Open Globe Research Articles

Association between ocular trauma and attention-deficit/hyperactivity disorder in adult patients.

Purpose:To investigate the potential relationship between ocular trauma and attention-deficit/hyperactivity disorder (ADHD)-related clinical outcomes in adults.Methods:This prospective case-control study included 108 ocular trauma patients and 90 age-sex-matched healthy control. The ocular trauma group was separated into the subgroups home accident, outdoor activity, and work related in terms of the reasons for ocular trauma, and as ocular surface problems, blunt trauma-related, and open globe injury in terms of the clinical findings. The ADHD-related clinical outcomes were evaluated using the Wender-Utah Rating Scale (WURS). The outcomes were compared between ocular trauma and control groups, and ocular trauma subgroups.Results:The demographic characteristics of ocular trauma groups and controls were similar (P > 0.05, for all). In comparison to the control group, the ocular trauma group had higher total WURS score and WURS subscale scores, but not significantly (P > 0.05, for all). According to comparisons of the subgroups separated by the reasons, there was significant difference in the mean behavioral problems/impulsivity scores in favor of outdoor activities (P = 0.015). On the other hand, the mean scores for WURS subscales of the subgroups separated by the clinical findings were similar (P > 0.05, for all)Conclusion:WURS scores in ocular trauma patients are similar to control; however, the score in behavioral problems/impulsivity subscales is higher for ocular trauma caused by outdoor activities.

Enucleation in pediatric open globe injuries: demographics and risk factors.

The purpose of this study is to report the demographics and risk factors for undergoing primary enucleation in the setting of acute open globe injury (OGI) in the pediatric population in the USA. This retrospective, cross-sectional study of pediatric patients with OGIs in the USA between 2002 and 2014 was conducted utilizing data from the National Inpatient Sample Database. Descriptive statistics, chi-square testing, and univariate and multivariable analyses were performed. In the USA, 8944 cases of pediatric OGI were identified between 2002 and 2014 in the NIS Database, of which 344 underwent primary enucleation. Blacks and Asian/Pacific Islanders made up higher proportions of enucleated cases compared to non-enucleated cases. Older age, male sex, being Black or Asian/Pacific Islander, OGI with an intraocular foreign body, rupture type OGI, and concurrent endophthalmitis were identified as risk factors for undergoing enucleation. There was no significant difference in insurance status among enucleated versus non-enucleated cases. Mean length of hospital stay (in days) was almost 3 times higher in enucleated OGIs. By hospital's geographic location, the Midwest hospitals had a greater proportion of enucleated versus non-enucleated cases compared to other regions. Significant demographic differences were identified in OGI patients that underwent primary enucleation versus repair with regard to age, sex, race, the geographic location of hospital admission, mean length of hospital stay, type of ocular injury, and other ocular complications. Most pediatric traumatic enucleations between 2002 and 2014 were reported in teenagers (16-20 age group), in males, and in Blacks.

Clinical and ultrasound biomicroscopic (UBM) correlation in eyes with closed globe injury

To correlate UBM and clinical findings in patients with closed globe injury. Prospective observational study of 75 patients, ≥ 12 years of age presenting to ophthalmic outpatient department within one week of sustaining closed globe injury. Patients with seriously ill polytrauma and open globe injuries were excluded from the study. Comprehensive ophthalmic examination including Visual acuity assessment, slit lamp examination, fundus examination and IOP measurement. Gonioscopy and UBM examination was done in all patients on presentation except for patients with hyphema (UBM and gonioscopy done at 4 weeks to prevent rebleed).Mean age of the patients was 31.4 ±8 years, most common external findings included lid ecchymosis (47%), subconjunctival hemorrhage (93%). The common anterior segment finding included traumatic iritis (87%), traumatic hyphema (61%) and traumatic cataract in 27% of patients. Clinical evidence of zonular dialysis was seen in 13% of patients. UBM was able to detect zonular defects in 62% patients (P=0.008). Most of the patients (57%) had zonular dialysis less than 3 clock hours on UBM examination. UBM confirmed the presence of other clinical findings like iridodialysis, cyclodialysis. UBM is a safe and effective adjunctive tool for clinical assessment and management of ocular trauma. It can diagnose subtle zonular dialysis and other anterior segment changes following blunt trauma. UBM should be an integral part of ophthalmic examination especially in patients requiring surgical intervention after closed globe injury.

