Ocular and Psychosocial Outcomes After Pediatric Open Globe Injury Repair

Ocular and Psychosocial Outcomes After Pediatric Open Globe Injury Repair | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Ocular and Psychosocial Outcomes After Pediatric Open Globe Injury Repair Esra Biberoğlu Çelik, Didem Dizdar Yiğit, Ayşe Tuğçe Kılıçarslan Varlı, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9188151/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Purpose: To evaluate the clinical and demographic characteristics of children undergoing surgical repair for open globe injuries(OGIs) and to examine the associations between ocular findings, executive functioning, sleep disturbances, and parental quality of life. Methods: Twenty-three children who underwent OGI repair and 25 age- and sex-matched healthy controls were included. Clinical data, including baseline and final best-corrected visual acuity(BCVA), number of surgeries, and injury zone, were collected retrospectively. Parents completed the Pediatric Quality of Life Inventory: Family Impact Module (PedsQL-FIM), the Sleep Disturbance Scale for Children(SDSC), and the Behavior Rating Inventory of Executive Function(BRIEF) at the final follow-up visit after trauma Group comparisons and correlation analyses were performed to assess relationships between ocular and psychosocial variables. Results: The median follow-up was 21 months. Among patients, 73.9% had penetrating injuries, 17.4% ruptures, and 8.7% intraocular foreign bodies. Injury location was zone 1 in 69.6%, zone 2 in 21.7%, and zone 3 in 8.7%. Median BCVA improved from 1.8 to 0.4 LogMAR(p=0.006). No significant group differences were found in executive or sleep functions(p>0.05). Parents of patients reported significantly lower scores in physical(p=0.001), emotional(p=0.002), anxiety(p=0.020), and daily activity(p=0.028) domains. Baseline BCVA correlated negatively with Shift(r=–0.415, p=0.049) and Emotional Control(r=–0.452, p=0.030). Final BCVA correlated negatively with parental cognitive functioning(r=–0.443, p=0.034) and children’s night awakenings(r=–0.415, p=0.049). Conclusion: Early intervention in OGIs is crucial for favorable visual outcomes. Although executive and sleep functions were similar to controls, poorer vision was linked to emotional and cognitive difficulties in children and heightened caregiver stress, highlighting the need for multidisciplinary, family-centered care. Pediatric ocular trauma open globe injury executive functions sleep disturbances parents' quality of life psychosocial outcomes Introduction A significant proportion of youth globally—estimated at nearly 66%—experience traumatic incidents prior to the age of sixteen, often involving violence, accidents, or disasters [ 1 ]. Pediatric OGI have been identified as a significant cause of vision loss and acquired blindness in children [ 2 – 4 ]. OGI require urgent surgical intervention and prolonged postoperative care, and this extraordinary situation can be a significant source of stress for both pediatric patients and their caregivers. An increasing number of studies suggest that children with deficits in executive functions such as attention, impulse control and behaviour regulation may be more prone to unintentional injuries due to increased risk-taking and impaired environmental awareness [ 5 , 6 ]. Similarly, sleep disorders have been linked to emotional dysregulation and slower reaction times, which could hinder a child's ability to respond to dangerous situations [ 7 , 8 ]. These behavioural and neurocognitive sensitivities may place children with such profiles at a higher risk of eye injury. Against this backdrop, the current study aims to investigate whether underlying behavioural regulation difficulties contribute to increased injury susceptibility in pediatric patients. Following such injuries, children often resist clinical examinations due to fear, and even the administration of topical eye drops becomes problematic. Occlusion of the eyes with bandages, reduced visual acuity, postoperative discomfort such as stinging or burning, and even exposure to examination tools or light can cause distress in these patients. In many cases, parents resort to administering drops while the child is asleep, which may contribute to poor sleep quality. School-aged children are frequently unable to attend school for extended periods, falling behind their peers academically and socially. Despite advances in surgical techniques and follow-up protocols, these challenges may result in sleep disturbances and impairments in executive functioning within this vulnerable population. In addition to children, parents are also affected, facing the psychological burden of potentially losing their child’s vision, which further diminishes their quality of life. To capture these multidimensional effects, the study design includes validated assessment tools. The Family Impact Module (PedsQL-FIM) was used to assess the impact of the child's condition on parents' quality of life and family functioning, the Sleep Disorders in Children Scale (SDSC) was used to identify and measure sleep-related issues, and the Behavioral Rating Inventory of Executive Functions (BRIEF) was used to evaluate the cognitive and behavioral aspects of executive functions in daily life [ 9 – 11 ]. However, there is no research examining the reciprocal relationship between sleep disorders, executive functions, and parents' quality of life in children who have undergone pediatric OGI repair [ 12 – 14 ]. While prior studies have addressed individual psychosocial domains in visually impaired or chronically ill children, there is currently no research exploring how specific ocular variables—such as visual acuity, injury zone, and surgical burden—relate to sleep disturbances, executive function profiles, and parental quality of life in pediatric patients with OGI [ 15 – 17 ]. This study is the first in the ophthalmology literature to examine these complex, interrelated outcomes in a single, integrated model. Materials and Methods This retrospective observational study included pediatric patients (under 18 years of age) who underwent surgical repair for OGI at the tertiary clinic between January 2017 and December 2024. The inclusion criteria that were employed in this study were as follows: a confirmed diagnosis of OGI, primary surgical intervention performed within 48 hours of the trauma, and a minimum of six months of postoperative follow-up. Patients with congenital ocular abnormalities, systemic neurodevelopmental disorders, or incomplete medical records were excluded from the study. The patients were evaluated in terms of the following criteria: age and gender, trauma type and location of injury, initial and final best corrected visual acuity (BCVA), surgical procedures performed, complications, and need for additional surgery. The OGI was categorized according to BETTS [ 18 ]. At the final follow-up visit after trauma, three surveys were administered to the participants' parents in a secure electronic environment during an eye examination. The surveys included the Pediatric Quality of Life Questionnaire: PedsQL™-Fim, SDSC, and BRIEF. All questionnaires were fully completed, and no missing data were observed. The BRIEF is administered by parents or teachers and is designed for children between the ages of 5 and 18 [ 19 ]. It assesses several domains of executive functioning, including inhibition, shifting, emotional control, working memory, planning and organising, organising materials, and monitoring. The instrument is particularly useful in identifying functional impairments in children with neurological, developmental or behavioural conditions [ 19 ]. The validity and reliability of the scale in Turkey were established by Batan and colleagues [ 11 ]. SDSC is a scale used to assess sleep disturbance in children. This scale is designed to gather information about potential sleep problems in children and adolescents [ 20 ]. The scale consists of 26 items and allows a parent or caregiver to rate the child's sleep habits over the past 6 months. Each item is rated on a five-point Likert scale. The validity and reliability of the scale in Turkey were established by Ağadayı and colleague [ 9 ]. PedsQL – FIM is a standardised instrument designed to assess the effect of a child's chronic health condition on the quality of life of their family members [ 21 ]. The overarching PedsQL framework appraises the child's quality of life, whereas the Family Impact Module is specifically concerned with the impact of the child's condition on family functioning and caregiver well-being. A Turkish validation and reliability study of the scale was conducted by Gürkan et al. in families of children with Type 1 diabetes mellitus [ 10 ]. The same questionnaires were administered to the families of healthy individuals of appropriate age and gender who attended routine eye examinations. Data obtained from the patient group and control group were evaluated. The study was approved by the ethics committee(protocol-number:09.2025.25–0799) and adhered to the principles of the Declaration of Helsinki. Statistical Analysis Descriptive statistics were computed for the study, including frequencies and percentages for categorical variables and means, standard deviations, medians, and ranges for continuous variables. To compare the groups, non-parametric Mann-Whitney U tests were employed to evaluate differences between children with eye trauma and control participants across various psychological and functional scales. Spearman correlation analyses were conducted within the trauma group to examine the associations between PedsQL™ Family Impact Module subscales and EF and sleep disturbance measures. Furthermore, linear regression analyses were performed to identify cognitive and behavioral predictors of family functioning outcomes. All statistical analyses were performed using SPSS version 27, with the significance level set at p 0.05) and sex distribution (male: 73.9% [n = 17] vs. 72.0% [n = 18]; p = 0.05). The mean follow-up duration in the patient group was 21 (range: 6–80 months). The data indicates that 56.5%,8 (n = 13) of accidents occurred at home, 26.0% (n = 6) outside, and the remaining 17.39% at school. Furthermore, left eye involvement was observed in 56.5% (n = 4) of patients. The demographic and clinical characteristics of the patients are presented in Table 1 . The patient