Predictability of visual outcome based on injury size and location following penetrating ocular trauma in children.

Abstract

Background: Penetrating ocular trauma is the most common form of open globe injury in children. However, the open globe classification may not accurately reflect the impact of different anterior ocular injuries on visual prognosis. This study aimed to analyze the factors influencing the prognosis of pediatric patients with penetrating ocular trauma in Shandong Province and evaluate the applicability of OTS and POTS.

Methods: Sixty-six pediatric patients from Shandong Provincial Hospital Affiliated to Shandong First Medical University, between January 2017 and September 2024, were included in this retrospective study. Patient characteristics, injury causes, initial visual acuity (IVA), final visual acuity (FVA), and treatment were recorded. Injuries in the anterior ocular were reclassified into zones I, II, III, I_a, and II_a, FVA were analyzed about different zones, and the prognostic factors for visual outcomes were assessed. Each patient was evaluated using the OTS and POTS and followed for at least 3 months, with final visual outcomes compared with the predicted outcomes.

Results: A total of 66 patients (mean age 6.9 ± 3.1 years) were included, with 49 males (74.2%) and 17 females (25.8%). OTS and POTS both correlated with FVA (r = -0.313, p = 0.032; r = -0.270, p = 0.028) but underestimated good outcomes in the ≥ 0.5 group (p = 0.029, p = 0.016, p < 0.05). FVA ≥ 0.5 was defined as a successful outcome, and the best outcomes were in zones II and III (100% success), and the poorest outcomes were in zone I_a (71.4% success). In multivariable analysis, older age (B=-0.031, p = 0.037), zone III (B=-0.307, p = 0.011), or zone II_a (B=-0.235, p = 0.042) injuries were independently associated with better outcomes when compared with zone I_a.

Conclusion: Larger and more centrally located injuries are associated with worse prognoses, older age and more peripherally located injuries are associated with better prognoses. OTS and POTS tend to underestimate the probability of good visual outcomes, indicating limitations in their applicability.