Epidemiology and prognosis factors in open globe injuries in the Federal District of Brazil

ObjectiveTo identify the epidemiological profile and prognostic factors of open globe injuries that require emergency surgical treatment.DesignRetrospective cohort study.SubjectsPatients with OGI who underwent publicly funded emergency surgical treatment in the Federal District from 2014 to 2018.MethodsData were collected by reviewing electronic medical records through a questionnaire and tabulated. The statistical analysis was performed in SPSS Statistics 26.0.0.0 (p ≤ 0.05).ResultsA total of 359 records were included, corresponding to 336 eyes of 334 patients (294 males and 40 females). The average age was 32.7 years. The affected eye was the right eye in 165 cases, the left eye in 166 cases, and both eyes in 3 cases. The average time between injury and hospitalization was 75.7 h, and the time between injury and surgery averaged 173.7 h. The injury types were as follows: 197 penetrating; 109 rupture; 19 IOFB; 11 perforating. The injuries were in the following zones: 181 zone I; 82 zone II; 70 zone III. The OTS grades were as follows: 57 were classified as grade 1; 101 were grade 2; 142 were grade 3; 28 were grade 4; and 8 were 5. The most commonly performed surgeries were corneal suture, corneoscleral suture, and evisceration. The most common clinical features were traumatic cataract, herniated iris and hyphema. The following were risk factors for poor prognosis: zone III, time between trauma and surgery > 72 h, rupture injury, retinal detachment, disorganization of the eyeball, endophthalmitis, uveal prolapse, OTS classification 1 or 2, and low initial visual acuity. The following factors predicted a good prognosis: initial VA > 1/200, penetrating injury, OTS 4 and zone II.ConclusionsThe high frequency of many of these factors may explain the high rate of severe visual loss found. Injury localization in zone II was identified as a previously unrecognized protective factor against severe visual loss.

Open globe injuries from projectile impact: Initial presentation and outcomes.

Purpose:To describe the characteristics and correlates of open globe injuries secondary to projectile injury and outcomes following surgical open globe repair at an urban tertiary referral center.Methods:Records of all patients with a history of open globe injury secondary to projectile injury and surgical open globe at a tertiary referral hospital between January 1, 2010 and December 31, 2016 were reviewed. Demographics, type of trauma, wound extent, presence of foreign body, and presenting clinical findings are reported. Outcomes for patients with greater than 6 months of follow-up included additional surgeries, final visual acuity, and clinical findings.Results:Of 214 patients who underwent open globe repair, 73 (34.1%) were due to projectile impact. Mean age was 37.9 years and patients were primarily male (n = 66, P < 0.001). Most injuries resulted in globe laceration (68.5%, P < 0.001), and wound extent was zone 1 (45.2%), zone 2 (20.5%), zone 3 (27.4%), or unknown (6.8%). Associated findings included foreign body (35.6%) and orbital fracture (15%). Of 41 patients with at least 6 months of follow-up, 70% had additional surgeries following their initial surgical repair. Laceration injuries tended to be more anterior (P = 0.002) with better visual outcomes (P = 0.045) than those with globe rupture, and concomitant orbital fracture associated with poor visual outcomes. Overall, 58.5% of patients had 20/40 or better final best-corrected visual acuity.Conclusion:This is the largest report of open globe injury due to projectile impact. Visual prognosis in this population is very good, with most patients achieving better than 20/40 vision in our study.

Commentary: Open globe injury: The Indian perspective.

Commentary: Open globe injury: The Indian perspective.

