Long-term corneal endothelial cell loss after paediatric ocular trauma: a specular microscopy study

Aims To evaluate long-term corneal endothelial changes in children following ocular trauma and the influence of trauma type and surgical history. Methods Prospective study that evaluated corneal endothelial parameters in a retrospectively identified cohort of 59 paediatric patients with unilateral trauma and bilateral specular microscopy ≥6 months after injury. Endothelial cell density (ECD), coefficient of variation (CV) and percentage of hexagonal cells (HEX) were compared between traumatised and fellow eyes. Subgroup analyses were performed according to trauma type (open vs closed globe) and surgical history. Results 59 children (mean age 7.3±3.6 years) were included, comprising 37 open-globe (OGI) and 22 closed-globe injuries (CGI). At a mean follow-up of 48.6±31.8 months, traumatised eyes exhibited significantly lower ECD (2528±633 vs. 3202±356 cells/mm²; p<0.01), higher CV (p<0.01) and lower HEX (p<0.01). Both OGI and CGI demonstrated significant endothelial loss relative to controls. Eyes that underwent additional intraocular surgery exhibited a 33.3% reduction in ECD compared with fellow eyes in OGI (p<0.01) and a 15.7% reduction in CGI (p=0.043). Even without additional intraocular surgery, ECD loss persisted in both OGI (15.7%; p<0.01) and CGI (7.6%; p=0.015). Conclusions Paediatric ocular trauma was associated with lower endothelial cell density and morphologic alterations. Although endothelial compromise was observed across both OGI and CGI, the magnitude of loss was greater in OGI and in eyes requiring additional intraocular surgery. These findings highlight the importance of careful surgical planning to help preserve endothelial reserve in eyes with prior trauma.