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The Relationship between Visual Outcome and Ocular Trauma Score after Open Globe Injuries in Children

소아청소년 개방안구손상 환자에서의 시력예후와 안외상 점수와의 연관성

  • Park, Su Jin (Department of Ophthalmology, School of Medicine, Kyungpook National University) ;
  • Son, Byeong Jae (Department of Ophthalmology, School of Medicine, Kyungpook National University)
  • 박수진 (경북대학교 의과대학 안과학교실) ;
  • 손병재 (경북대학교 의과대학 안과학교실)
  • Received : 2018.06.21
  • Accepted : 2018.10.21
  • Published : 2018.11.15

Abstract

Purpose: We evaluated the prognostic factors of open globe injuries in children and adolescents, and compared the ocular trauma score (OTS) and pediatric penetrating ocular trauma score (POTS). Methods: We performed a retrospective review of 77 children under 18 years of age who visited our clinic with open globe injuries between May 1993 and April 2014. We investigated the factors that may affect final visual acuity. We also compared the OTS and POTS using receiver operating characteristic curves as a method to predict final visual acuity. Results: By univariate analysis, an initial visual acuity less than 20/200, globe rupture, wound size greater than 7.0 mm, retinal detachment, lens dislocation, and total number of operations contributed to worse visual outcomes (<20/200). Conversely, central corneal involvement, traumatic cataract, wound size less than 7.0 mm, and initial visual acuity greater than 20/200 were better prognostic indicators (${\geq}20/32$). Both OTS and POTS had diagnostic value as a predictor of final visual acuity, although there were no statistically significant differences between the two scoring systems. Conclusions: Initial visual acuity and wound size are important prognostic factors for the final visual acuity in children and adolescent, following open globe injuries. Both OTS and POTS are reliable prognostic models for open globe injuries in children and adolescents.

목적: 소아청소년 환자에서 발생한 개방안구손상의 임상 양상을 분석하여 최종시력을 예측할 수 있는 인자를 알아보고, 최종시력을 예측하는 방법으로 안외상 점수(ocular trauma score, OTS)와 소아 안외상 점수(penetrating ocular trauma score, POTS)를 평가해 보고자 한다. 대상과 방법: 1993년 5월부터 2014년 4월까지 개방안구손상으로 본원에 내원한 18세 이하 소아청소년 환자 77명을 대상으로 의무기록을 후향적으로 분석하였다. 최종시력에 영향을 미칠 수 있는 인자들을 조사하였고, 최종시력을 예측하는 방법으로 OTS와 POTS를 receiver operating characteristic 곡선을 이용하여 평가해 보았다. 결과: 단변량 분석에서 20/200 미만의 초기시력, 안구파열, 7.0 mm 이상의 손상 크기, 망막박리, 수정체이탈, 총 수술 횟수는 불량한 최종시력(<20/200)과 유의한 관련성이 있었다. 반면에 20/32 이상의 좋은 최종시력의 경우 각막중심 침범 유무, 외상백내장 유무, 7.0 mm 미만의 손상 크기, 20/200 이상의 초기시력과 관련성이 있었다. OTS와 POTS 모두 최종시력을 예측하는 방법으로 진단적 가치가 있었으며, 통계적으로 두 점수 체계에 유의한 차이는 없었다. 결론: 소아청소년에게 발생한 개방안구손상에서 초기시력과 안구손상 크기는 최종시력에 영향을 주는 중요한 예측인자이다. 소아청소년 개방안구손상 환자의 최종시력 예측에 있어 기존의 안외상 점수(OTS)뿐만 아니라 소아 안외상 점수(POTS) 또한 좋은 예측도를 보여주어 둘 모두 유용한 평가 방법으로 생각된다.