Penetrating ocular injury due to fish hook accident: A case report

Introduction: Open globe trauma is caused by sharp objects (lacerations) or blunt objects (ruptures). Lacerations can be divided into three parts: penetrating wound, intraocular foreign body (IOFB), and perforating wounds. One of the ocular laceration trauma that needs to be aware of is the penetration of fishing hooks. There are two important aspects of injuries due to fishing hooks: intraocular foreign bodies and infections.Case description: The patient of a 4-year-old girl with a chief complaint left eye was exposed to a fishing hook approximately 3 hours before coming to the hospital. Ophthalmological examination was obtained visual acuity on the right eye fixes and follow the object. Examination of the anterior segment of the right eye was found corneal edema, penetrating injury due to fish hook direction at nine o'clock. The fish hook was stick on the entire thickness of the cornea. Then we also found iris trauma and opacity in the lens. The patient was diagnosed with traumatic cataracts with ocular iridolysis dextra. Initial therapy is tobroson eye drop 1 drop every 3 hours, cefadroxil syrup three times a day, and methylprednisolone 3x1/2 tablets. The patient was advised to undergo surgery.Conclusion: Initial management should be quick and careful to aggravate the trauma. Adequate eye protection and supervision are necessary to prevent fishing hook trauma, especially children.

Globe Ruptures: Outcomes and Prognostic Analysis of Severe Ocular Trauma

Purpose: Eye trauma is an important cause of monocular visual loss worldwide. This study aimed to describe the structural and functional characteristics and outcomes of 281 globe ruptures. Methods: Medical records of all patients undergoing surgery for a ruptured globe at Centro Hospitalar Universitário do Porto in the last 17 years were retrospectively reviewed. Results: 281 eyes of 277 patients were included. The majority of them were males (71%) with a mean age of 59.7 ± 20.5. In 38.8% of the cases, the cause was a fall. At the time of admission, 29.5% of the eyes had a visual acuity (VA) greater than 20/200 and 12.5% had no light perception. The median time between trauma and primary repair was less than 8 h (interquartile range 5–12 h). A primary reconstruction was always attempted. Primary evisceration was performed in 14 cases (5%). In multivariable analysis, independent predictors of vision survival were male gender, shorter wound size, and absence of vitreous hemorrhage. Conclusion: In this large, retrospective study on globe ruptures, we identified male gender, short wound length, and the absence of vitreous hemorrhage or retinal detachment as predictors of improved functional outcome. We found a correlation between the presenting and final VAs. The Ocular Trauma Score predicted the outcome well. Our determination to reconstruct the traumatized eyes as early and as completely as possible was justified by the functional results: despite the severity of the injuries, one out of four eyes reached a final VA greater than 20/200.

Sensorimotor Outcomes in Pediatric Patients With Ocular Trauma in Baltimore.

To evaluate sensorimotor outcomes following traumatic open globe injuries in the pediatric population. A retrospective cohort of 80 pediatric patients aged 0.4 to 17.7 years (mean age: 9.3 years, median age: 8.3 years) presenting with traumatic open globe injury to the Johns Hopkins and University of Maryland Medical Centers was evaluated between January 2006 and January 2020. Parameters included the mechanism of injury, length of time of visual deprivation, initial and final visual acuity, additional eye pathologies, and demographic factors such as age and sex. Among children with more than 6 months of follow-up, 77.4% developed poor stereopsis and 50% developed strabismus. Children who developed strabismus had a lower Pediatric Ocular Trauma Score (POTS), indicating greater severity of injury, than children who did not develop strabismus (P = .005, chi-square test). A higher POTS, indicating less severe ocular injury, significantly correlated to a better stereoacuity (P = .001, chi-square test). The findings indicate that strabismus and poor stereopsis are common in pediatric open globe injuries, occurring in more than half of children with pediatric open globe trauma. These outcomes are associated with poor presenting visual acuity, more severe ocular trauma, and a lower presenting POTS. [J Pediatr Ophthalmol & Strabismus. 2022;59(5):303-309.].

Demography of Ocular Trauma in Pediatrics Patient, A Systematic Review

Background : Ocular injuries are the most common cause of acquired monocular blindness in children. Eye injuries in childhood are largely preventable but unfortunately remain common. Objectives : We sought to perform a systematics review of demography ocular trauma in children over the past fifth years. Methods: A systematic review was performed on PubMed and Scopus search term “Pediatrics” “Trauma” and “Ocular”. Results: Four articles identified between 2017 and 2021 specifically addressed ocular trauma in pediatrics. A total of 1039 patients were included in these four studies. The incidence of close globe injury is higher than open globe injury, two journals claim that the most incidence of ocular trauma occurs in the home, the two others claim that outside/street is the most commonplace, the incidence in the male group is higher than female and incidence ocular trauma mostly occur in 2-14 years old age group. Conclusion: Overall, the average close globe injury incidence is 65,8% and the average of open globe injury is 22,4%. The most common injury that occurs in pediatric trauma is close globe injury.