cohort exhibited a 73.9% penetrating injuries (n = 17), a 17.4% globe ruptures (n = 4), and a 8.7% intraocular foreign bodies (IOFB) (n = 2). The anatomical location of the injuries was zonally classified as follows: The distribution of the sample across zones is as follows: 69.6% (n = 16) in zone I, 21.7% (n = 5) in zone II, and 8.7% (n = 2) in zone III. Table 1 The demographic and clinical characteristics of the Patients Age Median (Range) 7 (3–16) Follow-up period (month) 21 (6–80) Initial BCVA (LogMAR) 1.8 (0–3) Final BCVA (LogMAR) 0.4 (0–3) Number of operations 1.0 (1–5) Type of injury Penetran Rupture IOYC %73.9(17) %17.4(4) %8.7(2) Site of injury Zone 1 Zone 2 Zone 3 %69.6(16) %21.7(5) %8.7(2) The median number of surgical interventions per patient was 1 (range: 1–5). During the initial surgery, lens extraction was performed in 6 eyes (30.4%). Three patients underwent pars plana vitrectomy, two underwent pupilloplasty and two underwent scleral fixation secondary lens implantation. Four patients underwent secondary lens implantation to sulcus and one patient underwent evisceration due to phthisis. The median initial BCVA was 1.8 LogMAR, which improved to 0.4 LogMAR at final follow-up (p = 0.006), indicating a statistically significant improvement in visual function. Psychosocial and Cognitive Outcomes Table 1 presents a comparison of scale performances between the eye trauma and control groups. No statistically significant differences were observed in the BRIEF total scores or subscales, including Behavioral Regulation and Metacognition (p > 0.05, Table 2 ). Table 2 Evaluation of Scales between Children with Eye Trauma and Control Groups Trauma Control Z p M SD M SD BRIEF Inhibit 5.30 5.55 5.25 4.59 -0.262 0.793 Shift 5.32 3.46 5.78 3.81 -0.464 0.643 Emotional control 7.66 6.13 7.02 5.30 -0.181 0.857 Initiate 5.36 4.00 4.92 4.18 -0.686 0.493 Working memory 6.70 5.45 7.81 6.90 -0.332 0.740 Plan/Organize 7.48 7.01 7.06 7.02 -0.322 0.748 Organization of materials 4.57 4.12 4.11 3.46 -0.242 0.809 Monitor 5.13 4.63 5.65 4.34 -0.595 0.552 Behavior control 18.28 13.76 18.05 11.81 -0.200 0.841 Metacognition 29.22 22.63 29.55 23.75 -0.060 0.952 Global 47.51 35.16 47.60 34.35 -0.080 0.936 PedsQL™ FIM Physical Functionality 6.90 4.31 11.31 4.15 -3.424 0.001** Emotional Functionality 5.27 4.60 9.31 3.86 -3.114 0.002** Social Functionality 4.10 3.23 5.81 3.43 -1.629 0.103 Cognitive Functionality 4.36 4.25 5.73 3.57 -1.527 0.127 Communication 2.71 1.87 3.51 2.03 -0.833 0.405 Anxiety 5.61 4.37 8.23 4.03 -2.325 0.020* Daily Activities 4.80 2.68 6.15 1.97 -2.204 0.028* SDSC Initiating and Maintaining Sleep 7.37 5.58 6.92 3.47 -0.241 0.809 Sleep Apnea 1.94 2.07 2.81 2.33 -1.311 0.190 Disorders of Arousal 1.14 1.98 1.18 1.88 -0.198 0.843 Sleep-Wake Transition Disorders 3.78 3.62 4.04 4.49 -0.245 0.807 Excessive Somnolence 3.20 3.14 3.90 2.30 -1.395 0.163 Sleep Hyperhydrosis 1.06 1.77 1.62 1.44 -1.665 0.096 *. p < 0.05. **p < 0.01. Mann-Whitney U BRIEF: The Behavior Rating Inventory of Executive Function PedsQL-FIM: Pediatric Quality of Life Inventory: Family Impact Module SDSC: the Sleep Disturbance Scale for Children Within the PedsQL™ FIM, parents of children with eye trauma reported significantly lower scores in physical functioning (p = 0.001) and emotional functioning (p = 0.002) compared to controls (Table 2 ). On the SDSC, no significant group differences were found across subscales, including sleep apnea and disorders of arousal (p > 0.05). For example, the mean score for sleep apnea was 1.94 (SD = 2.07) in the eye trauma group versus 2.81 (SD = 2.33) in controls (p = 0.190). Table 3 shows correlations between PedsQL subscales and other measures in the eye trauma group. Emotional functionality was significantly correlated with emotional control (r = 0.613, p < 0.05), and cognitive functionality with cognitive control (r = 0.710, p < 0.05). Social functionality was correlated with emotional control (r = 0.624, p < 0.05), and sleep regulation disorders with cognitive functionality (r = 0.637, p < 0.05). Sleep apnea was also correlated with cognitive functionality (r = 0.552, p < 0.05). Table 3 Correlation Analysis of PedsQL™ Family Impact Module subscale and other scales of Children with Eye Trauma Inhibit Physical Functionality Emotional Functionality Social Functionality Cognitive Functionality Communication Anxiety Daily Activities 0.072 0.400 0.425 0.412 0.225 0.239 0.156 Shift 0.421 * 0.562 ** 0.523 * 0.604 ** 0.392 0.412 0.105 Emotional control 0.394 0.613 ** 0.624 ** 0.710 ** 0.514 * 0.480 * 0.203 Initiate 0.012 0.073 0.051 0.181 0.267 -0.028 -0.269 Working memory 0.313 0.507 * 0.434 0.526 ** 0.492 * 0.507 * 0.140 Plan/Organize 0.309 0.485 * 0.310 0.468 * 0.424 * 0.363 -0.013 Organization of materials 0.378 0.602 ** 0.518 * 0.609 ** 0.569 ** 0.538 ** 0.309 Monitor 0.439 * 0.548 ** 0.592 ** 0.617 ** 0.538 ** 0.542 ** 0.172 Behavior control 0.311 0.577 ** 0.581 ** 0.635 ** 0.419 * 0.415 * 0.180 Metacognition 0.332 0.507 * 0.435 0.541 ** 0.511 * 0.438 * 0.073 Global 0.335 0.552 ** 0.512 * 0.597 ** 0.493 * 0.444 * 0.118 Initiating and Maintaining Sleep 0.156 0.409 0.536 * 0.522 * 0.203 0.042 0.126 Sleep Apnea 0.347 0.465 * 0.405 0.552 ** 0.335 0.155 0.049 Disorders of Arousal 0.193 0.397 0.338 0.646 ** 0.302 0.028 -0.133 Sleep-Wake Transition Disorders 0.238 0.582 ** 0.443 0.637 ** 0.350 0.161 0.105 Excessive Somnolence 0.263 0.398 0.438 0.621 ** 0.336 0.034 -0.080 Sleep Hyperhydrosis 0.104 0.216 0.520 * 0.348 0.057 0.035 0.218 *. p < 0.05., ** <0.01. PedsQL-FIM: Pediatric Quality of Life Inventory: Family Impact Module Regression analysis results are presented in Table 4 . Monitoring (β = 1.001, p = 0.002) significantly predicted parental physical functioning, while Inhibition (β = -0.715, p = 0.020) was negatively associated with it. Emotional regulation difficulties in children (Emotion subscale) significantly predicted parental scores in emotional (β = 0.613, p = 0.002), social (β = 0.624, p = 0.002), and cognitive functioning domains (β = 0.532, p = 0.002). Nighttime awakenings (β = 0.422, p = 0.009) significantly predicted reduced parental communication. Predictors of parental anxiety included difficulties in organizing materials (β = 0.569, p = 0.005), increased monitoring needs (β = 0.801, p = 0.001), and lower task initiation (β = -0.470, p = 0.029). Table 4 Regression analysis of Analysis of PedsQL™ Family Impact Module subscale and other scales of Children with Eye Trauma Physical Functionality B t p Monitor 1.001 3.538 0.002** İnhibition 0-.715 -2.527 0.020* Emotional Functionality Emotion 0.613 3.558 0.002** Social Functionality Emotion 0.624 3.389 0.003** Cognitive Functionality Emotion 0.532 3.642 0.002** Communication Nightawake 0.422 2.889 0.009** Anxiety Materyal 0.569 3.167 0.005** Monitor 0.801 4.018 0.001** İnitiate -0.470 -2.358 0.029* *. p < 0.05. **p < 0.01. PedsQL: Pediatric Quality of Life Inventory Associatons Between Ocular Variables and Psychosocial Outcomes Correlation analysis showed a significant negative relationship between baseline BCVA and the BRIEF subscales of Shift (r = − 0.415, p = 0.049) and Emotional Control (r = − 0.452, p = 0.030), whereas other executive function domains—including Inhibition (r = − 0.244, p = 0.262), Initiation (r = − 0.230, p = 0.291), Working Memory (r = − 0.309, p = 0.152), Planning (r = − 0.246, p = 0.257), and Monitoring (r = − 0.116, p = 0.597) were not significantly correlated with BCVA. No significant correlations were found between baseline BCVA and any of the sleep subscales or parental quality of life scores (p > 0.05). In linear regression analysis, baseline BCVA significantly predicted scores on the Emotional Control subscale of the BRIEF (p < 0.05), indicating that poorer visual acuity was associated with greater difficulties in emotional regulation. In pediatric patients who underwent surgical repair for OGIs, correlation analyses between final BCVA and neuropsychological variables revealed a statistically significant negative relationship with the Cognitive Functioning subscale of the PedsQL Family Impact Module (r = − 0.443, p = 0.034) and the Night Awakenings subscale of the Sleep Disturbance Scale for Children (r = − 0.415, p = 0.049). Although negative correlations were observed between final BCVA and several executive function domains assessed by the BRIEF—including Inhibition (r = − 0.006, p = 0.971), Shift (r = − 0.182, p = 0.407), Emotional Control (r = − 0.348, p = 0.103), and Working Memory (r = − 0.301, p = 0.162) none of these associations reached statistical significance. Similarly, no significant correlations were found between final BCVA and the remaining PedsQL subdomains or other sleep-related parameters (p > 0.05). When analyzing the relationship between injury zone and psychosocial measures, no statistically significant differences were found across the three anatomical zones (p = 0.791). This result is likely attributable to the small sample size and the predominance of Zone I injuries, which may have limited the ability to detect between-group differences. Pearson correlation analysis revealed a statistically significant positive association between the number of surgical interventions and the Inhibition subscale of the BRIEF (r = 0.436, p = 0.038), suggesting that children who underwent more surgical procedures exhibited greater difficulties in behavioral inhibition. However, no significant correlations were observed between the number of surgeries and other executive function domains or sleep disturbance subscales (all p > 0.05). Additionally, correlation analyses revealed no statistically significant associations between the number of surgical procedures and any of the subscales of the PedsQL Family Impact Module. Specifically, correlations with Physical Functioning (r = 0.072, p = 0.745), Emotional Functioning (r = 0.063, p = 0.776), Social Functioning (r = 0.163, p = 0.492), Cognitive Functioning (r = 0.007, p = 0.973), Communication (r = 0.198, p = 0.364), Worry (r = 0.114, p = 0.603), and Daily Activities (r = 0.099, p = 0.652) were all non-significant (p > 0.05). Discussion In accordance with preceding research, the present study corroborates the notion that OGIs predominantly affect male children, with the majority of cases occurring within domestic settings during unsupervised play involving sharp objects. Beyond these demographic and clinical patterns, this study is among the first