This is a retrospective case series of 71 open globe injuries in children of less than 18 years of age, with a minimum follow-up period of one year, between 1 September 1992 to 31 July 2011, from the Eye Department of Ophthalmology of the Medical University of Graz, Austria. The aim of the study was to assess the predictive value and applicability of the ocular trauma score (OTS) for paediatric eye injuries. The OTS and paediatric OTS (POTS) parameters analysed for their impacts on visual outcome included initial visual acuity, glove rupture, endophthalmitis, perforation of the globe, retinal detachment, age, wound location (I=cornea, II=anterior 5mm of the sclera, III=posterior to zone II, as defined by the Ocular Trauma Classification Group), iris prolapse, hyphaema, organic injury object, delay of surgery >48 h, traumatic cataract and vitreous haemorrhage. All POTS and OTS parameters were routinely assessed, except for the relevant afferent pupillary defect (RAPD). The authors found that the initial visual acuities, retinal detachment, wound locations (p=0.001 each), lens injuries (p=0.001), posterior segment injuries (p=0.002), traumatic cataracts (p=0.010), hyphaema (p=0.011) and vitreous haemorrhage (p=0.026) had significant impacts on the final visual outcome. The authors reported that the assessment for the absence or presence of mild degree of relative afferent pupillary defect was difficult due to the cooperation of the trial at the time of the assessment. Therefore, calculating the OTS without evaluation of the RAPD was easily applicable for the initial examinations while remaining significantly prognostic with other parameters (p<0.001). The predictions of the POTS correlated with the actual final visual acuities (p<0.001), but several POTS variables (i.e., iris prolapse, age, organic injuries and delay of surgery >48h) had only limited impacts on visual outcome. The authors concluded that the OTS score has a very good predictive value for the visual outcome after open globe injuries in children, even without evaluation of RAPD. 

Ocular Trauma Scores in paediatric open globe injuries.
Schorkhuber MM, Wackernagel W, Riedl R, et al.
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Jonathan Chan

Royal Hallamshire Hospital, Sheffield, UK.

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