INCIDENCE AND RISK FACTORS OF POSTOPERATIVE ENDOPHTHALMITIS AFTER PRIMARY SURGICAL REPAIR COMBINED WITH INTRAOCULAR FOREIGN BODY REMOVAL.

To analyze the incidence and risk factors of postoperative endophthalmitis after primary surgical repair and intraocular foreign body (IOFB) removal within 24 hours of injury. The records of all patients treated surgically for open globe injury and IOFB removal at the Eye Hospital of Shandong First Medical University between January 1, 2015, and June 30, 2020, were retrospectively reviewed. Variables included time from injury to operation, cause of injury, details of surgical repair, and follow-up. The incidence and risk factors of endophthalmitis after IOFB removal were studied. During 5 years, 99 patients with IOFB were reviewed. Of these, 19 patients were diagnosed with endophthalmitis on admission, and 5 were suspected of having endophthalmitis during operation. Fifty-four cases had no clinical signs of endophthalmitis on admission and during operation and were treated with operation within 24 hours after the injury. Two patients (2 of 54; 3.70%) developed endophthalmitis after IOFB removal, and the causative agent in both cases was Bacillus cereus. The incidence of infectious endophthalmitis after primary surgical repair combined with IOFB removal (≤24 hours) was 3.70% in patients who received a series of standard treatments, and B. cereus infection might be a risk factor.

Epidemiological Characteristics and Outcome of Open Globe Injuries in Tabuk City, Kingdom of Saudi Arabia: Retrospective Cohort Study.

IntroductionThe objective of this study was to assess the epidemiological characteristics, clinical features and visual outcomes of open globe eye injury (OGI) in Tabuk, Saudi Arabia.MethodsA retrospective chart review of OGI patients who had undergone operative repair of their injuries in Tabuk, Saudi Arabia. The collected data included patients’ demographics, duration between trauma and presentation and the mechanism of trauma, wound location, extent of injury, presence of intraocular foreign body, and initial and final visual acuity data.ResultsSixty-three eyes of 63 patients who were admitted for traumatic globe rupture were included; 84.1% were males and 39.7% were of pediatric age. Delay in seeking medical care for > 24 h was recorded in 4.8% of patients. The most common (42.9%) mechanism was blunt trauma followed by sharp trauma (38.1%) and projectile trauma (9.5%); 55.6% had the injury in zone 1. Intraocular foreign body was reported in 9.5% of patients. Intraocular foreign bodies were significantly more common in adults (p = 0.018) compared to children. Poor visual acuity was noted in 77.8% of patients upon presentation and 60.3% on last visit.ConclusionThe incidence of OGI was more common in males. The most common cause of OGI was blunt injury, and half of the injuries were in zone 1. Visual outcomes are guarded for most patients with OGIs.

Visual outcomes of open globe injury patients with traumatic cataracts.

Open globe injury (OGI) is a serious form of ocular trauma that can significantly lower quality of life post-injury due to comorbidities. This study was designed to investigate how traumatic cataracts and other pre-operative variables affect visual outcomes of OGIs. A retrospective review was conducted for OGI patient records with presence of traumatic cataracts, visual outcomes, comorbidity data and provider training. Multivariable logistic regression analysis determined if several pre-operative variables including traumatic cataracts, retinal detachment and hyphema were predictive of final visual acuity and need for retinal surgery. Ancillary multivariable analysis was conducted to evaluate if timing of traumatic cataract extraction predicted poor final visual acuity. Multivariable logistic regression analysis did not find traumatic cataract to be an independent predictor of final visual outcome in the open globe injury sample population (n = 102, p = 0.386), but did find retinal detachment (p = 0.008), hyphema (p = 0.035) and scleral laceration (p = 0.009) to be independent predictors of poor final visual acuity. In the subgroup of eyes with traumatic cataract (n = 64), delayed cataract extraction was not found to be an independent predictor of poor final visual acuity (p = 0.156). Our results suggest that retinal detachment, hyphema, and scleral laceration influence final visual outcome while traumatic cataract does not. Within the subpopulation of patients that received lens extraction, timing of extraction was not found to independently influence final visual acuity.