to investigate how specific ophthalmic variables—such as baseline and final BCVA, injury zone, and number of surgeries—relate to neurocognitive and psychosocial outcomes, including executive functioning, sleep disturbances, and parental quality of life. It is noteworthy that poorer baseline BCVA was significantly associated with increased emotional dysregulation and difficulties in cognitive flexibility. Furthermore, worse final BCVA predicted elevated nighttime awakenings and greater cognitive strain reported by caregivers. Furthermore, the number of surgical interventions was found to be positively correlated with behavioural disinhibition in children, which may be indicative of cumulative psychological stress arising from repeated procedures. The present findings underscore the long-term ramifications of paediatric OGIs, demonstrating that the consequences extend beyond ocular morbidity to encompass the emotional, behavioural and familial domains. This underscores the urgent need for integrated, family-centred care that addresses both visual rehabilitation and psychosocial well-being in the recovery process. The mean age of trauma in our cohort was 8.4 years, which is in line with similar studies from Turkey, Iran and Tunisia, which also reported a mean age of 7–8 years [ 22 – 24 ]. This confirms that early school age is a high-risk period for ocular trauma and highlights the need for targeted prevention efforts. Kabakcı et al in a Turkish tertiary centre found that 80.5% of cases were in boys and that 75.6% of injuries involved zone I of the eye, with sharp objects such as knives being the most common cause [ 22 ]. Similarly, Azimi et al in southern Iran reported that 75.9% of their cohort were male and 79.6% had corneal lacerations due to penetrating trauma, often during home play [ 23 ]. Similar patterns were observed globally, with most injuries occurring at home in young boys, as reported in both the U.S. and Thailand. [ 25 , 26 ]. Malek et al, reporting on Tunisian data, found similar results, with 80% of injuries occurring at home and penetrating trauma being the predominant mechanism [ 24 ]. Aldahash et al. from Saudi Arabia also reported a strong male predominance and corneal involvement in the majority of pediatric OGIs [ 27 ]. In all of these studies, the anterior segment - particularly the cornea - was the most commonly affected site, which mirrors the distribution in our cohort. This anterior location often allows for better surgical access and visual rehabilitation. Assessing visual acuity at presentation remains one of the most challenging aspects in evaluating pediatric OGIs, largely due to limited cooperation; however, as highlighted in previous studies, it retains prognostic relevance and should be attempted to the extent permitted by the child's compliance [ 28 , 29 ]. In our study, we documented a statistically significant improvement in best-corrected visual acuity (from 1.66 to 1.15 LogMAR), which is consistent with the visual improvements reported by Kabakcı et al (from 1.87 to 0.96 LogMAR) [ 22 ]. Initial BCVA was significantly associated with executive dysfunction, particularly in emotional control and cognitive flexibility. These findings are consistent with research demonstrating that visual impairment in children can disrupt self-regulatory capacities due to limited environmental feedback and increased stress responses. Tadić et al. found that children with congenital visual impairment exhibited reduced attentional control and executive processing, especially in planning and shifting tasks [ 16 ]. Similarly, Pinquart and Pfeiffer identified elevated emotional and behavioral problems in visually impaired youth, which may be compounded by acute trauma and postoperative recovery in our study population [ 30 ]. Regression analysis confirmed that baseline BCVA significantly predicted emotional dysregulation, reinforcing the notion that vision loss can exacerbate difficulties in modulating affective responses. These patterns may emerge from increased dependency, reduced autonomy, and heightened vulnerability experienced by children with compromised vision—particularly in stressful settings such as clinical care or school reintegration. Poorer final BCVA was linked to more night-time awakenings in children and higher cognitive burden in parents. These results align with a recent scoping review which synthesized literature across 83 studies and highlighted a high prevalence of sleep problems—including insomnia, night awakenings, and circadian rhythm disturbances—among individuals with visual impairment [ 15 ]. Although other executive function domains and parental quality of life dimensions did not show statistically significant correlations with final BCVA, trend-level associations suggest a broader impact of visual outcomes on psychosocial functioning that may become clearer with larger samples or longitudinal follow-up. No significant differences were observed between injury zones and psychosocial outcomes. This may be due to sample size limitations and the predominance of Zone I injuries. Still, it is likely that functional parameters such as visual acuity, rather than anatomical location alone, better capture the real-world impact of OGI. A notable finding was the positive correlation between the number of surgical interventions and behavioral disinhibition. Children undergoing multiple procedures may face cumulative psychological stress, anticipatory anxiety, and difficulty reestablishing behavioral control—a phenomenon supported by findings from pediatric intensive care contexts [ 17 ]. However, surgical frequency was not associated with parental distress or sleep dysfunction, possibly indicating some degree of caregiver adaptation or buffering mechanisms. Regression analysis results suggest that, although behavioral control problems in children jeopardize parents' well-being, increased parental supervision may be a preventative measure. They also suggest that perceived emotional dysregulation in children can cause emotional and mental stress on caregivers, affecting various aspects of their daily lives. Families experiencing greater executive dysfunction in their children may be more anxious, likely due to increased monitoring responsibility, concerns about the child's independence, and sensitivity to environmental stressors. To our knowledge, this is the first study to comprehensively evaluate the interplay between ophthalmologic variables and psychosocial outcomes—including sleep disturbances, executive functioning, and parental quality of life—in pediatric patients following surgical repair of OGIs. By integrating validated instruments such as the BRIEF, PedsQL™ Family Impact Module, and SDSC within a controlled study design, the current research provides novel insights into the multidimensional impact of OGIs that extend beyond anatomical recovery. The comparison with a healthy control group further strengthens the interpretive value of the findings, allowing for a more nuanced understanding of post-traumatic pediatric functioning and caregiver burden. However, several limitations must be acknowledged. The relatively small sample size and single-center design may restrict the generalizability of the results. In addition, the subjective nature of parent-reported outcomes, particularly in the context of young or emotionally distressed children, could introduce response bias. Finally, the cross-sectional design and limited follow-up duration preclude evaluation of long-term psychosocial adaptation or delayed-onset symptoms. Despite these limitations, the findings underscore the value of early psychosocial screening and family-centered intervention in pediatric ophthalmic trauma care. Conclusion Pediatric OGIs are more common in boys and typically occur at home. Despite the implementation of timely and appropriate surgical intervention, the long-term visual outcomes of patients may be permanently affected. Since executive and sleep functions did not differ between groups, OGI risk may not be limited to specific neurocognitive profiles, underscoring the need for universal preventive measures. Poorer BCVA was associated with emotional and cognitive challenges in both children and caregivers. Additionally, a higher number of surgeries correlated with greater behavioral inhibition issues. These findings underscore the importance of holistic, family-centered care in pediatric eye trauma. The observation of a significant deterioration in the quality of life of parents of children who have experienced OGI emphasizes the need for psychiatric support for these families. Declarations Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript . Competing Interests The authors have no financial or non-financial relationships to disclose. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Marmara University . Consent to participate Written informed consent was obtained from the parents. C onsent for Publication Not applicable. Author Contributions All authors contributed to the conception and design of the study. Material preparation, data collection, and analysis were performed by Esra Biberoğlu Çelik and Ümmügülsüm Gündoğdu. Data collection was also carried out by Ayşe Tuğçe Kılıçarslan Varlı. Review and revision of the manuscript were performed by Esra Biberoğlu Çelik, Didem Dizdar Yiğit, Mehmet Orkun Sevik, Ümmügülsüm Gündoğdu, and Özlem Şahin. The first draft of the manuscript was written by Esra Biberoğlu Çelik, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Data Availability The datasets generated and/or analyzed during the current study are not publicly available due to patient privacy and ethical restrictions but are available from the corresponding author on reasonable request References Copeland WE, Keeler G, Angold A, Costello EJ. Traumatic events and posttraumatic stress in childhood. Arch Gen Psychiatry. 2007;64:577–84. 10.1001/archpsyc.64.5.577 . Cao H, Li L, Zhang M, Li H. Epidemiology of pediatric ocular trauma in the Chaoshan Region, China, 2001–2010. PLoS ONE. 2013;8:e60844. 10.1371/journal.pone.0060844 . Madan AH, Joshi RS, Wadekar PD. Ocular Trauma in Pediatric Age Group at a Tertiary Eye Care Center in Central Maharashtra, India. Clin Ophthalmol. 2020;14:1003–9. 10.2147/OPTH.S244679 . Puodziuviene E, Jokubauskiene G, Vieversyte M, Asselineau K. A five-year retrospective study of the epidemiological characteristics and visual outcomes of pediatric ocular trauma. BMC Ophthalmol. 