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Post-surgery outcome in children with ocular trauma
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Introdução | O trauma ocular é uma causa importante de morbilidade e uma das principais causas de baixa visão monocular adquirida em crianças [1]. O principal objetivo deste estudo foi avaliar o outcome visual (melhor acuidade visual corrigida) pós-cirurgia no contexto de trauma ocular numa população pediátrica.
Métodos | Realizou-se um estudo observacional retrospectivo de crianças com trauma ocular que se apresentaram no serviço de urgência de oftalmologia do Hospital de Santa Maria, entre 8 de agosto de 2008 e 31 de dezembro de 2022. Todas as crianças menores de 18 anos, que foram submetidas a cirurgia oftalmológica, foram incluídas. Foram recolhidos dados demográficos, follow-up, circunstâncias da lesão traumática, abordagem e melhor acuidade visual corrigida. As lesões oculares foram categorizadas utilizando o sistema Birmingham Eye Trauma Terminology (BETT) e o Paediatric Ocular Trauma Score (POTS) foi determinado.
Resultados | Foram identificadas um total de 46 crianças. O rácio masculino:feminino foi de 1.6:1. A idade média foi de 8.57 (±5.01) anos. A maioria dos doentes (76,1%) tiveram lesão de globo aberto. O tipo de lesão incluiu penetração (45.7%), perfuração (13.0%), corpo estranho intraocular (CEIO) (17.4%), contusão (15.2%), ruptura (4.3%) e laceração lamelar (2.2%). As lesões cortantes foram documentadas em 47.7% dos casos, e as contusas em 24.0%. Foi realizada cirurgia de emergência na maioria das crianças, sutura corneoscleral em 82.6% delas. Mais de metade dos doentes (54.5%) tiveram diminuição leve/não tiveram diminuição da AV, 12.1% tiveram diminuição moderada e 33.4% tiveram diminuição grave/cegueira. A AV (logMAR) média final foi de 0.92 ± 1.1. Nesta amostra, 41.3% das crianças obtiveram um POTS do grupo 1, 32.6% do grupo 2, 19.6% do grupo 3 e 6.5% do grupo 5. A correlação entre o POTS e a AV final demonstrou uma má previsão da AV utilizando este score (o coeficiente de correlação de Pearson mostrou uma correlação linear negativa moderada (-0.312, p=0.06) e o coeficiente de correlação rho de Spearman indicou uma correlação negativa mais forte (-0.369, p=0.025)).
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Conclusão | O traumatismo ocular em crianças permanece com mau prognóstico. Os rapazes em idade escolar ainda são os mais expostos, e as lesões são maioritariamente unilaterais. O trauma com objetos cortantes ocorre duas vezes mais frequentemente do que o trauma contuso. No entanto, este último demonstrou pior prognóstico. A AV inicial não é muitas vezes registada. O POTS subestima grosseiramente o resultado visual final. A melhor AV final corrigida foi favorável em mais da metade dos doentes e variou consoante o tipo e objeto do trauma, as estruturas afetadas e o número de cirurgias realizadas, embora sem significado estatístico. No entanto, um terço das crianças apresentou grave diminuição da AV/cegueira, o que apela à necessidade de implementação de medidas preventivas e de segurança pediátrica mais eficazes, bem como o estabelecimento de uma equipa de trauma ocular de ação rápida, garantindo o tratamento em tempo útil.
