Zhuang Xiaonan, Jiang Rui, Xu Gezhi, Sun Zhongcui
Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.
Transl Pediatr. 2021 May;10(5):1346-1354. doi: 10.21037/tp-21-162.
To analyze the clinical features of pediatric open globe injury (OGI) in left-behind children (LBC) and in non-left-behind children (non-LBC) prospectively.
Patients diagnosed with OGI were included and divided into 2 groups: LBC and non-LBC. A complete ophthalmological examination was performed. Primary wound repair was completed within 8 hours from initial administration. Pars plana vitrectomy (PPV) was subsequently performed for retained intraocular foreign body (IOFB), endophthalmitis, retinal detachment, or non-clearing vitreous hemorrhage.
A total of 96 patients (4 to 15 years old) were recruited, including 54 LBC and 42 non-LBC. Rupture of the eyeball (P<0.001), endophthalmitis (P<0.001), primary hospitalization time (PHT) over 24 hours (PHT >24 h) (P=0.016), traumatic cataract (P=0.013), vitreous hemorrhage (P=0.040), numbers of surgeries (P<0.001), and lower OTS scores and grades (P<0.001) predisposed patients to poorer final visual acuity (VA). Compared with non-LBC, LBC were significantly younger (P<0.001), had lower OTS scores (P=0.020), had longer PHT (P<0.001), and worse baseline (P=0.011) and final VA (P<0.001). The 3 most common injury sources were pencils (20 cases, 20.8%), knives (11 cases, 11.5%), and iron wire (7 cases, 7.3%). Pencils were the major injury source for IOFB (14 cases, 53.8%). LBC were significantly more likely to be injured by instruments which should be routinely kept away from children (P=0.009).
The prognosis of pediatric OGI was worse in LBC than in non-LBC. It is necessary to improve the guardianship of LBC. Many tragedies may be avoided if adult instruments are properly stored and if children are educated to properly use writing devices.
前瞻性分析留守儿童与非留守儿童小儿开放性眼球损伤（OGI）的临床特征。
纳入诊断为OGI的患者并分为两组：留守儿童组和非留守儿童组。进行全面的眼科检查。在首次给药后8小时内完成一期伤口修复。随后，对于眼内异物残留（IOFB）、眼内炎、视网膜脱离或玻璃体出血不吸收的情况，进行玻璃体切割术（PPV）。
共纳入96例患者（4至15岁），其中54例为留守儿童，42例为非留守儿童。眼球破裂（P<0.001）、眼内炎（P<0.001）、初次住院时间（PHT）超过24小时（PHT>24 h）（P=0.016）、外伤性白内障（P=0.013）、玻璃体出血（P=0.040）、手术次数（P<0.001）以及较低的儿童眼外伤评分（OTS）分数和等级（P<0.001）使患者最终视力（VA）较差。与非留守儿童相比，留守儿童年龄显著更小（P<0.001）、OTS分数更低（P=0.020）、PHT更长（P<0.001）、基线视力（P=0.011）和最终视力（P<0.001）更差。3种最常见的致伤源为铅笔（20例，20.8%）、刀（11例,11.5%）和铁丝（7例，7.3%）。铅笔是IOFB的主要致伤源（14例，53.8%）。留守儿童更有可能被应常规远离儿童的器械致伤（P=0.009）。
留守儿童小儿OGI的预后比非留守儿童差。有必要加强对留守儿童的监护。如果成人器械妥善存放且儿童接受正确使用书写工具的教育，许多悲剧可能会避免。