2018;18:10. 10.1186/s12886-018-0676-7 . 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J Turk Sleep Med. 2020;7:65–72. 10.4274/jtsm.galenos.2020.98598 . Gürkan KP, Bahar Z, Çapık C, Aydoğdu NG, Beşer A. Psychometric properties of the Turkish version of the pediatric quality of life: The family impact module in parents of children with type 1 diabetes. Children’s Health Care. 2019;49:87–99. 10.1080/02739615.2019.1570464 . Batan SN. Öget Öktem-Tanör, and Erkan Kalem. Reliability and validity studies of Behavioral Rating Inventory Of Executive Function (BRIEF) in a Turkish normative sample. Elementary Educ Online. 2011;10. Sveen J, Sjoberg F, Oster C. Health-related quality of life in Swedish pediatric burn patients and associations with burn and family characteristics. Burns. 2014;40:987–94. 10.1016/j.burns.2013.10.005 . Cousino MK, Hazen RA. Parenting stress among caregivers of children with chronic illness: a systematic review. J Pediatr Psychol. 2013;38:809–28. 10.1093/jpepsy/jst049 . Lupon M, Armayones M, Cardona G. Quality of life of caregivers of children with visual impairment: A qualitative approach. Res Dev Disabil. 2023;138:104538. 10.1016/j.ridd.2023.104538 . Choi S, Kim G, Pionke JJ. The Sleep Health of Individuals with Visual Impairments: A Scoping Review. Ophthalmic Epidemiol. 2025;32:259–77. 10.1080/09286586.2024.2361167 . Tadic V, Pring L, Dale N. Are language and social communication intact in children with congenital visual impairment at school age? J Child Psychol Psychiatry. 2010;51:696–705. 10.1111/j.1469-7610.2009.02200.x . Rennick JE, Dougherty G, Chambers C, Stremler R, Childerhose JE, Stack DM, et al. Children's psychological and behavioral responses following pediatric intensive care unit hospitalization: the caring intensively study. BMC Pediatr. 2014;14:276. 10.1186/1471-2431-14-276 . Kuhn F, Morris R, Witherspoon CD, Mester V. The Birmingham Eye Trauma Terminology system (BETT). J Fr Ophtalmol. 2004;27:206–10. 10.1016/s0181-5512(04)96122-0 . Gioia GA, Isquith PK, Guy SC, Kenworthy L. Behavior Rating Inventory of Executive Function. BRIEF: Psychological Assessment Resources, Lutz.; 2000. Bruni O, Ottaviano S, Guidetti V, Romoli M, Innocenzi M, Cortesi F, et al. The Sleep Disturbance Scale for Children (SDSC). Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. J Sleep Res. 1996;5:251–61. 10.1111/j.1365-2869.1996.00251.x . Varni JW, Sherman SA, Burwinkle TM, Dickinson PE, Dixon P. The PedsQL Family Impact Module: preliminary reliability and validity. Health Qual Life Outcomes. 2004;2:55. 10.1186/1477-7525-2-55 . Kabakci A, Atik B, Livan E, Ocak S, Elçioğlu M. Pediatric Open-Globe Injuries: Clinical Characteristics and Outcomes of Repair in a Tertiary Center in Istanbul, Turkey. Beyoglu eye J. 2024;9 4:213–9. 10.14744/bej.2024.19577 . Azimi A, Abdollahi F, Sadeghi E, Reza Farsiani A, Moshksar S, Nadi M. Epidemiological and Clinical Features of Pediatric Open Globe Injuries: A Report from Southern Iran. J Ophthalmic Vis Res. 2023;18:88–96. 10.18502/jovr.v18i1.12729 . Malek I, Sayadi J, Zerei N, Mekni M, El Amri K, Zgolli H, et al. Epidemiology and prognostic factors of open globe injuries in a Tunisian pediatric population. J Fr Ophtalmol. 2020;43:604–10. 10.1016/j.jfo.2019.10.024 . Uppuluri S, Uppuluri A, Zarbin MA, Bhagat N. Epidemiology of Pediatric Open Globe Injury in the United States. J Pediatr Ophthalmol Strabismus. 2021;58:232–9. 10.3928/01913913-20210224-01 . Saksiriwutto P, Charuchinda P, Atchaneeyasakul LO, Surachatkumtonekul T, Phamonvaechavan P. Epidemiology of Pediatric Open Globe Injuries in a University Hospital in Thailand. Cureus. 2021;13:e19366. 10.7759/cureus.19366 . AlDahash F, Mousa A, Gikandi PW, Abu El-Asrar AM. Pediatric open-globe injury in a university-based tertiary hospital. Eur J Ophthalmol. 2020;30:269–74. 10.1177/1120672118818013 . Irawati Y, Ardiani LS, Gondhowiardjo TD, Hoskin AK. Predictive value and applicability of ocular trauma scores and pediatric ocular trauma scores in pediatric globe injuries. Int J Ophthalmol. 2022;15:1352–6. 10.18240/ijo.2022.08.19 . Gupta A, Rahman I, Leatherbarrow B. Open globe injuries in children: factors predictive of a poor final visual acuity. Eye (Lond). 2009;23:621–5. 10.1038/eye.2008.32 . Pinquart M, Pfeiffer JP. Associations of Extroversion and Parental Overprotection with Forming Relationships with Peers among Adolescents with and without Visual Impairments. J Visual Impairment Blindness. 2011;105(2):96–107. https://doi.org/10.1177/0145482X1110500207 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 13 May, 2026 Reviewers agreed at journal 04 May, 2026 Reviewers agreed at journal 05 Apr, 2026 Reviewers invited by journal 31 Mar, 2026 Editor assigned by journal 31 Mar, 2026 Editor invited by journal 30 Mar, 2026 Submission checks completed at journal 30 Mar, 2026 First submitted to journal 30 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9188151","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":617062766,"identity":"fee88b41-7ce7-4ebd-a8fe-0ce0c9a995f4","order_by":0,"name":"Esra Biberoğlu Çelik","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYDCCAxCqXp69B8zg4SNWS4Jhzxkwh4eNaC0MN3IgHIJa+G4fPvy5ooYhj3Hm24OPP+bYybAxMD98dAOPFslzaWmSZ44xFLNL5yUbHNyWDHQYm7FxDh4tBmd4zBgb2BgYG2fnmEkc3MYM1MLDJo1fC//njw3/GBgbbp4BaaknRgsPg2RjG0Niww0ekJbDhLVInmEzk2zskzA27MkxNji77TgPGzMBv/CdYX78seGbjZw8+xnDB5Xbqu352ZsfPsanBQokkNjMhJWPglEwCkbBKCAAAFgmRb5WbpjkAAAAAElFTkSuQmCC","orcid":"","institution":"Medeniyet University Faculty of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Esra","middleName":"Biberoğlu","lastName":"Çelik","suffix":""},{"id":617062767,"identity":"8968c4ae-9578-45ff-bd71-112ca2dd25b9","order_by":1,"name":"Didem Dizdar Yiğit","email":"","orcid":"","institution":"Marmara University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Didem","middleName":"Dizdar","lastName":"Yiğit","suffix":""},{"id":617062768,"identity":"5ac145c2-1da9-43be-9445-354a63354ed3","order_by":2,"name":"Ayşe Tuğçe Kılıçarslan Varlı","email":"","orcid":"","institution":"Marmara University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ayşe","middleName":"Tuğçe Kılıçarslan","lastName":"Varlı","suffix":""},{"id":617062769,"identity":"56e39df0-996c-4ca7-886d-4ef3df53fd6d","order_by":3,"name":"Mehmet Orkun Sevik","email":"","orcid":"","institution":"Marmara University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"Orkun","lastName":"Sevik","suffix":""},{"id":617062770,"identity":"99edcfe4-d83d-424e-82c4-e44f5eed58d6","order_by":4,"name":"Ümmügülsüm Gündoğdu","email":"","orcid":"","institution":"Marmara University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ümmügülsüm","middleName":"","lastName":"Gündoğdu","suffix":""},{"id":617062771,"identity":"3d471c80-a701-485d-8ec4-6c99ae37c7aa","order_by":5,"name":"Özlem Şahin","email":"","orcid":"","institution":"Marmara University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Özlem","middleName":"","lastName":"Şahin","suffix":""}],"badges":[],"createdAt":"2026-03-21 22:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9188151/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9188151/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106415207,"identity":"45642299-5380-40ab-8de8-b91bb3c12b58","added_by":"auto","created_at":"2026-04-08 10:33:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1203454,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9188151/v1/41379bd8-1e1d-45cd-82ae-8d0fd61f1f01.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Ocular and Psychosocial Outcomes After Pediatric Open Globe Injury Repair","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA significant proportion of youth globally\u0026mdash;estimated at nearly 66%\u0026mdash;experience traumatic incidents prior to the age of sixteen, often involving violence, accidents, or disasters [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Pediatric OGI have been identified as a significant cause of vision loss and acquired blindness in children [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOGI require urgent surgical intervention and prolonged postoperative care, and this extraordinary situation can be a significant source of stress for both pediatric patients and their caregivers. An increasing number of studies suggest that children with deficits in executive functions such as attention, impulse control and behaviour regulation may be more prone to unintentional injuries due to increased risk-taking and impaired environmental awareness [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Similarly, sleep disorders have been linked to emotional dysregulation and slower reaction times, which could hinder a child's ability to respond to dangerous situations [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These behavioural and neurocognitive sensitivities may place children with such profiles at a higher risk of eye injury. Against this backdrop, the current study aims to investigate whether underlying behavioural regulation difficulties contribute to increased injury susceptibility in pediatric patients. Following such injuries, children often resist clinical examinations due to fear, and even the administration of topical eye drops becomes problematic. Occlusion of the eyes with bandages, reduced visual acuity, postoperative discomfort such as stinging or burning, and even exposure to examination tools or light can cause distress in these patients. In many cases, parents resort to administering drops while the child is asleep, which may contribute to poor sleep quality. School-aged children are frequently unable to attend school for extended periods, falling behind their peers academically and socially. Despite advances in surgical techniques and follow-up protocols, these challenges may result in sleep disturbances and impairments in executive functioning within this vulnerable population. In addition to children, parents are also affected, facing the psychological burden of potentially losing their child\u0026rsquo;s vision, which further diminishes their quality of life.