Background | Eye trauma is a major cause of morbidity and one of the leading causes of acquired monocular low vision in children [1]. The main objective of this study was to evaluate the visual outcome (best corrected visual acuity, BCVA) post-surgery in the context of eye trauma in a paediatric population. Methods | We conducted a retrospective observational study of children with ocular trauma who presented to the ophthalmology emergency department of the Hospital de Santa Maria between August 8, 2008, and December 31, 2022. All children under the age of 18 who underwent ophthalmic surgery were included. Data were collected on demographic data, follow-up, circumstances of traumatic injury, management, and BCVA. The Birmingham Eye Trauma Terminology (BETT) system was used to categorise ocular injuries, and the Paediatric Ocular Trauma Score (POTS) was determined. Results | A total of 46 patients were identified. The male-female ratio was 1.6:1. The mean age was 8.57 (±5.01) years. Most patients (76.1%) had an open-globe injury. Types of injury included penetration (45.7%), perforation (13.0%), intraocular foreign body (IOFB) (17.4%), contusion (15.2%), rupture (4.3%), and lamellar laceration (2.2%). Sharp injuries were documented in 47.7% of cases and blunt in 24.0%. Emergency surgery was performed on most children, with corneoscleral sutures in 82.6%. Over half of the patients (54.5%) had mild/no VI, 12.1% moderate VI, and 33.4% severe VI/blindness. The mean final logMAR BCVA was 0.92±1.1. In this sample, 41.3% of the children scored a POTS of group 1, 32.6% of group 2, 19.6% of group 3, and 6.5% of group 5. Assessment between POTS and final BCVA found a poor prediction of the final VA using this score (Pearson correlation coefficient showed a moderate negative linear correlation (-0.312, p=0.06), and Spearman's rho correlation coefficient indicated a stronger negative correlation (-0.369, p=0.025)). 6 Conclusions | Ocular trauma injuries in children remain poorly prognostic. School-aged boys are still the most exposed, and injuries are mainly unilateral. Ocular trauma with sharp objects occurs twice as often as blunt trauma. However, the latter showed a worse prognosis. Initial VA is often not recorded. The POTS shows a gross underestimation of the final visual outcome. The final BCVA was favourable in more than half of the patients and varied depending on the type and object of trauma, structures affected, and the number of surgeries carried out, although not statistically significant. Nevertheless, a third of the patients developed severe visual impairment/blindness, which calls for implementing more effective preventive and paediatric safety measures and establishing a rapid-action eye trauma team to ensure timely treatment.
Background | Eye trauma is a major cause of morbidity and one of the leading causes of acquired monocular low vision in children [1]. The main objective of this study was to evaluate the visual outcome (best corrected visual acuity, BCVA) post-surgery in the context of eye trauma in a paediatric population. Methods | We conducted a retrospective observational study of children with ocular trauma who presented to the ophthalmology emergency department of the Hospital de Santa Maria between August 8, 2008, and December 31, 2022. All children under the age of 18 who underwent ophthalmic surgery were included. Data were collected on demographic data, follow-up, circumstances of traumatic injury, management, and BCVA. The Birmingham Eye Trauma Terminology (BETT) system was used to categorise ocular injuries, and the Paediatric Ocular Trauma Score (POTS) was determined. Results | A total of 46 patients were identified. The male-female ratio was 1.6:1. The mean age was 8.57 (±5.01) years. Most patients (76.1%) had an open-globe injury. Types of injury included penetration (45.7%), perforation (13.0%), intraocular foreign body (IOFB) (17.4%), contusion (15.2%), rupture (4.3%), and lamellar laceration (2.2%). Sharp injuries were documented in 47.7% of cases and blunt in 24.0%. Emergency surgery was performed on most children, with corneoscleral sutures in 82.6%. Over half of the patients (54.5%) had mild/no VI, 12.1% moderate VI, and 33.4% severe VI/blindness. The mean final logMAR BCVA was 0.92±1.1. In this sample, 41.3% of the children scored a POTS of group 1, 32.6% of group 2, 19.6% of group 3, and 6.5% of group 5. Assessment between POTS and final BCVA found a poor prediction of the final VA using this score (Pearson correlation coefficient showed a moderate negative linear correlation (-0.312, p=0.06), and Spearman's rho correlation coefficient indicated a stronger negative correlation (-0.369, p=0.025)). 6 Conclusions | Ocular trauma injuries in children remain poorly prognostic. School-aged boys are still the most exposed, and injuries are mainly unilateral. Ocular trauma with sharp objects occurs twice as often as blunt trauma. However, the latter showed a worse prognosis. Initial VA is often not recorded. The POTS shows a gross underestimation of the final visual outcome. The final BCVA was favourable in more than half of the patients and varied depending on the type and object of trauma, structures affected, and the number of surgeries carried out, although not statistically significant. Nevertheless, a third of the patients developed severe visual impairment/blindness, which calls for implementing more effective preventive and paediatric safety measures and establishing a rapid-action eye trauma team to ensure timely treatment.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Traumatismo ocular pediátrico Lesão ocular penetrante Paediatric penetrating ocular trauma score (POTS) Acuidade visual Cirurgia oftalmológica Oftalmologia