score (OTS) and Pediatric OTS (POTS) for visual prognosis.
Main Methods:
- Retrospective cohort study of 398 children (<16 years) with ocular trauma.
- Data collected on demographics, injury mechanisms, clinical findings, and visual acuity (BCVA).
- Statistical analysis including Chi-squared test and Cohen's kappa coefficient; OTS and POTS calculated.
Main Results:
- Mean age 7.95 years, male predominance (5.32:1). Closed-globe injury (CGI) in 321 eyes, open-globe injury (OGI) in 101 eyes.
- Home injuries common, with falls (CGI) and tree branches (OGI) as leading causes.
- Factors for poor prognosis: delayed consultation, initial poor BCVA, OGI, large injury size, endophthalmitis, and associated lesions. Both OTS and POTS predicted final BCVA.
Conclusions:
- Pediatric ocular trauma in Tunisia has a distinct epidemiological profile.
- Identifying risk factors like delayed consultation and OGI is vital for preventive strategies.
- OTS and POTS are valuable tools for predicting visual outcomes, with POTS offering advantages in pediatric assessment.
Purpose:
To describe the epidemiological profile, clinical characteristics, and visual outcome of pediatric ocular trauma in Tunisia.
Methods:
In this retrospective cohort study, we reviewed the charts of 398 children younger than 16 years of age, presenting to the Emergency Department "B" of Hedi Rais Institute of Ophthalmology, for ocular trauma. The study period was between January 1, 2013, and January 1, 2019. The final best-corrected visual acuity (BCVA) was measured at the end of the follow-up period, which was 6 months. We used the Chi-squared test to compare the two groups of final visual acuities (good vs. poor visual outcome) for different prognostic factors. The ocular trauma score (OTS) and the pediatric OTS (POTS) were calculated for each child. We used the Cohen's kappa coefficient to evaluate the agreement between our final visual acuities using OTS and POTS.
Results:
The mean age was 7.95 years with a sex ratio (males to females) of 5.32. Closed-globe injury (CGI) was found in 321 eyes, while 101 eyes had open-globe injury (OGI). Injuries were bilateral in 24 children. The majority of injuries occurred at home. The predominant mechanism of injury was fall in CGI and tree branch in OGI. Initial and final BCVA were predominantly ≤0.3 logMAR in both CGI and OGI. OTS category 3 and POTS category 2 were the most common. Factors associated with poor prognosis included delay to consultation >24 h (P = 0.0001); initial BCVA >1 logMAR (P = 0.0001); OGI (P = 0.001); size of injury ≥5 mm (P = 0.01); zone III in OGI (P = 0.032); endophthalmitis (P = 0.001); OTS 1 and 2 (P = 0.01); POTS 1 (P = 0.0001); and the following associated lesions: cataract (P = 0.006), retinal detachment (P = 0.03), and intraocular foreign body (P = 0.03). We found that both OTS (P = 0.001) and POTS (P = 0.003) were predictive of the final BCVA, with a moderate agreement between them (Cohen's kappa = 0.56).
Conclusions:
Studying the epidemiological profile and identifying the risk factors for poor visual outcome of pediatric ocular trauma are necessary to implement preventive measures. A thorough clinical evaluation and close patient follow-up are crucial for identifying these risk factors. Both OTS and POTS were predictive of the final visual outcome. POTS has the advantage of bypassing the initial visual acuity which may be difficult to assess in children.
