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This retrospective, comparative, interventional case-control study was aimed to investigate possible risk factors and prognosis of initial no light perception (NLP) in paediatric open globe injuries (POGI). A total of 851 cases were reviewed, including 837 unilateral cases and 14 bilateral cases, for a total of 865 eyes. There were 810 eyes with initial light perception (LP) and 55 eyes with initial NLP. The follow-up period was 4.2 ±7.1 months (range from one month to five years), male: female ratio 3.1:1.0. Right:left eye involvement was 1.1:1.0; age range 3-16 years. Timing range of surgical intervention from injury was 1-15 days, in initial LP and 1-14 days in NLP eyes. Rupture was more common in the NLP group (6/55, 10.9%) than in the LP group (34/810, 4.2%, p=0.036). The proportions of eyes with large scleral wounds (≥10mm) in the NLP group and the LP group were 5.5% (3/55) and 1.4% (11/810), respectively, and the difference was not statistically significant (p=0.054). Blunt injury was more common in the NLP group than in the LP group. More eyes achieved final LP or better vision and anatomic success in the LP group than the NLP group (p<0.001, both). In the LP group 527 eyes had two or more surgeries, 787 eyes retained final LP, 772 eyes had anatomic success, 13 had recurrent retinal detachment (RD), and 49 suffered proliferative vitreoretinopathy (PVR). Twenty-one remained as silicon sustained eyes and three developed optic atrophy, as opposed to the NLP group in which 42 eyes had two or more surgeries, and two eyes gained LP. Anatomic success was achieved in 45 eyes. Two eyes developed recurrent RD. There were two silicon sustained eyes and three eyes suffered with optic atrophy. No eyes suffered sympathetic ophthalmitis. Of the 865 sample eyes, 52 eyes remained NPL and 425 eyes had a vision of 20/200 or above. Severe intraocular haemorrhage, RD, choroidal damage and endophthalmitis were possible predictors of initial NLP in POGI. Choroidal damage was the major factor related to an NLP prognosis. Traumatised eyes with initial NLP could be anatomically and functionally preserved by vitreoretinal surgery. Limitations: Retrospective study; injuries involved the whole eyeball, and the injury mechanisms were variable, so these factors may have caused bias for statistical analysis. Some patients may have had a short follow-up. Strengths: Large sample size.

Risk factors and prognosis of pediatric open globe injuries without initial light perception.
Wen X, Yuana M, Lia C, et al.
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Sofia Rokerya

MBBS MRCOphth FRCSI, King's College University Hospital, UK.

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