Keywords

Acknowledgement

Supported by : Kyungpook National University Hospital

References

  1. Kuhn F, Morris R, Witherspoon CD. Birmingham eye trauma terminology (BETT): terminology and classification of mechanical eye injuries. Ophthalmol Clin North Am 2002;15:139-43, v. https://doi.org/10.1016/S0896-1549(02)00004-4
  2. Schmidt GW, Broman AT, Hindman HB, Grant MP. Vision survival after open globe injury predicted by classification and regression tree analysis. Ophthalmology 2008;115:202-9. https://doi.org/10.1016/j.ophtha.2007.04.008
  3. Negrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol 1998;5:143-69. https://doi.org/10.1076/opep.5.3.143.8364
  4. Thompson CG, Kumar N, Billson FA, Martin F. The aetiology of perforating ocular injuries in children. Br J Ophthalmol 2002;86:920-2. https://doi.org/10.1136/bjo.86.8.920
  5. Esmaeli B, Elner SG, Schork MA, Elner VM. Visual outcome and ocular survival after penetrating trauma. A clinicopathologic study. Ophthalmology 1995;102:393-400. https://doi.org/10.1016/S0161-6420(95)31009-3
  6. Sternberg P Jr, de Juan E Jr, Michels RG, Auer C. Multivariate analysis of prognostic factors in penetrating ocular injuries. Am J Ophthalmol 1984;98:467-72. https://doi.org/10.1016/0002-9394(84)90133-8
  7. De Juan E Jr, Sternberg P Jr, Michels RG. Penetrating ocular injuries. types of injuries and visual results. Ophthalmology 1983;90:1318-22. https://doi.org/10.1016/S0161-6420(83)34387-6
  8. Rahman I, Maino A, Devadason D, Leatherbarrow B. Open globe injuries: factors predictive of poor outcome. Eye (Lond) 2006;20:1336-41. https://doi.org/10.1038/sj.eye.6702099
  9. Dalma-Weiszhausz J, Quiroz-Mercado H, Morales-Canton V, et al. Vitrectomy for ocular trauma: a question of timing? Eur J Ophthalmol 1996;6:460-3. https://doi.org/10.1177/112067219600600421
  10. Miyake Y, Ando F. Surgical results of vitrectomy in ocular trauma. Retina 1983;3:265-8. https://doi.org/10.1097/00006982-198300340-00006
  11. Pieramici DJ, MacCumber MW, Humayun MU, et al. Open-globe injury. update on types of injuries and visual results. Ophthalmology 1996;103:1798-803. https://doi.org/10.1016/S0161-6420(96)30424-7
  12. Hutton WL, Fuller DG. Factors influencing final visual results in severely injured eyes. Am J Ophthalmol 1984;97:715-22. https://doi.org/10.1016/0002-9394(84)90503-8
  13. Punnonen E, Laatikainen L. Prognosis of perforating eye injuries with intraocular foreign bodies. Acta Ophthalmol (Copenh) 1989;67:483-91.
  14. Matthews GP, Das A, Brown S. Visual outcome and ocular survival in patients with retinal detachments secondary to openor closedglobe injuries. Ophthalmic Surg Lasers Imaging Retina 1998;29:48-54.
  15. Brinton GS, Aaberg TM, Reeser FH, et al. Surgical results in ocular trauma involving the posterior segment. Am J Ophthalmol 1982;93:271-8. https://doi.org/10.1016/0002-9394(82)90524-4
  16. Martin DF, Meredith TA, Topping TM, et al. Perforating (throughand- through) injuries of the globe. surgical results with vitrectomy. Arch Ophthalmol 1991;109:951-6. https://doi.org/10.1001/archopht.1991.01080070063036
  17. Sternberg P Jr, de Juan E Jr, Michels RG. Penetrating ocular injuries in young patients. initial injuries and visual results. Retina 1984;4:5-8. https://doi.org/10.1097/00006982-198400410-00002
  18. Barr CC. Prognostic factors in corneoscleral lacerations. Arch Ophthalmol 1983;101:919-24. https://doi.org/10.1001/archopht.1983.01040010919013
  19. Groessl S, Nanda SK, Mieler WF. Assault-related penetrating ocular injury. Am J Ophthalmol 1993;116:26-33. https://doi.org/10.1016/S0002-9394(14)71739-8