\u003c/p\u003e \u003cp\u003eTo capture these multidimensional effects, the study design includes validated assessment tools. The Family Impact Module (PedsQL-FIM) was used to assess the impact of the child's condition on parents' quality of life and family functioning, the Sleep Disorders in Children Scale (SDSC) was used to identify and measure sleep-related issues, and the Behavioral Rating Inventory of Executive Functions (BRIEF) was used to evaluate the cognitive and behavioral aspects of executive functions in daily life [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, there is no research examining the reciprocal relationship between sleep disorders, executive functions, and parents' quality of life in children who have undergone pediatric OGI repair [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. While prior studies have addressed individual psychosocial domains in visually impaired or chronically ill children, there is currently no research exploring how specific ocular variables\u0026mdash;such as visual acuity, injury zone, and surgical burden\u0026mdash;relate to sleep disturbances, executive function profiles, and parental quality of life in pediatric patients with OGI [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This study is the first in the ophthalmology literature to examine these complex, interrelated outcomes in a single, integrated model.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis retrospective observational study included pediatric patients (under 18 years of age) who underwent surgical repair for OGI at the tertiary clinic between January 2017 and December 2024. The inclusion criteria that were employed in this study were as follows: a confirmed diagnosis of OGI, primary surgical intervention performed within 48 hours of the trauma, and a minimum of six months of postoperative follow-up. Patients with congenital ocular abnormalities, systemic neurodevelopmental disorders, or incomplete medical records were excluded from the study. The patients were evaluated in terms of the following criteria: age and gender, trauma type and location of injury, initial and final best corrected visual acuity (BCVA), surgical procedures performed, complications, and need for additional surgery. The OGI was categorized according to BETTS [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. At the final follow-up visit after trauma, three surveys were administered to the participants' parents in a secure electronic environment during an eye examination. The surveys included the Pediatric Quality of Life Questionnaire: PedsQL\u0026trade;-Fim, SDSC, and BRIEF. All questionnaires were fully completed, and no missing data were observed.\u003c/p\u003e \u003cp\u003eThe BRIEF is administered by parents or teachers and is designed for children between the ages of 5 and 18 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. It assesses several domains of executive functioning, including inhibition, shifting, emotional control, working memory, planning and organising, organising materials, and monitoring. The instrument is particularly useful in identifying functional impairments in children with neurological, developmental or behavioural conditions [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The validity and reliability of the scale in Turkey were established by Batan and colleagues [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSDSC is a scale used to assess sleep disturbance in children. This scale is designed to gather information about potential sleep problems in children and adolescents [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The scale consists of 26 items and allows a parent or caregiver to rate the child's sleep habits over the past 6 months. Each item is rated on a five-point Likert scale. The validity and reliability of the scale in Turkey were established by Ağadayı and colleague [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePedsQL \u0026ndash; FIM is a standardised instrument designed to assess the effect of a child's chronic health condition on the quality of life of their family members [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The overarching PedsQL framework appraises the child's quality of life, whereas the Family Impact Module is specifically concerned with the impact of the child's condition on family functioning and caregiver well-being. A Turkish validation and reliability study of the scale was conducted by G\u0026uuml;rkan et al. in families of children with Type 1 diabetes mellitus [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe same questionnaires were administered to the families of healthy individuals of appropriate age and gender who attended routine eye examinations. Data obtained from the patient group and control group were evaluated.\u003c/p\u003e \u003cp\u003e The study was approved by the ethics committee(protocol-number:09.2025.25\u0026ndash;0799) and adhered to the principles of the Declaration of Helsinki.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were computed for the study, including frequencies and percentages for categorical variables and means, standard deviations, medians, and ranges for continuous variables. To compare the groups, non-parametric Mann-Whitney U tests were employed to evaluate differences between children with eye trauma and control participants across various psychological and functional scales. Spearman correlation analyses were conducted within the trauma group to examine the associations between PedsQL\u0026trade; Family Impact Module subscales and EF and sleep disturbance measures. Furthermore, linear regression analyses were performed to identify cognitive and behavioral predictors of family functioning outcomes. All statistical analyses were performed using SPSS version 27, with the significance level set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDemographic and Clinical Characteristics\u003c/h2\u003e \u003cp\u003eThe patient and control groups were comparable in terms of age (mean age: 8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3 years [range: 3\u0026ndash;16] vs. 9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1 years [range: 3\u0026ndash;17]; p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) and sex distribution (male: 73.9% [n\u0026thinsp;=\u0026thinsp;17] vs. 72.0% [n\u0026thinsp;=\u0026thinsp;18]; p\u0026thinsp;=\u0026thinsp;0.05). The mean follow-up duration in the patient group was 21 (range: 6\u0026ndash;80 months). The data indicates that 56.5%,8 (n\u0026thinsp;=\u0026thinsp;13) of accidents occurred at home, 26.0% (n\u0026thinsp;=\u0026thinsp;6) outside, and the remaining 17.39% at school. Furthermore, left eye involvement was observed in 56.5% (n\u0026thinsp;=\u0026thinsp;4) of patients.\u003c/p\u003e \u003cp\u003eThe demographic and clinical characteristics of the patients are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The patient cohort exhibited a 73.9% penetrating injuries (n\u0026thinsp;=\u0026thinsp;17), a 17.4% globe ruptures (n\u0026thinsp;=\u0026thinsp;4), and a 8.7% intraocular foreign bodies (IOFB) (n\u0026thinsp;=\u0026thinsp;2). The anatomical location of the injuries was zonally classified as follows: The distribution of the sample across zones is as follows: 69.6% (n\u0026thinsp;=\u0026thinsp;16) in zone I, 21.7% (n\u0026thinsp;=\u0026thinsp;5) in zone II, and 8.7% (n\u0026thinsp;=\u0026thinsp;2) in zone III.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe demographic and clinical characteristics of the Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMedian (Range)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e7 (3\u0026ndash;16)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up period (month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e21 (6\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInitial BCVA (LogMAR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1.8 (0\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinal BCVA (LogMAR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e0.4 (0\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of operations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1.0 (1\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eType of injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePenetran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRupture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIOYC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%73.9(17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%17.4(4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%8.7(2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSite of injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eZone 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eZone 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eZone 3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%69.6(16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%21.7(5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%8.7(2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe median number of surgical interventions per patient was 1 (range: 1\u0026ndash;5). During the initial surgery, lens extraction was performed in 6 eyes (30.4%). Three patients underwent pars plana vitrectomy, two underwent pupilloplasty and two underwent scleral fixation secondary lens implantation. Four patients underwent secondary lens implantation to sulcus and one patient underwent evisceration due to phthisis.\u003c/p\u003e \u003cp\u003eThe median initial BCVA was 1.8 LogMAR, which improved to 0.4 LogMAR at final follow-up (p\u0026thinsp;=\u0026thinsp;0.006), indicating a statistically significant improvement in visual function.