Visual Outcomes and Prognostic Factors for Pediatric Open Globe Injuries.

Open globe injuries (OGIs) in children can be visually devastating traumas and are a common cause of unilateral blindness in children. Three commonly used ocular trauma scores (Ocular Trauma Score [OTS], Pediatric Penetrating Ocular Trauma Score [POTS], and Toddler/Infant Ocular Trauma Score [TOTS]) can be used to help predict visual outcomes in ocular injuries. Each has strengths and weaknesses, but these scores have not been studied extensively in the pediatric population. The medical records of all pediatric patients presenting at a single institution with OGIs from 2011 to 2016 were retrospectively reviewed. Initial clinical presentation and subsequent examinations were reviewed. The 3 trauma scoring systems were applied to patient data to determine the effectiveness at predicting final visual acuity (VA). A total of 15 patients met inclusion criteria. The mean age at presentation was 6.97 years. Seven of 15 (47%) of the patients had a final VA of 20/40 or better. The OTS was applied to 8 of 15 patients, as the OTS requires initial VA, which could not be obtained in 7 patients. The POTS and TOTS were applied to all 15 patients. The POTS, TOTS, and OTS were all significantly correlated to final VA. Incidence of relative afferent pupillary defect and more posterior zone of injury were correlated with poorer visual outcomes. All 3 available ocular trauma scores were effective at predicting final VA in our cohort of pediatric patients with OGIs even outside of the age ranges for which they have been created. Of all the factors included in the scores, relative afferent pupillary defect and zone of injury were most closely correlated with poor final VA.

Analysis of ocular injury 1-year outcome in survivors of Beirut Port ammonium nitrate blast.

PurposeAscertain the 1-year outcome of patients who sustained open eye injuries from the Beirut Port ammonium nitrate (AN) explosion, one of the most powerful non-nuclear explosions in history.MethodsRetrospective chart review of the operated eyes in 2 major eye hospitals.ResultsOut of 42 patients with open globe injury that was originally sutured, 29 patients (34 eyes) were followed at the 1-year mark. The initial vision in logMAR (mean ± SD) was 2.93 ± 0.87 (hand motion equivalent) and the final vision was 1.80 ± 1.47 (counting finger 2 m equivalent). No light perception (NLP) vision was noted in 12 eyes on presentation and 10 eyes remained so, while 2 eyes reached light perception (LP) vision. Eight eyes had an intraoperative expulsive choroidal hemorrhage (7 NLP and 1 LP both pre- and postoperatively), and 6 of the 8 developed phthisis. All eyes that developed phthisis had NLP preoperatively and postoperatively. Ocular Trauma Score (OTS) correlated inversely with both initial and final vision (p < 0.001). Zone of injury inversely correlated with initial vision (p = 0.02) and positively with final vision (p < 0.001). Final vision was significantly worse in zone 3 vs. zones 1 and 2 (3.2 ± 0.5) vs. 0.9 ± 1.1) (p < 0.001) injuries, as was the initial vision (3.3 ± 0.5 vs. 2.7 ± 0.8; p = 0.002).ConclusionThe OTS, which provides prognostic information for serious ocular trauma, also yields valuable prognostic information for AN-associated ocular injuries. Expulsive choroidal hemorrhage and NLP vision at presentation remain very poor prognostic signs.

Evaluation of Traumatic Corneal Rupture Treatment Outcome in dr. Cipto Mangunkusumo Hospital: Two Years Retrospective Study

