Epidemiology, Clinical Profile and Factors Associated with Poor Visual Outcome among Children with Closed Globe Injury in Northern Tanzania (2020-2024)

Abstract

Background and Aim: Ocular trauma refers to injuries of the eye, its surrounding structures, or the orbit. It is a significant but often underrecognized cause of visual impairment and blindness, as it usually affects only one eye and is underreported in epidemiological studies. To assess, clinical profile, visual outcome, complications and factors associated with poor visual outcome among pediatric patients with closed-globe injuries in northern zone Tanzania. Study Design: A hospital-based retrospective cohort study. Place and Duration of Study: A 5 years study, conducted at Kilimanjaro Christian Medical Centre from January 2020 to December 2024. Methodology: A total of 324 patients (332 eyes) aged 16years and below attending pediatric eye clinic at Kilimanjaro Christian Medical Centre (KCMC) hospital were enrolled. The final best corrected visual acuity (BCVA) was measured at the end of follow-up period, which was 3 months. A detailed medical history and ocular examination including visual acuity, slit-lamp biomicroscope and fundus examination, was obtained. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 25. Results: The prevalence of closed globe injury among total ocular trauma cases were (33.7%), the mean age at presentation was 7 ± 4 years, male were 2.4 times involved than female. Majority of injury occur in children aged 5-9 years (45.8%). The highest proportion of injuries occur in street (34.9%) followed closed by home (30.1%). The most common mechanism of injury were child play (41.3%) and majority of injury caused by blunt object (40.4%) followed by vegetative matter (30.7%). Closed globe contusion were 216(65.1%) mostly involving zone I and cornea tissue frequently involved (51.7%). BCVA >6/60 at 3 months were better in 70.5%.Poor initial VA(AOR = 7.05, p = 0.008), vitreous hemorrhage and Retina hemorrhage(AOR = 0.11, p = 0.009) and (AOR = 0.05, p = 0.027) respectively, Zone II injury (AOR = 5.22, p = 0.001), Zone III injury(AOR = 24.94, p < 0.0001),POTS 1(AOR = 117.46, p = 0.002),POTS 2(AOR = 14.43, p = 0.030), were associated with poor final visual outcome Conclusion: A significant proportion of closed globe injury occurred mostly during child play in school aged male. More than two third attained best corrected visual acuity better than 6/60 at 3month follow up. Poor initial visual acuity, vitreous hemorrhage, retinal hemorrhage, zone II injury, zone III injury, POTS 1and POTS 2 were significantly associated with poor final visual outcome