The epidemiology of traumatic open globe injuries in children: an overview of the last 21-years in a tertiary hospital in the Netherlands

Abstract

Introduction: Pediatric open globe injuries are an important cause of non-congenital monocular visual acuity loss in children. In young children, who are still in their visual development, amblyopia is of great concern. Predicting the final visual outcome is important for proper counselling and management. The aim of this retrospective study is to investigate the epidemiology, aetiology, and the final visual acuity of traumatic open-globe injuries in children in a tertiary referral centre in the Netherlands. Secondly, potential factors for a poor final vision will be examined. Design: Retrospective cohort study Methods: Medical data of 45 children with open globe injuries who visited the UMC Utrecht between 2000 and 2021 where reviewed. Data was analysed and compared between patients with a final vision of ≥6/12 and patients with a final vision <6/12. Also, children in the amblyopic age group were analysed separately. Results: The median age was 7.5 years (range:1.5-18). Metal was the most prevalent type of material (36%). Involvement of the lens, iris and vitreous body were found to significant for a final vision of <6/12 (p=0.015, p=0.022, p=0.008). Endophthalmitis occurred in only one (2%) eye and a total of four (9%) eyes became non-functional. The most frequent secondary development were astigmatism (80%), and traumatic cataract (67%). A total of 22 (49%) eyes had a vision >6/12 of which 11 (55%) were of amblyopic age at trauma. The lens status showed to be significantly associated with the visual outcome (p=0.012). Conclusion: Our study is the first to explore pediatric open globe injuries in the Netherlands. The nature of the trauma and the anatomical structures involved have a major influence on the final vision. In addition, the preservation of one’s own lens makes for a better visual prognosis. About half of the children end up with a vision of less than 6/12, larger prospective research is needed. So that ultimately fewer children are left with an impaired vision.