spektrum der augenheilkunde - 150 Jahre Augenklinik Graz

original articleMädchen (23 = 22,1 %, p < 0,001). Ein geschlechterspezifischerUnterschied trat auch im Verletzungsalter auf:Die verletzten Mädchen waren deutlich jünger als dieverletzten Buben (Median sechs und elf Jahre, p = 0,001).Wir operierten 76 (73,1 %) penetrierende Verletzungen,19 (18,3 %) mit intraokularem Fremdkörper, sechs(5,8 %) Rupturen und drei (2,9 %) perforierende Verletzungen.Die häufigsten Verletzungsobjekte waren Werkzeuge( n = 21, 20,2 %), Stecken und Pfeile ( n = 18, 17,3 %)und Glassplitter ( n = 12, 11,5 %). Von den 88 Patientenmit dokumentiertem Endvisus betrug die Sehschärfebei 52 (59,1 %) zumindest 0,5, 14 (15,9 %) erblindeten.Der Endvisus war signifikant besser als der Aufnahmevisus( p < 0,001).Schlussfolgerung Die Mehrzahl der Verletzten warenmännliche Teenager, die häufigsten VerletzungsobjekteWerkzeuge. Die Mädchen waren zum Zeitpunkt der Verletzungsignifikant jünger als die Buben.Schlüsselwörter Augenverletzung · Bulbuseröffnend ·Penetrierend · Intraokularer Fremdkörper · KinderIntroductionInjury is a major source of visual impairment in theindustrialized world. In the United States, 35 % of all eyeinjuries are estimated to occur in children aged 17 yearsand younger [1 –3 ].Th e classification of eye injuries has been veryheterogeneous until the Birmingham Eye TraumaTerminology (BETT) [ 4 ] provided a standardized terminology.According to it, open globe injuries are definedas injuries with at least one full-thickness wound ofthe eyewall (cornea and sclera). They are subdividedinto four groups: penetrating and perforating injuries,ruptures, and injuries with an intraocular foreignbody (IOFB). A penetrating injury is characterized byone or more entrance wounds, but no exit wound. Ifan IOFB remains in the globe, the injury is called IOFBinjury. A perforating injury is characterized by at leastone entrance wound plus one or more exit wounds. Arupture is a break of the eye wall at its weakest pointthrough an inside-out force vector resulting fromcompression.Over the past decades, preventive health care hascome into sharp focus in general medicine as well asin ophthalmology. Societies like Prevent Blindness inAmerica were founded, and call for further epidemiologicalstudies concerning eye injuries [ 3 ]. The WHO definedinjury prevention as an objective of the program Vision2020 [ 5 ].Pediatric preventive care still has to be expanded [ 6 – 8 ],to prevent unilateral childhood blindness [ 2 , 9 – 15 ].Pediatric open globe injuries in Europe have rarelybeen analyzed so far [ 16 – 18 ], but the pre-existing literatureshows that injury circumstances and prognosis varystrongly with the culture in which they occur [ 19 – 30 ].The present study provides data from a mixed urban andTable 1 Age distributionAge-groups (years) n (%)0–5 29 (27.9)6–10 32 (30.8)11–14 16 (15.4)15–17 27 (26.0)Total 104 (100.0)rural Middle-European patient collective, focusing ongender differences.MethodsWe conducted a retrospective study, scanning the medicalcharts of the Department of Ophthalmology of theMedical University of Graz for all the records of childrenwith open globe injuries who were operated on betweenSeptember 1, 1992, and July 31, 2011. Children weredefined as individuals younger than 18 years of age andcategorized into four age-groups (Table 1 ).We excluded patients without a follow-up of at least1 year from the analysis of the visual outcome. Thepatients’ records were reviewed for the following criteria:age, gender, injury type, operations, final visual acuity(FVA), anatomical results, factors influencing the visualoutcome, and aggression or child abuse.The terms “open globe injury,” “penetrating injury,”“perforating injury,” “rupture,” and “intraocular foreignbody injury” are used in accordance with the BETT [ 31 ].Blindness is defined as a visual acuity of less than 3/60,according to the definition of the WHO [ 1 , 32 ].A thorough examination in general anesthesia wasperformed, if slit lamp examination did not reveal all relevantinjury details.The FVA is grouped as follows: no light perception(NLP), light perception and hand movements (LP/HM),1/200 to19/200, 20/200 to 20/50, and 20/40 or better.Visual acuity testing was performed with Snellen charts,letter charts, and picture charts, depending on age andcompliance.Suture removal and eye examinations under anesthesiaare not ranked among operations.Th e statistical analysis was performed using the statisticalsoftware SPSS 19.0 (SPSS Inc, Chicago, IL). Continuousdata are presented as mean and standard deviationor as median and interquartile range (IQR), minimumand maximum, and categorical data as absolute andrelative frequencies. To test whether the frequency ofopen globe injuries is equally distributed across genderand age-groups (0–5, 6–10, 11–14, and 15–17 years),chi-square tests were used. Group comparisons wereconducted using Mann–Whitney U test, Kruskal–Wallistest, and Fisher’s exact test. For comparison of initialvisual acuity (IVA) and FVA, Wilcoxon signed ranktest and Spearman’s correlation coefficient were used.A p -value of < 0.05 was considered to indicate statistical306 Gender differences in open globe injuries in children 1 3