A ten-year study of clinical presentation and predictive factors on final visual outcome in paediatric trauma patients

Abstract

Purpose: To present the demographic and clinical presentation, and to evaluate the predictive factors for final visual outcomes in paediatric ophthalmic trauma. Methods: A retrospective observational study was conducted in Indonesia’s private tertiary eye hospital between 2012 and 2021. Results: A total of 194 patients/201 eyes were included. Closed globe injuries (CGI) represented the most common injury (80/194, 41.2%), followed by adnexal injury (65/194, 33.5%), open globe injuries (OGI) (30/194, 15.5%), chemical injuries (13/194, 6.7%), orbital fracture (3/194, 1.5%), and fireworks injuries (3/194, 1.5%). The mean age was 8.60 ± 5.23 years, with children aged 11–18 years (69/194, 35.5%) comprising the majority of cases. The home (43/201, 21.4%) and blunt trauma (105/201, 52.2%) were identified as the most common setting and mechanism of injury, respectively. There were 78/201 (38.8%) eyes included in the visual acuity (VA) predictors analysis. The mean initial VA and final VA were 0.595 ± 0.775 logMAR and 0.461 ± 0.790 logMAR,respectively. A strong correlation between initial VA, final VA, and type of injury was found (r = 0.761, P < 0.001), with 13/78 (16.7%) patients having severe visual impairment and blindness. In multivariate analysis, initial VA (P = 0.003), scleral injury (P = 0.013), and hyphaema (P = 0.013) were statistically significant as visual outcome predictors. Conclusion: CGI and adnexal injury show high incidence in paediatric ophthalmic trauma. The home is the most common setting for paediatric ophthalmic trauma. OGI causes visual impairment to blindness. Initial VA, scleral injury, and hyphaema are identified as visual outcome prognostic factors.