Dilara PİRHAN, Sevgi SUBAŞI, Kübra DEMİRCİ KÜÇÜK

Pediatrik Hastalarda Oküler Travmaların Etiyolojik Özellikleri ve Görsel Sonuçları

Amaç: Açık glob yaralanması (AGY) nedeni ile acil kliniğimize başvuran, tedavi ve takibi yapılan 60 pediatrik olgunun demografik özelliklerini ve prognozu etkileyen faktörleri araştırmak. Yöntem: Kliniğimizde 2010-2021 yılları arasında AGY nedeni ile ameliyat edilip, en az bir yıl takip yapılmış olan 16 yaş ve altı 69 olgunun dosya kayıtları retrospektif olarak incelendi. Kayıtlardan AGY’nin tipi, oluş nedeni, eşlik eden muayene bulguları, hastaneye başvuru zamanı ile ilk ve son görme keskinlikleri (GK), ek cerrahileri kaydedildi. Bulgular: Olguların ortalama yaşı 11±5 yıl idi. %17,4’si kız %82,6’sı erkek idi. AGY’nin şekli en sık korneal kesi, en sık etiyolojik nedeni kesici ve delici aletler (%65,1) oluşturmakta idi. Olguların %87 sinde sadece bölge 1, %40,6 sında bölge 2, %13 ünde bölge 3 etkilenmişti. Olguların %37,7 sinde relatif afferent pupil defekti (RAPD) vardı. %5,8’i rüptür, %8,7’si retina dekolmanı, %2,9’u endoftalmi, %4,3’ü perforan yaralanma idi. Olguların başvuru anında %7’sinde GK değerlendirilemezken, %60’ında 0.1 ve daha altında, %25,7’sinde 0.1-0,6. %4,3’ünde ise 0.6’dan daha iyi GK’ya sahipti. Olguların takiplerinde 6. ayda ise %2,9’ unda GK değerlendirilemezken (inop), %11,4’ ünde 0.1 ve daha altında, %25,7’sinde 0.1-0.6 ve %60’ında ise 0.6’dan daha iyi GK’ya sahipti. Oküler travma skoru (OTS) 74±16, pediatrik oküler travma skoru (POTS) 64±19 idi. OTS başlangıçtaki GK ile orta derecede ilişkili (r=0,687, p<0,001), takipteki GK ile orta derecede ilişkili (r=0,611, p<0,001) idi. Pediatrik oküler travma skorunun korelasyon değerleri ise daha düşük bulundu (başlangıç GK ile r=0,574, p<0,001). Sonuç: Pediatrik AGY’de görsel prognozu tahmin edebilmek için RAPD değerlendirilemediğinde bile OTS güvenilir bir araçtır.

Anahtar Kelimeler:

oküler travma, körlük, göz yaralanması, penetran göz yaralanması, çocukluk çağı göz yaralanması

Etiological Findings and Visual Outcomes of Ocular Injuries in Pediatric Patients

Objective: To investigate the demographic characteristics and prognostic factors of 60 pediatric patients who applied to our emergency clinic due to open globe injury (OGI) and were treated and followed up. Methods: The medical records of 69 patients aged 16 years and younger, who were operated for OGI between 2010-2021 and followed up for at least one year, were retrospectively reviewed. The patients’ demographic data, the type, cause and mechanism of injury, wound location and accompanying examination findings at the time of admission, time of admission to the hospital, first and last visual acuities (VA), additional surgeries were collected from the records. Results: The mean age was 11±5 years old. 17.4% were girls and 82.6% were boys. The most common shape of OGI was corneal incision, the most common etiological cause was sharp and penetrating objects (65.1%). Only zone 1 was affected in 87% of the cases, zone 2 in 40.6%, and zone 3 in 13%. Relative afferent pupil defect (RAPD) was present in 37.7% of the cases. Rupture was 5.8%, retinal detachment 8.7%, endophthalmitis 2.9%, perforating injury 4.3%. While VA cannot be evaluated in 7% of the cases at the time of admission, it is 0.1 or less in 60%, 0.1-0.6% in 25.7%. 4.3% had a VA better than 0.6. In the sixth month of follow-up, VA could not be evaluated in 2.9% of the cases, while VA was 0.1 or less in 11.4%, 0.1-0.6 in 25.7%, and better than 0.6 in 60%. Ocular trauma score (OTS) was 74±16 and pediatric ocular trauma score (POTS) was 64±19. OTS was moderately correlated with baseline VA (r=0.687, p<0.001) and moderately correlated with follow-up VA (r=0.611, p<0.001). Correlation values of pediatric ocular trauma score were lower (r=0.574, p<0.001) with baseline VA. Conclusion: Even though RAPD cannot be evaluated, OTS is a reliable tool to predict visual prognosis in pediatric OGI.

Keywords:

ocular trauma, blindness, eye injury, penetrating eye injury, childhood eye injury,

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