Open Globe Injury Location, Length May Determine Visual Outcome in Children

Corneal wound localization and length may be associated with visual outcome in children with open globe injuries, according to a study published in the Canadian Journal of Ophthalmology.

Researchers reviewed records from 54 children aged 0 to 7 years (group 1; 69% boys, mean age, 4.6 years) and 39 children aged 8 to 15 years (group 2; 82% boys, mean age, 11.5 years) presenting to a single center with an open globe injury. The research team obtained demographics, trauma characteristics, ocular trauma score (OTS; 1, most severe; 5, least severe) and initial and final best-corrected visual acuity (BCVA). Wound location was classified into 1 of 3 anatomic zones which included the cornea and limbus (zone 1), cornea and sclera (zone 2) and macula and optic nerve (zone 3). Corneal zone injuries were classified as central, paracentral, or peripheral. Wound length was determined by the longer axis of the wound.

Most injuries were penetrating and caused by nonmetallic sharp objects. A corneal injury was detected in 45 patients (83.3%) in group 1 and in 29 patients (74.4%) in group 2. Localization of the corneal wound was mostly central (46.7%) in group 1 and peripheral (48.3%) in group 2 (P =.045). Mean corneal wound length was significantly longer in group 1 compared with group 2 (P =.018). 

Group 1 participants had an OTS of 2 (50%) compared with an OTS of 3 in group 2 participants (38.5%). 

Poor visual outcome in both groups correlated with lower OTS, worse initial BCVA, a central corneal wound location, longer corneal and total wound length, and the presence of lens damage, retinal detachment, and hypotonia (P <.05 for all). 

Poor final BCVA was significantly associated with a longer scleral wound in group 2 and vitreous hemorrhage and uveal tissue prolapse in the posterior segment in group 1 (P <.05 for all).

“Although there are visual prognostic factors affecting all age groups, it should be kept in mind that there are also age-specific visual prognostic factors,” according to the researchers. “Especially in preschool-aged children, mostly central localization of a corneal wound can be a challenging factor for visual rehabilitation.”

Study limitations include a retrospective nature and short duration of follow-up.