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePsychosocial and Cognitive Outcomes\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents a comparison of scale performances between the eye trauma and control groups. No statistically significant differences were observed in the BRIEF total scores or subscales, including Behavioral Regulation and Metacognition (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvaluation of Scales between Children with Eye Trauma and Control Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTrauma\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eZ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eBRIEF\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInhibit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eShift\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.643\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmotional control\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.857\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInitiate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.493\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorking memory\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.740\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlan/Organize\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrganization of materials\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.809\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonitor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.595\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBehavior control\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMetacognition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.952\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGlobal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.936\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePedsQL\u0026trade; FIM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical Functionality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmotional Functionality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial Functionality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.629\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCognitive Functionality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnxiety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.020*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDaily Activities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.028*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSDSC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInitiating and Maintaining Sleep\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.241\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.809\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSleep Apnea\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDisorders of Arousal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.843\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSleep-Wake Transition Disorders\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.807\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExcessive Somnolence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSleep Hyperhydrosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.665\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e*. p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e \u003cp\u003eMann-Whitney U\u003c/p\u003e \u003cp\u003eBRIEF: The Behavior Rating Inventory of Executive Function\u003c/p\u003e \u003cp\u003ePedsQL-FIM: Pediatric Quality of Life Inventory: Family Impact Module\u003c/p\u003e \u003cp\u003eSDSC: the Sleep Disturbance Scale for Children\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWithin the PedsQL\u0026trade; FIM, parents of children with eye trauma reported significantly lower scores in physical functioning (p\u0026thinsp;=\u0026thinsp;0.001) and emotional functioning (p\u0026thinsp;=\u0026thinsp;0.002) compared to controls (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOn the SDSC, no significant group differences were found across subscales, including sleep apnea and disorders of arousal (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). For example, the mean score for sleep apnea was 1.94 (SD\u0026thinsp;=\u0026thinsp;2.07) in the eye trauma group versus 2.81 (SD\u0026thinsp;=\u0026thinsp;2.33) in controls (p\u0026thinsp;=\u0026thinsp;0.190).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows correlations between PedsQL subscales and other measures in the eye trauma group. Emotional functionality was significantly correlated with emotional control (r\u0026thinsp;=\u0026thinsp;0.613, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and cognitive functionality with cognitive control (r\u0026thinsp;=\u0026thinsp;0.710, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Social functionality was correlated with emotional control (r\u0026thinsp;=\u0026thinsp;0.624, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and sleep regulation disorders with cognitive functionality (r\u0026thinsp;=\u0026thinsp;0.637, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Sleep apnea was also correlated with cognitive functionality (r\u0026thinsp;=\u0026thinsp;0.552, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation Analysis of PedsQL\u0026trade; Family Impact Module subscale and other scales of Children with Eye Trauma\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eInhibit\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical Functionality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEmotional Functionality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSocial Functionality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCognitive Functionality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDaily Activities\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.400\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.425\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.412\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.239\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eShift\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.421\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.562\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.523\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.604\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.392\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmotional control\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.394\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.613\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.624\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.710\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.514\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.480\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.203\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInitiate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.269\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorking memory\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.507\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.526\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.492\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.507\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlan/Organize\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.485\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.468\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.424\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrganization of materials\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.378\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.602\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.518\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.609\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.569\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.538\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.309\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonitor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.439\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.548\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.592\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.617\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.538\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.542\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBehavior control\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.577\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.581\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.635\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.419\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.415\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.180\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMetacognition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.507\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.541\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.511\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.438\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGlobal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.552\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.512\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.597\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.493\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.444\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInitiating and Maintaining Sleep\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.536\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.522\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSleep Apnea\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.465\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.552\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDisorders of Arousal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.646\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSleep-Wake Transition Disorders\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.582\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.637\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExcessive Somnolence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.621\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.080\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSleep Hyperhydrosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.520\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.218\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e*. p\u0026thinsp;\u0026lt;\u0026thinsp;0.05., ** \u0026lt;0.01.\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePedsQL-FIM: Pediatric Quality of Life Inventory: Family Impact Module\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegression analysis results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Monitoring (β\u0026thinsp;=\u0026thinsp;1.001, p\u0026thinsp;=\u0026thinsp;0.002) significantly predicted parental physical functioning, while Inhibition (β = -0.715, p\u0026thinsp;=\u0026thinsp;0.020) was negatively associated with it. Emotional regulation difficulties in children (Emotion subscale) significantly predicted parental scores in emotional (β\u0026thinsp;=\u0026thinsp;0.613, p\u0026thinsp;=\u0026thinsp;0.002), social (β\u0026thinsp;=\u0026thinsp;0.624, p\u0026thinsp;=\u0026thinsp;0.002), and cognitive functioning domains (β\u0026thinsp;=\u0026thinsp;0.532, p\u0026thinsp;=\u0026thinsp;0.002). Nighttime awakenings (β\u0026thinsp;=\u0026thinsp;0.422, p\u0026thinsp;=\u0026thinsp;0.009) significantly predicted reduced parental communication. Predictors of parental anxiety included difficulties in organizing materials (β\u0026thinsp;=\u0026thinsp;0.569, p\u0026thinsp;=\u0026thinsp;0.005), increased monitoring needs (β\u0026thinsp;=\u0026thinsp;0.801, p\u0026thinsp;=\u0026thinsp;0.001), and lower task initiation (β = -0.470, p\u0026thinsp;=\u0026thinsp;0.029).