Clinical Features and Prognostic Factors in Pediatric Open Globe Injuries

Purpose: To characterize the features of open globe injuries (OGIs) and the visual outcomes of pediatric patients using a modified Pediatric Ocular Trauma Score (POTS). Methods: A retrospective chart review was conducted of pediatric patients presenting to a Level I Trauma Center with unilateral OGIs from 2015 to 2023. Demographic data, injury characteristics, clinical findings at presentation, surgical timing, and visual outcomes were analyzed. The POTS was calculated to assess its prognostic value. Results: A total of 53 individuals were analyzed (mean age: 9.3 ± 5.3 years). Blunt trauma accounted for 69.8% of injuries, most of which occurred at home (54.7%). More than half (52.8%) were transferred from outside facilities, and surgical repair was performed within 48 hours in 60.4% of cases. Most injuries were zone I (83.0%). Uveal prolapse (71.7%) and traumatic cataract (39.6%) were frequently observed. At presentation, 5.7% had no light perception (NLP) and 35.8% had light perception/hand motion (LP/HM). Three-month follow-up best corrected visual acuity (BCVA) was available for 25 patients (47.2%); among these, 76% achieved a final BCVA of 0.1 or better. The POTS for all patients was 53.9 ± 19.9. For individuals with follow-up, mean POTS were correlated with final BCVA: LP/HM (47.5), CF (37.5), 0.1 to 0.5 (56.5), and 0.6 to 1.0 (70.0). Conclusions: This evaluation of pediatric OGIs found mainly zone I injuries causing LP/HM visual acuity. The incorporation of POTS highlights the potential for visual recovery in some patients, with 24% achieving 20/32 BCVA at 3 months of follow-up. These data support POTS as a prognostic tool for physicians managing OGIs in children.