  20. Unal MH, Aydin A, Sonmez M, et al. Validation of the ocular trauma score for intraocular foreign bodies in deadly weapon-related open-globe injuries. Ophthalmic Surg Lasers Imaging 2008;39:121-4. https://doi.org/10.3928/15428877-20080301-15
  21. Acar U, Tok OY, Acar DE, et al. A new ocular trauma score in pediatric penetrating eye injuries. Eye (Lond) 2011;25:370-4. https://doi.org/10.1038/eye.2010.211
  22. Zhu L, Wu Z, Feng J, et al. Two kinds of ocular trauma score for paediatric traumatic cataract in penetrating eye injuries. Injury 2015;46:1828-33. https://doi.org/10.1016/j.injury.2015.04.024
  23. Choovuthayakorn J, Patikulsila P, Patikulsila D, et al. Characteristics and outcomes of pediatric open globe injury. Int ophthalmol 2014;34:839-44. https://doi.org/10.1007/s10792-013-9890-8
  24. Schorkhuber MM, Wackernagel W, Riedl R, et al. Ocular trauma scores in pediatric open globe injuries. Br J ophthalmol 2014;98:664-8. https://doi.org/10.1136/bjophthalmol-2013-304469
  25. Kuhn F, Maisiak R, Mann L, et al. The Ocular Trauma Score (OTS). Ophthalmol Clin North Am 2002;15:163-5, vi. https://doi.org/10.1016/S0896-1549(02)00007-X
  26. Sobaci G, Akin T, Erdem U, et al. Ocular trauma score in deadly weapon-related open-globe injuries. Am J Ophthalmol 2006;141:760-1. https://doi.org/10.1016/j.ajo.2005.11.002
  27. Doskova H. Evaluation of results of the penetrating injuries with intraocular foreign body with the Ocular Trauma Score (OTS). Cesk Slov Oftalmol 2006;62:48-52.
  28. Unver YB, Kapran Z, Acar N, Altan T. Ocular trauma score in open -globe injuries. J Trauma 2009;66:1030-2. https://doi.org/10.1097/TA.0b013e3181883d83
  29. Uysal Y, Mutlu FM, Sobaci G. Ocular trauma score in childhood open-globe injuries. J Trauma 2008;65:1284-6. https://doi.org/10.1097/TA.0b013e31817de3cc
  30. Han SB, Yu HG. Visual outcome after open globe injury and its predictive factors in Korea. J Trauma 2010;69:E66-72. https://doi.org/10.1097/TA.0b013e3181cc8461
  31. Lee YH, Kwag JY, Lee SB. The predictability of ocular trauma score and prognostic factors of open globe injury. J Korean Ophthalmol Soc 2012;53:825-32. https://doi.org/10.3341/jkos.2012.53.6.825
  32. Shin YI, Lee YH, Kim KN, Lee SB. The availability of modified ocular trauma score in Korean patients with open globe injury. J Korean Ophthalmol Soc 2013;54:1902-6. https://doi.org/10.3341/jkos.2013.54.12.1902
  33. Yoo JH, Lee H, Lee J, et al. A statistical observation of ocular injuries and visual predictive value of ocular trauma score. J Korean Ophthalmol Soc 2011;52:1024-9. https://doi.org/10.3341/jkos.2011.52.9.1024
  34. Chio JS, Kim SS, Yi KP. A clinical study of pediatric ocular injuries through emergency room. J Korean Ophthalmol Soc 1990;31:69-79.
  35. Kim HJ, Kwon JY. A clinical observation of perforating ocular injuries. J Korean Ophthalmol Soc 1989;30:123-30.
  36. Oh TS, Ahn Y. Clinical picture of the pediatric ocular trauma. J Korean Ophthalmol Soc 2001;42:119-26.
  37. Seo KS. Development of Korean preventive guideline for eye injury. Cheongju: KCDC; 2010 Feb. 160p. Report No.: KCDC 2010-E33005-00.
  38. Kim CR, Lee CS, Kim JB, Park YG. Clinical evaluation of the pediatric ocular trauma. J Korean ophthalmol Soc 2000;41:993-9.
  39. Jandeck C, Kellner U, Bornfeld N, Foerster MH. Open globe injuries in children. Graefe's Arch Clin Exp Ophthalmol 2000;238:420-6. https://doi.org/10.1007/s004170050373
  40. Kim JH, Yu YS. Clinical course and predictive factors of final visual acuity in children with penetrating ocular trauma. J Korean ophthalmol Soc 2003;44:699-705.
  41. Read SP, Canuoto KM. Traumatic open globe injury in young pediatric patients: characterization of a novel prognostic score. J AAPOS 2016;20:141-4. https://doi.org/10.1016/j.jaapos.2015.11.008