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRegression analysis of Analysis of PedsQL\u0026trade; Family Impact Module subscale and other scales of Children with Eye Trauma\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePhysical Functionality\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMonitor\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.001\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.538\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002**\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eİnhibition\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0-.715\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.527\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.020*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmotional Functionality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEmotion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial Functionality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEmotion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCognitive Functionality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEmotion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.532\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.642\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNightawake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.889\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.009**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAnxiety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMateryal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.569\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.005**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMonitor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.801\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eİnitiate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.470\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.029*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e*. p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e \u003cp\u003ePedsQL: Pediatric Quality of Life Inventory\u003c/p\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eAssociatons Between Ocular Variables and Psychosocial Outcomes\u003c/h3\u003e\n\u003cp\u003eCorrelation analysis showed a significant negative relationship between baseline BCVA and the BRIEF subscales of Shift (r = \u0026minus;\u0026thinsp;0.415, p\u0026thinsp;=\u0026thinsp;0.049) and Emotional Control (r = \u0026minus;\u0026thinsp;0.452, p\u0026thinsp;=\u0026thinsp;0.030), whereas other executive function domains\u0026mdash;including Inhibition (r = \u0026minus;\u0026thinsp;0.244, p\u0026thinsp;=\u0026thinsp;0.262), Initiation (r = \u0026minus;\u0026thinsp;0.230, p\u0026thinsp;=\u0026thinsp;0.291), Working Memory (r = \u0026minus;\u0026thinsp;0.309, p\u0026thinsp;=\u0026thinsp;0.152), Planning (r = \u0026minus;\u0026thinsp;0.246, p\u0026thinsp;=\u0026thinsp;0.257), and Monitoring (r = \u0026minus;\u0026thinsp;0.116, p\u0026thinsp;=\u0026thinsp;0.597) were not significantly correlated with BCVA. No significant correlations were found between baseline BCVA and any of the sleep subscales or parental quality of life scores (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eIn linear regression analysis, baseline BCVA significantly predicted scores on the Emotional Control subscale of the BRIEF (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating that poorer visual acuity was associated with greater difficulties in emotional regulation.\u003c/p\u003e \u003cp\u003eIn pediatric patients who underwent surgical repair for OGIs, correlation analyses between final BCVA and neuropsychological variables revealed a statistically significant negative relationship with the Cognitive Functioning subscale of the PedsQL Family Impact Module (r = \u0026minus;\u0026thinsp;0.443, p\u0026thinsp;=\u0026thinsp;0.034) and the Night Awakenings subscale of the Sleep Disturbance Scale for Children (r = \u0026minus;\u0026thinsp;0.415, p\u0026thinsp;=\u0026thinsp;0.049).\u003c/p\u003e \u003cp\u003eAlthough negative correlations were observed between final BCVA and several executive function domains assessed by the BRIEF\u0026mdash;including Inhibition (r = \u0026minus;\u0026thinsp;0.006, p\u0026thinsp;=\u0026thinsp;0.971), Shift (r = \u0026minus;\u0026thinsp;0.182, p\u0026thinsp;=\u0026thinsp;0.407), Emotional Control (r = \u0026minus;\u0026thinsp;0.348, p\u0026thinsp;=\u0026thinsp;0.103), and Working Memory (r = \u0026minus;\u0026thinsp;0.301, p\u0026thinsp;=\u0026thinsp;0.162) none of these associations reached statistical significance. Similarly, no significant correlations were found between final BCVA and the remaining PedsQL subdomains or other sleep-related parameters (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eWhen analyzing the relationship between injury zone and psychosocial measures, no statistically significant differences were found across the three anatomical zones (p\u0026thinsp;=\u0026thinsp;0.791). This result is likely attributable to the small sample size and the predominance of Zone I injuries, which may have limited the ability to detect between-group differences.\u003c/p\u003e \u003cp\u003ePearson correlation analysis revealed a statistically significant positive association between the number of surgical interventions and the Inhibition subscale of the BRIEF (r\u0026thinsp;=\u0026thinsp;0.436, p\u0026thinsp;=\u0026thinsp;0.038), suggesting that children who underwent more surgical procedures exhibited greater difficulties in behavioral inhibition. However, no significant correlations were observed between the number of surgeries and other executive function domains or sleep disturbance subscales (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eAdditionally, correlation analyses revealed no statistically significant associations between the number of surgical procedures and any of the subscales of the PedsQL Family Impact Module. Specifically, correlations with Physical Functioning (r\u0026thinsp;=\u0026thinsp;0.072, p\u0026thinsp;=\u0026thinsp;0.745), Emotional Functioning (r\u0026thinsp;=\u0026thinsp;0.063, p\u0026thinsp;=\u0026thinsp;0.776), Social Functioning (r\u0026thinsp;=\u0026thinsp;0.163, p\u0026thinsp;=\u0026thinsp;0.492), Cognitive Functioning (r\u0026thinsp;=\u0026thinsp;0.007, p\u0026thinsp;=\u0026thinsp;0.973), Communication (r\u0026thinsp;=\u0026thinsp;0.198, p\u0026thinsp;=\u0026thinsp;0.364), Worry (r\u0026thinsp;=\u0026thinsp;0.114, p\u0026thinsp;=\u0026thinsp;0.603), and Daily Activities (r\u0026thinsp;=\u0026thinsp;0.099, p\u0026thinsp;=\u0026thinsp;0.652) were all non-significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn accordance with preceding research, the present study corroborates the notion that OGIs predominantly affect male children, with the majority of cases occurring within domestic settings during unsupervised play involving sharp objects. Beyond these demographic and clinical patterns, this study is among the first to investigate how specific ophthalmic variables\u0026mdash;such as baseline and final BCVA, injury zone, and number of surgeries\u0026mdash;relate to neurocognitive and psychosocial outcomes, including executive functioning, sleep disturbances, and parental quality of life. It is noteworthy that poorer baseline BCVA was significantly associated with increased emotional dysregulation and difficulties in cognitive flexibility. Furthermore, worse final BCVA predicted elevated nighttime awakenings and greater cognitive strain reported by caregivers. Furthermore, the number of surgical interventions was found to be positively correlated with behavioural disinhibition in children, which may be indicative of cumulative psychological stress arising from repeated procedures. The present findings underscore the long-term ramifications of paediatric OGIs, demonstrating that the consequences extend beyond ocular morbidity to encompass the emotional, behavioural and familial domains. This underscores the urgent need for integrated, family-centred care that addresses both visual rehabilitation and psychosocial well-being in the recovery process.\u003c/p\u003e \u003cp\u003eThe mean age of trauma in our cohort was 8.4 years, which is in line with similar studies from Turkey, Iran and Tunisia, which also reported a mean age of 7\u0026ndash;8 years [\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This confirms that early school age is a high-risk period for ocular trauma and highlights the need for targeted prevention efforts. Kabakcı et al in a Turkish tertiary centre found that 80.5% of cases were in boys and that 75.6% of injuries involved zone I of the eye, with sharp objects such as knives being the most common cause [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Similarly, Azimi et al in southern Iran reported that 75.9% of their cohort were male and 79.6% had corneal lacerations due to penetrating trauma, often during home play [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Similar patterns were observed globally, with most injuries occurring at home in young boys, as reported in both the U.S. and Thailand. