spektrum der augenheilkunde - 150 Jahre Augenklinik Graz

original articleof operations, as they also underwent surgical care inother hospitals. In total, 55 children were operated once,and 45 at least twice, with a maximum of eight operationsin one child who suffered from a retinal detachmentand a secondary glaucoma in consequence of theinjury. The median number of operations per patient wasone. Concerning the different types of injury, the medianfrequency of operations was one (IQR = 2, 1–8) for penetratinginjuries, one (IQR = 1, 1–6) for IOFB injuries, four(IQR = 2, 3–5) for perforating injuries, and three (IQR = 1,1–3) for ruptures.A primary wound closure was conducted in every child,except for one with a lamellar penetration of the globe.This boy was only operated 2 months later because of atraumatic cataract. A total of 32 posterior vitrectomies wereconducted in 22 children, of whom 14 underwent a singularposterior vitrectomy, 6 required 2, and 2 required 3 ofthese procedures. Five children underwent a scleral buckling.A lensectomy was conducted in 39 children. Of them,26 got an intraocular lens implanted, and 13 remainedaphakic. In 10 of the aphakic children, the best-correctedFVA was 30/200 or less, 2 children were 3 and 5 years old,respectively, and another one was offered the implantation,but refused surgery. Surgery of secondary strabismuswas conducted in four cases. A corneal transplantationand a reconstruction of a cicatricial ectropion were performedin one child each. One eye was enucleated, andanother one was eviscerated. A total of 19 patients had aretinal detachment at the initial examination or at a follow-upexamination. In 15 of these, the retina was completelyattached at the end of the follow-up period.IVA was available for 80 patients, of whom 18 (22.5 %)had a vision of 20/40 or more (Table 4 ).FVA was available for 88 patients; 52 (59.1 %) of themrecovered a vision of at least 20/40, 19 (21.6 %) of 20/50to 20/200, 6 (6.8 %) of 19/200 to 1/200, 5 (5.7 %) ended upwith LP to HM, and 6 (6.8 %) with NLP (Table 4 ).Th e FVAs were significantly better than the IVAs( p < 0.001). Regarding the 71 children for whom both IVAand FVA were recorded, the vision category improved in40 children (56.3 %), remained unchanged in 28 children(39.4 %), and deteriorated in 3 children (4.2 %). As far asthe children with unchanged vision are concerned, 16(57.1 %) remained in the category of 20/40 or better.The IVA was prognostic for FVA, with a correlation ofr = 0.56 ( p < 0.001).As far as injuries with blunt objects and rocket or guninjuries are concerned, their outcome was significantlyworse than that of injuries with sharp objects ( p < 0.001for both comparisons).A total of 14 (15.9 %) children with a recorded FVAwent unilaterally legally blind ( < 3/60) in consequenceof the injuries; 13 (92.9 %) of them suffered from posterioropen globe injuries; and in 12 (85.7 %) of the blindeyes, an affection of the retina was recorded at the initialexamination.No case of child abuse was recorded. Among the 71 injuriesfor which the responsibility was clear, 37 (52.1 %) wereself-inflicted and 34 (47.9 %) provoked by someone else.Table 4 Initial and final visual acuitiesDiscussionIVA, n (%) FVA, n (%)NLP 4 (5.0) 6 (6.8)LP to HM 24 (30.0) 5 (5.7)1/200 to 19/200 14 (17.5) 6 (6.8)20/200 to 20/50 20 (25.0) 19 (21.6)≥ 20/40 18 (22.5) 52 (59.1)Total 80 (100.0) 88 (100.0)FVA fi nal visual acuity, IVA initial visual acuity, NLP no light perception, LPlight perception, HM hand movementsBoys are at a higher risk for injuries. A study of more than190,000 pediatric injuries (not only eye injuries) showsa higher risk for them as early as in the first year of life[ 33 ]. Concerning open globe injuries in children, malessustain between 67 and 87 % of the injuries [16 –30 ]. Withpuberty, the male predominance becomes more pronounced[16 , 20 , 24 , 25 , 27 , 29 ].The low rate of ruptured globes in our patient collective(5.8 %) resembles the outcomes of other studies witha pediatric patient collective, which report ruptures in4–13 % of the cases [ 17 , 26 ]. In contrast to that, anotherMiddle-European investigation [ 34 ] reports a rate of73 % of ruptured eyes among citizens aged 65 years andolder with open globe injuries. There is evidence thatthe threshold to rupture is lower in older eyes, and thatprevious surgical procedures produce predeterminedbreaking points [34 , 35 ].According to our expectations, our patients were oftenhurt by toys. However, what we did not anticipate wasthat more than one out of five injury objects were a tool.Interestingly, all but one of these injuries happened inboys. In the literature about open globe injuries in children,these objects have rarely been described so far [ 26 ],apart from scissors [ 16 , 20 , 24 ] and singular nail injuries[ 19 – 21 , 24 ]. We partially explain this finding by our inclusioncriterion of 18 years of age or less, compared with15 [ 20 ], 18 [ 21 ], 13 [ 16 ], 16 [ 24 ] and 13 [ 26 ] years of ageor less in the investigations mentioned earlier in the text.But still, 13 tool injuries (13 % of all injuries) occurred inchildren less than 16 years of age; 8 tool injuries (38.1 % ofall tool injuries) even occurred in patients aged 12 yearsof age and younger. It seems that the danger of tool injuriesin children is underestimated in our culture.As far as glass fragments, accounting for 12 % of ourinjuries, are concerned, they seem to play an importantrole in all other studies, independent of their origin [ 16 – 21 ,24 , 25 , 28 ].Knife injuries (5 % in this investigation) are often mentionedin the literature, too, accounting for 3–33.6 % of theinjury objects of previous studies [17 –19 , 21 , 36 ]. Attacksby animals rarely seem to cause open globe injuries. Inour study, only one (1 %) injury was caused by an animal,a cock to be precise. In other studies which mention suchinjuries, the rate lies between 1 and 2.5 % [ 25 , 29 ].308 Gender differences in open globe injuries in children 1 3