Clinical characteristics and outcomes of ocular injuries in pediatric patients

BACKGROUND: Childhood eye injuries are one of the most common causes of acquired unilateral blindness. In this study, our purpose was to investigate the demographics, etiology, and outcome of pediatric patients with ocular injury.
METHODS: The charts of children with ocular trauma who presented to Baskent University Hospitals, between January 1, 2017 and December 31, 2019 were retrospectively reviewed. All patients who were under 16 years of age were included. Data were collected on age, sex, time of trauma, injury type, associated injuries, treatments, visual impairment, intraocular pressure (IOP), and ophthalmic sequelae. Ocular traumas were classified according to the Birmingham Eye Trauma Terminology (BETT) system.
RESULTS: A total of 21 patients were identified. Male-female ratio was 13/8. The mean age of the patients was 8.5±3.4 years. Mean post-treatment follow-up was 8.2±4.3 months. Injury was unilateral in all cases (10 right eye, 11 left eye). Fifteen patients (71.4%) had open globe, and 6 (28.5%) had closed globe injury. Type of injury was rupture in 7 cases, perforation in 5, penetration in 4, and intraocular foreign body in 4. A total of 5 cases were documented to have retinal detachment during the follow-up. Sharp injuries were documented in 11 (64.7%) cases, and blunt in 6 (35.2%). The most frequent finding was hyphema in blunt injury, and corneal laceration in perforating injury. Five patients had choroidal hemorrhage, 3 had commotio retinae, 2 had intravitreal hemorrhage, 1 had subhyaloidal hemorrhage, 1 had macular hole, and 1 had optic nerve avulsion. Lens aspiration was performed in 12 (57.1%) cases, and 2 of them had intraocular lens implantation. In children whose initial vision was able to be taken, 4 had no light perception, 7 had light perception-counting fingers, and 5 had best-corrected visual acuity of 0.05–0.3. At final visit, 61.9% of patients had a VA of 0.05–0.8. Corneal scar or leucoma was observed in 14 (66.6%) cases at last visit. One eye was enucleated due to post-traumatic endophthalmitis that did not respond to treatment. At final visit, IOP <6 mmHg was identified in 2 cases and >21 mmHg in 4.
CONCLUSION: Anterior segment damage is the main cause of visual morbidity in pediatric ocular trauma. Injuries with sharp objects occur twice as often as blunt trauma and reduce vision with residual corneal scarring in about two-thirds of patients. Under-standing the pattern of eye injuries is useful in determining the strategies required to protect children’s eye health.

Çocukluk çaðý göz yaralanmalarýnýn klinik özellikleri ve tedavi sonuçlarý

AMAÇ: Çocukluk çaðý göz yaralanmalarý edinsel tek taraflý körlüðün en yaygýn nedenlerinden biridir. Bu çalýþmada çocukluk çaðý göz yaralanmalarýnýn nedenleri, hastalarýn demografik özellikleri ve tedavi sonuçlarýnýn deðerlendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþmada Baþkent Üniversitesi Hastanesi Göz Klinikleri’ne 1 Ocak 2017–31 Aralýk 2019 tarihleri arasýnda baþvuran oküler travmalý çocuklar deðerlendirildi. Çalýþmaya 16 yaþýn altýndaki tüm hastalar dahil edildi. Olgular yaþ, cinsiyet, travmanýn zamaný, yaralanma tipi, eþlik eden yaralanmalar, tedavi, görme bozukluðu, göz içi basýncý (GÝB) ve geliþen oftalmik sekeller açýsýndan deðerlendirildi. Oküler travmalar, Birmingham Göz Travma Terminolojisi (BETT) sistemine göre sýnýflandýrýldý.
BULGULAR: Çalýþmaya toplam 21 hasta alýndý. Erkek-kadýn oraný 13/8 idi. Hastalarýn ortalama yaþý 8.5±3.4 idi. Ortalama tedavi sonrasý takip 8.2±4.3 aydý. Olgularýn tümünde yaralanma tek taraflý idi (10 sað göz, 11 sol göz). On beþ hastada (%71.4) açýk glob yaralanmasý ve altý hastada (%28.5) kapalý glob yaralanmasý mevcuttu. Yedi olguda rüptür, beþ olguda perforasyon, dört olguda penetrasyon ve dört olguda göz içi yabancý cisim tespit edildi. Takip süresi boyunca beþ olguda retina dekolmaný saptandý. On bir (%52.3) olguda kesici tarzda, 10 (%47.6) olguda künt tarzda yara-lanma görüldü. En sýk eþlik eden bulgular perforan yaralanmada kornea laserasyonu ve künt yaralanmada hifema idi. Beþ olguda koroidal hemoraji, üç olguda kommosyo retina, iki olguda vitre içi kanama, bir olguda retina diyalizi, bir olguda makulada subhyaloidal hemoraji, bir olguda makula deliði ve bir olguda optik sinir avulsiyonu saptandý. On iki (%57.1) olguya lensektomi uygulandý ve bunlarýn ikisine göz içi lens implantasyonu yapýldý. Ýlk baþvuruda görme keskinliði alýnabilen çocuklarýn dördünde ýþýk persepsiyonu yoktu. Yedi olguda görme ýþýk persepsiyonu ve parmak sayma düzeyindeydi. Beþ hastada en iyi düzeltilmiþ görme keskinliði (EÝDGK) 0.05–0.3 arasýnda idi. Son kontrolde, olgularýn %61.9’unda EÝDGK 0.05–0.8 düzeyinde idi. Takip sonunda 14 (%66.6) olguda korneada skar, veya lökom izlendi. Bir olguya tedaviye yanýt vermeyen posttravmatik endoftalmi nedeniyle enükleasyon uygulandý. Son muayenede, iki olguda GÝB <6 mmHg, dört olguda GÝB >21 mmHg idi.
TARTIÞMA: Çocukluk çaðý göz yaralanmalarýnda ön segment hasarý, görme azlýðýnýn baþlýca nedenidir. Keskin nesnelerle olan yaralanmalar, künt trav-maya göre iki kat daha sýk meydana gelir ve hastalarýn yaklaþýk üçte ikisinde korneada rezidüel yara izi ile görmeyi azaltýr. Travmalarýn özelliklerinin bilinmesi çocuk göz saðlýðýný korumak açýsýndan gerekli olan stratejilerin belirlenmesinde faydalý olacaktýr.