Open globe injury is an injury that requires prompt treatment which could predict the final outcome. This study evaluates the characteristics and outcome of corneal rupture management in dr. Cipto Mangunkusumo National Hospital’s emergency room. We conducted a retrospective study based on the patient’s medical record between January 2016 – December 2017. Data regarding patients’ demographic, clinical characteristics according to Birmingham Eye Trauma Terminology Score (BETTS) criteria, duration of trauma to surgery, use of early topical steroid, one month visual function result, and risk of endophthalmitis were collected. A repeated ANOVA test with posthoc Bonferroni was used to compare the mean of a paired numeric variable. A total of 163 patients with corneal rupture were recorded, consisted of mostly male (92%) and median age of 27 years old. We found 36.8% cases occurred in the household, 71% cases in the zone I, 62.6% penetrating cases, and mostly came with 4/200-light perception visual acuity (VA) for all zones, mostly caused by inorganic materials and 50.9% cases involved lens. Endophthalmitis was higher in inorganic causes (69.2% vs 30.8%, p=0.33). A total of 95.2% of cases performed surgical treatment in &lt; 24 hours. In post-operative follow up, 53.3% of cases did not need re-operation or proceeding surgery. Several risk factors might affect the treatment outcome of eye injury. Most rupture occurred at zone I. Administration of topical steroids directly post-surgery was not associated with the incidence of endophthalmitis.

English

Ocular trauma has been described as one of the major aetiologies of monocular and non-congenital visual impairment and blindness in all parts of the world. Eye trauma constitutes 7% of all bodily injuries and 10%–15% of all eye diseases.1 Over 2.4 million eye injuries occur each year in The United States of America.2 Globally, there are approximately 1.6 million people who are blind from eye injuries, 2.3 million are bilaterally visually impaired, and 1.9 million have unilateral visual loss.3,4 Ocular trauma can be classified as closed and open globe injuries. Open globe injuries can be a rupture, penetrating injury, perforating injury or intra ocular foreign body.5 A perforating injury is defined as an injury that consists of two full thickness wounds - one entry and one exit wound.6 It usually occurs due to a projectile object travelling at a high velocity and kinetic energy that is capable of penetrating two opposite coats of the globe. Perforation injuries are common and cause severe visual impairment. Panda et al. presented a profile of ocular trauma in Delhi in which they observed that among the type of injuries, perforating injuries accounted for 75.3%, blunt injuries for 20.5% and extra- ocular for 4.2% of the total number of ocular trauma cases. Further the visual outcome in perforating injuries was &gt; 6/12 in 14 %; 6/18- 6/60 in 14% and less than 6/60 in 55.2% of the cases. 7 Profile of ocular trauma varies with country, geography, industrialisation and development of the place. These injuries do not occur as random events and there is evidence that some individuals are at increased risk because of exposure to hazards and/or inability to avoid or detect hazards.8 Some individuals are at increased risk of eye injury as a result of their occupation. Small scale and large-scale industrial workers constitute a group of individuals at high risk. These workers are exposed to such hazards as flying metal chips, burns in the eye and injury from radiation.9 Ludhiana and neighbouring areas are heavily industrialised mainly, with metalrelated products and therefore, there are more chances of industrial ocular trauma. We are reporting two unusual cases related to ocular trauma. The first one is that of an alleged accidental injury to the right eye with a piece of hack saw blade whereas the second case report is that of a dental student who injured his eye by orthodontic wire which is used for making braces.

Repair of penetrating ocular trauma with anterior and posterior pole involvement

Context: Ocular trauma is the leading cause of monocular visual impairment around the world, especially in developing countries like Mexico. Great part of this cases occurs in pediatric and young adult groups. Epidemiology can vary depending on the population studied, but different factors such as socioeconomic status, occupation, sport and other activities have a great influence. Approximately 30% to 40% of ocular blindness cases in the world is due to ocular trauma, and of these, between 80 and 90% of events are preventable.1,2 Objective: The aim of this paper is to expose the importance of an individualized and damage-oriented repair plan in the scenario of a penetrating ocular trauma and serve as a treatment guideline in similar cases. Method: A case report of a 15 year-old male with right eye open globe injury with metal cable tip causing a penetrating corneal injury, posterior capsule rupture, lens opacity and vitreous hemorrhage Conclusion: The present case report illustrates the diverse ways of presentation that can be found when managing a penetrating ocular trauma. Our patient history is a good example of extended ocular involvement including cornea, lens, vitreous and retina. Individualized and damaged oriented surgical treatment is key in ocular trauma scenarios.

Pediatric Open Globe Injury in Central China.

