Pediatric ocular trauma with pars plana vitrectomy in Southwest of China: clinical characteristics and outcomes

AIM: To investigate the clinical characteristics and predictive factors of pediatric ocular trauma patients with vitrectomy. METHODS: Pediatric ocular trauma patients (aged 14y or younger) who received vitrectomy in Southwest Hospital between January 2007 and December 2017 were reviewed retrospectively. Age, gender, mechanism of injury, final visual acuity (VA), and prognostic factors were analyzed. RESULTS: A total of 139 eyes in 139 pediatric patients were included in the study. The mean age was 7.4±3.7 years old and the male-to-female ratio was 5:1. There were 104 (74.8%) open globe injuries and 35 (25.2%) closed globe injuries. The top one traumatic eye injuries were penetrating injuries occur through sharp metal objects (43.9%). After vitrectomy, 116 patients had favorable anatomic outcome at the last follow-up, and 30 eyes (21.6%) achieved VA of 20/200 or better. Following univariate analysis, we found zone III injuries (P=0.021), poor initial VA (P=0.005), endophthalmitis (P=0.024), and recurrent retinal detachment (P<0.001) were poor prognostic factors for pediatric ocular trauma. After Logistic regression analysis, the poor initial VA (odds ratio: 8.276, 95%CI: 1.597-42.897, P=0.012) and recurrent retinal detachment (odds ratio: 6.455, 95%CI: 2.372-17.562, P<0.001) were significantly correlated with unfavorable vision outcome in pediatric ocular trauma. CONCLUSION: The treatment of vitrectomy for severe ocular trauma results in favorable anatomic outcomes, but VA improvement is not as good as anatomic outcomes. Initial VA and recurrent retinal detachment are the independent prognostic indicators for unfavorable visual outcome of severe pediatric ocular trauma.

Comparison of the Ocular Trauma Score and Pediatric Ocular Trauma Score as Two Prognostic Models in Pediatric Open Globe Injuries

Aim To compare the ocular trauma score (OTS) and the pediatric ocular trauma score (POTS) as prognostic models of visual outcome after open globe injury in children during a period of 19 years. Patients and Methods A retrospective study of 36 open globe injuries in 36 patients younger than 18 years was conducted from January 2000 to January 2019. For each case, OTS and POTS points were calculated. Results Significant differences were observed in our patients using the two models regarding categories 1 to 4. One third of the cases were in categories 1 and 2 using the OTS model, and nearly 60% using the POTS model. Nearly 60% of our patients were in categories 3 and 4 using the OTS model and 30.6% using the POTS model. In category 5, no difference was observed between the two models. The comparison of distribution of the percentage of final visual acuity between OTS and POTS model in each category revealed a significant difference in category 1 in final visual acuity 20/40 or more (25 vs. 50%) as well as in final visual acuity 20/20 (0 vs. 30%). In category 2, final visual acuity was not significantly different in 20/40 or more between the two models; however, there was a significant difference in final visual acuity 20/20 – 12.5% in the OTS model and 45.5% in the POTS model. In category 3, significant differences were revealed between the two models. Using the OTS model, final visual acuity 20/40 or more was observed in more than 60% and using POTS model in 100%; final visual acuity 20/20 was observed in 36.3% using OTS model and in 50% using POTS model. In category 4 and 5, no differences were observed between OTS and POTS models. Conclusion Our study did not confirm the benefit of POTS. The distribution of our cases among OTS categories demonstrated a significant difference between the two models with more cases distributed in lower categories in POTS group. In the POTS group, the prognosis for final visual acuity was significantly better in the first three categories than in the OTS group, probably as a result of a lower calculation for POTS points. In our opinion, the OTS model is easier to use, has a higher prognostic accuracy, and should be further used in counselling of paediatric cases.