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      A prospective cohort study on the epidemiology of ocular trauma associated with closed-globe injuries in pediatric age group

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          Abstract

          Purpose:

          To study the epidemiology of mechanical ocular trauma and closed globe injury using the Birmingham Eye Trauma Terminology System in patients belonging to the pediatric age group.

          Methods:

          This work involved a prospective cohort study of all ocular trauma patients (pediatric age group) registered between 2002 and 2017 at the ocular trauma care center. The data were collected using the international ocular trauma society form through our online MIS data and exported to the Excel sheet. The statistical analyses including the univariate analysis and cross tabulation were carried out using SPSS 22 software.

          Results:

          Our cohort consisted of 12687 patients with mechanical ocular trauma. There were 7546 (59.4%) eyes with open globe ocular injuries and 5328 (41.9%) with closed globe injuries. Of all closed globe injury patients, 1010 (19.0%) belonged to the pediatric age group (0-18 years), including 690 males (68.3%) and 320 females (31.7%). The mean age of the patients was 10.2 ± 5.1 years. Of all closed globe injuries, 692 (68.5%) were closed globe contusion and 318 (31.5%) were lamellar laceration.

          Conclusion:

          Closed globe injury is an important in cause of vision loss in children (24% <1/60). The condition is more prevalent in males and >51.7% in children under 10 years of age. The treatment has significant impact on the visual outcome in patients belonging to the pediatric age group.

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          Most cited references27

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          The Birmingham Eye Trauma Terminology system (BETT).

          To evaluate the international eye injury scene and design a standardized terminology for mechanical eye injuries. Surveys of practicing ophthalmologists and an extensive review of the international ocular trauma literature. Development of the Birmingham Trauma Terminology (BETT) using a logic-based approach. BETT always uses the entire globe as the tissue of reference. Its well-defined terms encompass all types of mechanical eye injury. A one-to-one relationship exists between terms and clinical conditions. BETT provides an unambiguous, consistent, simple, and comprehensive system to describe any type of mechanical globe trauma. Endorsed by several societies and peer-reviewed journals as the standardized international language of ocular traumatology, BETT is expected to become the preferred terminology for categorizing eye injuries in daily clinical practice.
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            Eye injuries in children: the current picture.

            To investigate the current causes and outcomes of paediatric ocular trauma. A prospective observational study of all children admitted to hospital with ocular trauma in Scotland over a 1 year period. The commonest mechanism of injury was blunt trauma, accounting for 65% of the total. 60% of the patients were admitted with a hyphaema. Injuries necessitating admission occurred most frequently at home (51%). Sporting activities were the commonest cause of injury in the 5-14 age group. There were no injuries caused by road traffic accidents or fireworks. Patients were admitted to hospital for a mean of 4.2 days (range 1-25 days). One (1%) child had an acuity in the "visually impaired" range (6/18-6/60) and one (1%) was "blind" (6/60) in the affected eye. No child was bilaterally blinded by injury and none required blind or partial sight registration. This study has shown that the incidence of eye injuries affecting children has fallen. The outcome of ocular trauma has improved significantly, and for the first time paediatric injuries appear to have a better prognosis than injuries affecting adults.
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              The epidemiology of ocular trauma in rural Nepal.

              To estimate the incidence of ocular injury in rural Nepal and identify details about these injuries that predict poor visual outcome. Reports of ocular trauma were collected from 1995 through 2000 from patients presenting to the only eye care clinic in Sarlahi district, Nepal. Patients were given a standard free eye examination and interviewed about the context of their injury. Follow up examination was performed 2-4 months after the initial injury. 525 cases of incident ocular injury were reported, with a mean age of 28 years. Using census data, the incidence was 0.65 per 1000 males per year, and 0.38 per 1000 females per year. The most common types of injury were lacerating and blunt, with the majority occurring at home or in the fields. Upon presentation to the clinic, 26.4% of patients had a best corrected visual acuity worse than 20/60 in the injured eye, while 9.6% had visual acuity worse than 20/400. 82% were examined at follow up: 11.2% of patients had visual acuity worse than 20/60 and 4.6% had vision worse than 20/400. A poor visual outcome was associated with increased age, care sought at a site other than the eye clinic, and severe injury. 3% of patients were referred for further care at an eye hospital at the initial visit; 7% had sought additional care in the interim between visits, with this subset representing a more severe spectrum of injuries. The detrimental effects of delayed care or care outside of the specialty eye clinic may reflect geographic or economic barriers to care. For optimal visual outcomes, patients who are injured in a rural setting should recognise the injury and seek early care at a specialty eye care facility. Findings from our study suggest that trained non-ophthalmologists may be able to clinically manage many eye injuries encountered in a rural setting in the "developing" world, reducing the demand for acute services of ophthalmologists in remote locations of this highly agricultural country.
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                Author and article information

                Journal
                Indian J Ophthalmol
                Indian J Ophthalmol
                IJO
                Indian Journal of Ophthalmology
                Medknow Publications & Media Pvt Ltd (India )
                0301-4738
                1998-3689
                March 2020
                14 February 2020
                : 68
                : 3
                : 500-503
                Affiliations
                [1]Department of Pediatric Ophthalmology, Drashti Netralaya, Dahod, Gujarat, India
                Author notes
                Correspondence to: Dr. Mehul A Shah, Department of Pediatric Ophthalmology, Drashti Netralaya, Nr. GIDC, Chakalia Road, Dahod - 389 151, Gujarat, India. E-mail: omtrustdahod@ 123456gmail.com
                Article
                IJO-68-500
                10.4103/ijo.IJO_463_19
                7043148
                32057012
                bbea2d6b-8888-4f58-8398-1a3d02191792
                Copyright: © 2020 Indian Journal of Ophthalmology

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 10 March 2019
                : 15 June 2019
                : 05 August 2019
                Categories
                Original Article

                Ophthalmology & Optometry
                birmingham eye trauma terminology system,blunt ocular trauma,pediatric ocular trauma

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