PurposeTo describe the characteristics, managements, and outcomes of pediatric open globe injury (OGI) in central China.MethodsRetrospective chart review of pediatric diagnosis in patients with OGI between 2017 and 2020 at Henan Eye Hospital. Four hundred and one eyes of the patients younger than 17 years were included in this study. Open globe injury was classified according to the Birmingham Eye Trauma Terminology system (BETT). Age, sex, history, cause, month of trauma, treatment received, and outcomes were recorded. Visual acuity was documented according to standard visual acuity chart (decimals).ResultsFour hundred and one eyes of patients were included in the study. The mean age was 6.6 ± 3.4 years with the range from 8 months to 16 years. Open globe injuries (OGIs) occurred most frequently in the 2–8 year age and significant male predominance was noted (70.8%). The incidence of pediatric OGIs was lowest in summer months while it increased in the winter months. The most common type of pediatric OGI was penetration (89%). Scissors/knife accounted for 22%, followed by pen/pencil (15.2%), and wood/bamboo sticks (14.5%) of all the pediatric OGIs. Among the injuries, the most frequently involved is the zone I (76.1%). Initially, 70.8% of the eyes received primary debridement and wound closure without any additional intervention, while only one eye has no possibility of anatomical reconstruction when it received an evisceration. After the initial management, 198 eyes received subsequent operation, including 44 eyes that underwent cataract removal + intraocular lens (IOL) implantation, and 24 eyes underwent IOL implantation. Finally, over 6 months of follow-up, 129 eyes (32.2%) got visual acuity (VA) of 0.3–1.5 and, 63 eyes (15.7%) got VA of 0.01–0.25, while 11 eyes (2.7%) were eviscerated.ConclusionThis study showed that pediatric OGIs in central China are most seen in 2–8-year age group with significant male predominance. Scissors/knife, pen/pencil, and wood/bamboo sticks accounted for over half of all cases. Pediatric OGIs often result in significant vision loss. In some severe cases (2.7%), evisceration was ultimately performed. We should call on the public to pay more attention to their children and build a safer environment for them.

Novel Suturing Methods for the Management of Traumatic Choroidal Avulsion in Globe Injuries

PurposeTo explore the long-term efficacy of novel choroidal suturing methods including trans-scleral mattress suturing (TSS) and intraocular suturing (IOS) in the treatment of choroidal avulsion.DesignProspective cohort, hospital-based study.MethodsA total of 24 patients who were diagnosed with choroidal avulsion were enrolled in this study. The demographic characteristics, baseline information of trauma, best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were collected before surgery, and the anatomic abnormities of the globe were recorded before or during surgery. All patients were diagnosed with choroidal avulsion and underwent choroid suturing treatment during vitrectomy, postoperative functional variables including BCVA and IOP, anatomic variables including retinal and choroidal reattachment rate, and silicone oil migration rate, which were recorded at the regular follow-ups at least 1 year after surgery.ResultsAll patients with open globe injury involved zone III, 70.8% of the patients presented with two quadrants of the avulsed choroid, and 29.2% with one quadrant involved; moreover, all patients had complications with retinal detachment (RD), of which 58.3% of patients had closed funnel retinal detachment. TSS was applied in nineteen patients and IOS in five patients. Postoperatively, a significant improvement on LogMAR BCVA was observed at each follow-up from 3.57 ± 0.69 before surgery to 2.82 ± 0.98 at the last follow-up (p < 0.05), and the proportion of no light perception (NLP) was also reduced from 69.6 to 37.5%. IOP was markedly elevated from 6.4 ± 4.1 mmHg preoperatively to 11.3 ± 4.3 mmHg at the last follow-up (p < 0.05). Choroidal reattachment was achieved in 91.7% of patients; two patients were observed with silicone oil migration at 3 months after surgery and underwent drainage of suprachoroidal silicone oil and sclera buckling. Meanwhile, retinal attachment was observed in 95.8% of patients, only one patient developed partial RD due to postoperative proliferative vitreoretinopathy, and secondary vitrectomy was performed; all patients were observed with complete retinal and choroidal attachment at the last follow-up. Eventually, four patients were silicone oil-free, and 20 patients were silicone oil-dependent.ConclusionsChoroidal suturing proved to be an effective method to fix the avulsed choroid, which greatly improved the BCVA and maintained the IOP, and efficiently increased the choroidal and retinal reattachment rate and preservation of the eyeball.