Epidemiology of Pediatric Open Globe Injuries in a University Hospital in Thailand.

OBJECTIVE: To describe the epidemiology, clinical characteristics, and clinical outcomes of pediatric traumatic open globe injuries and to determine the risk factors for poor visual outcome. METHODS: The medical records of patients aged younger than 15 years of age who were diagnosed with open globe injuries from January 2005 to December 2015 were retrospectively reviewed. The patients' demographic data were collected, including age, sex, injury date, place of injury, mechanism of injury, cause of injury, and the activity related to the injury. Clinical data were recorded, including initial visual acuity (VA), wound size, wound location, associated ocular findings at presentation, and complications. The prognostic factors for a poor visual outcome were assessed. RESULTS: In total, 46 pediatric patients were included in this study. The mean age was 6.8 years old. Most patients were male (65.2%). The most common type of injury was penetrating injury (60.9%) and mostly occurred during playing (60.9%). Household appliances/furniture and scissors/knives were common causes of injuries (17.4%, 15.2%, respectively). Poor final VA worse than 6/60 was found in 17 patients (37%). Wound location and retinal detachment (RD) at the time of presentation were significant prognostic factors for a poor visual outcome according to the univariate analysis (p = 0.008, <0.001). Only wound location at zone II and III was found to be significantly correlated with poor final VA in the multivariate analysis (adjusted risk ratio (RR) = 2.87, 95% confidence interval (CI), 1.26-6.55, p = 0.012). Traumatic cataract was the most common associated injury (45.7%). CONCLUSIONS: One-third of pediatric patients with open globe injuries had a poor visual outcome. Wound location at zone II and III significantly correlated with a poor visual outcome in pediatric open globe injuries. The parents and caregivers should be made aware of the seriousness of open globe injuries in order to prevent children from possible injuries.

Assessing nonsedated handheld cone flicker electroretingram as a screening test in pediatric patients: comparison to sedated conventional cone flicker electroretinogram.

PURPOSE: To assess the RETeval (LKC Technologies, Gaithersburg, MD) handheld electroretingram (ERG) device as a screening tool for cone dysfunction in pediatric patients by comparing it to conventional ERG. METHODS: Patients scheduled for ERG under general anesthesia (GA) underwent three tests: (1) RETeval standard 30 Hz cone flicker ERG using skin electrodes prior to GA, (2) E3 Diagnosys (Diagnosys LLC, Lowell, MA) conventional complete standard protocol full-field ERG using bipolar contact lens electrodes and handheld stimulus under GA, and (3) repeat RETeval testing under GA. The 30 Hz cone flicker amplitudes and implicit times from the three methods were compared. Negative and positive predictive values were calculated by applying a previously established 5 µV amplitude cut-off. RESULTS: Thirty patients ≤18 years of age were enrolled. Impaired conventional ERGs were found in 18 patients. Compared to conventional ERG under GA, RETeval cone flicker amplitudes were smaller before GA (mean difference, -42.2 ± 45.3 µV) and under GA (-37.1 ± 44.5 µV), likely due to skin electrode; and implicit times were shorter before GA (-1.06 ± 2.83 ms) and longer under GA (1.28 ± 4.12 ms), likely due to GA. Comparing RETeval responses before and under GA, the amplitudes were lower (-3.05 ± 6.82 µV), and implicit times were shorter (-2.25 ± 3.28 µV) before GA. Overall, the positive predictive value of the RETeval was 85%; the negative predictive value, 90%. CONCLUSIONS: The unsedated handheld RETeval 30 Hz cone flicker ERG is a feasible screening test for detecting cone dysfunction in pediatric patients. Full-protocol ERG is needed when screening ERG is reduced, equivocal, or clinically warranted.

Association between congenital nasolacrimal duct obstruction and mode of delivery at birth.

PURPOSE: To investigate the association between mode of delivery, incidence of congenital nasolacrimal duct obstruction (CNLDO), and treatment outcomes. METHODS: The medical records of children diagnosed with CNLDO at a tertiary referral center between 2012 and 2017 were analyzed retrospectively. Patient demographics, pregnancy and birth history, clinical characteristics of CNLDO, and treatment outcomes were compared in patients delivered via Cesarean section (CS) versus vaginal delivery (VD). The rates of CS, as well as full-term and premature births, were also compared to Miami-Dade County normative values to eliminate the confounding effects of prematurity. RESULTS: A total of 104 patients were included. A significantly higher percentage of patients with CNLDO (61%) were delivered via CS (P < 0.0001). Among full-term babies, there was 55% greater risk (OR = 1.55; 95% CI, 0.98-2.43; P = 0.067) of CNLDO for CS birth compared to all other babies. Among preterm babies, there were no significantly greater odds of CNLDO for CS compared to VD births (P = 0.575). CNLDO did not resolve spontaneously in 50 patients, including 37 CS (74%) and 13 VD (26%) patients (P = 0.007). Among those patients who failed first-line probing, 86.2% were born via CS, whereas 13.8% were born via VD (P = 0.0009). CONCLUSIONS: CS is a risk factor for CNLDO, independent of gestational age. Children born via CS also tend to have a more complicated clinical course requiring additional surgical interventions.