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Malek et al, reporting on Tunisian data, found similar results, with 80% of injuries occurring at home and penetrating trauma being the predominant mechanism [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Aldahash et al. from Saudi Arabia also reported a strong male predominance and corneal involvement in the majority of pediatric OGIs [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn all of these studies, the anterior segment - particularly the cornea - was the most commonly affected site, which mirrors the distribution in our cohort. This anterior location often allows for better surgical access and visual rehabilitation. Assessing visual acuity at presentation remains one of the most challenging aspects in evaluating pediatric OGIs, largely due to limited cooperation; however, as highlighted in previous studies, it retains prognostic relevance and should be attempted to the extent permitted by the child's compliance [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In our study, we documented a statistically significant improvement in best-corrected visual acuity (from 1.66 to 1.15 LogMAR), which is consistent with the visual improvements reported by Kabakcı et al (from 1.87 to 0.96 LogMAR) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInitial BCVA was significantly associated with executive dysfunction, particularly in emotional control and cognitive flexibility. These findings are consistent with research demonstrating that visual impairment in children can disrupt self-regulatory capacities due to limited environmental feedback and increased stress responses. Tadić et al. found that children with congenital visual impairment exhibited reduced attentional control and executive processing, especially in planning and shifting tasks [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Similarly, Pinquart and Pfeiffer identified elevated emotional and behavioral problems in visually impaired youth, which may be compounded by acute trauma and postoperative recovery in our study population [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegression analysis confirmed that baseline BCVA significantly predicted emotional dysregulation, reinforcing the notion that vision loss can exacerbate difficulties in modulating affective responses. These patterns may emerge from increased dependency, reduced autonomy, and heightened vulnerability experienced by children with compromised vision\u0026mdash;particularly in stressful settings such as clinical care or school reintegration.\u003c/p\u003e \u003cp\u003ePoorer final BCVA was linked to more night-time awakenings in children and higher cognitive burden in parents. These results align with a recent scoping review which synthesized literature across 83 studies and highlighted a high prevalence of sleep problems\u0026mdash;including insomnia, night awakenings, and circadian rhythm disturbances\u0026mdash;among individuals with visual impairment [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough other executive function domains and parental quality of life dimensions did not show statistically significant correlations with final BCVA, trend-level associations suggest a broader impact of visual outcomes on psychosocial functioning that may become clearer with larger samples or longitudinal follow-up.\u003c/p\u003e \u003cp\u003eNo significant differences were observed between injury zones and psychosocial outcomes. This may be due to sample size limitations and the predominance of Zone I injuries. Still, it is likely that functional parameters such as visual acuity, rather than anatomical location alone, better capture the real-world impact of OGI.\u003c/p\u003e \u003cp\u003eA notable finding was the positive correlation between the number of surgical interventions and behavioral disinhibition. Children undergoing multiple procedures may face cumulative psychological stress, anticipatory anxiety, and difficulty reestablishing behavioral control\u0026mdash;a phenomenon supported by findings from pediatric intensive care contexts [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, surgical frequency was not associated with parental distress or sleep dysfunction, possibly indicating some degree of caregiver adaptation or buffering mechanisms.\u003c/p\u003e \u003cp\u003eRegression analysis results suggest that, although behavioral control problems in children jeopardize parents' well-being, increased parental supervision may be a preventative measure. They also suggest that perceived emotional dysregulation in children can cause emotional and mental stress on caregivers, affecting various aspects of their daily lives. Families experiencing greater executive dysfunction in their children may be more anxious, likely due to increased monitoring responsibility, concerns about the child's independence, and sensitivity to environmental stressors.\u003c/p\u003e \u003cp\u003eTo our knowledge, this is the first study to comprehensively evaluate the interplay between ophthalmologic variables and psychosocial outcomes\u0026mdash;including sleep disturbances, executive functioning, and parental quality of life\u0026mdash;in pediatric patients following surgical repair of OGIs. By integrating validated instruments such as the BRIEF, PedsQL\u0026trade; Family Impact Module, and SDSC within a controlled study design, the current research provides novel insights into the multidimensional impact of OGIs that extend beyond anatomical recovery. The comparison with a healthy control group further strengthens the interpretive value of the findings, allowing for a more nuanced understanding of post-traumatic pediatric functioning and caregiver burden. However, several limitations must be acknowledged. The relatively small sample size and single-center design may restrict the generalizability of the results. In addition, the subjective nature of parent-reported outcomes, particularly in the context of young or emotionally distressed children, could introduce response bias. Finally, the cross-sectional design and limited follow-up duration preclude evaluation of long-term psychosocial adaptation or delayed-onset symptoms. Despite these limitations, the findings underscore the value of early psychosocial screening and family-centered intervention in pediatric ophthalmic trauma care.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePediatric OGIs are more common in boys and typically occur at home. Despite the implementation of timely and appropriate surgical intervention, the long-term visual outcomes of patients may be permanently affected. Since executive and sleep functions did not differ between groups, OGI risk may not be limited to specific neurocognitive profiles, underscoring the need for universal preventive measures. Poorer BCVA was associated with emotional and cognitive challenges in both children and caregivers. Additionally, a higher number of surgeries correlated with greater behavioral inhibition issues. These findings underscore the importance of holistic, family-centered care in pediatric eye trauma. The observation of a significant deterioration in the quality of life of parents of children who have experienced OGI emphasizes the need for psychiatric support for these families.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no financial or non-financial relationships to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Marmara University .\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the parents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003cstrong\u003eonsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the conception and design of the study. Material preparation, data collection, and analysis were performed by Esra Biberoğlu Çelik and Ümmügülsüm Gündoğdu. Data collection was also carried out by Ayşe Tuğçe Kılıçarslan Varlı. Review and revision of the manuscript were performed by Esra Biberoğlu Çelik, Didem Dizdar Yiğit, Mehmet Orkun Sevik, Ümmügülsüm Gündoğdu, and Özlem Şahin. The first draft of the manuscript was written by Esra Biberoğlu Çelik, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to patient privacy and ethical restrictions but are available from the corresponding author on reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCopeland WE, Keeler G, Angold A, Costello EJ. Traumatic events and posttraumatic stress in childhood. 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J Visual Impairment Blindness. 2011;105(2):96\u0026ndash;107. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0145482X1110500207\u003c/span\u003e\u003cspan address=\"10.1177/0145482X1110500207\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pediatric ocular trauma, open globe injury, executive functions, sleep disturbances, parents' quality of life, psychosocial outcomes","lastPublishedDoi":"10.21203/rs.3.rs-9188151/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9188151/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e To evaluate the clinical and demographic characteristics of children undergoing surgical repair for open globe injuries(OGIs) and to examine the associations between ocular findings, executive functioning, sleep disturbances, and parental quality of life.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eTwenty-three children who underwent OGI repair and 25 age- and sex-matched healthy controls were included. Clinical data, including baseline and final best-corrected visual acuity(BCVA), number of surgeries, and injury zone, were collected retrospectively. Parents completed the Pediatric Quality of Life Inventory: Family Impact Module (PedsQL-FIM), the Sleep Disturbance Scale for Children(SDSC), and the Behavior Rating Inventory of Executive Function(BRIEF) at the final follow-up visit after trauma Group comparisons and correlation analyses were performed to assess relationships between ocular and psychosocial variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe median follow-up was 21 months. Among patients, 73.9% had penetrating injuries, 17.4% ruptures, and 8.7% intraocular foreign bodies. Injury location was zone 1 in 69.6%, zone 2 in 21.7%, and zone 3 in 8.7%. Median BCVA improved from 1.8 to 0.4 LogMAR(p=0.006). No significant group differences were found in executive or sleep functions(p\u0026gt;0.05). Parents of patients reported significantly lower scores in physical(p=0.001), emotional(p=0.002), anxiety(p=0.020), and daily activity(p=0.028) domains. Baseline BCVA correlated negatively with Shift(r=–0.415, p=0.049) and Emotional Control(r=–0.452, p=0.030). Final BCVA correlated negatively with parental cognitive functioning(r=–0.443, p=0.034) and children’s night awakenings(r=–0.415, p=0.049).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Early intervention in OGIs is crucial for favorable visual outcomes. Although executive and sleep functions were similar to controls, poorer vision was linked to emotional and cognitive difficulties in children and heightened caregiver stress, highlighting the need for multidisciplinary, family-centered care.\u003c/p\u003e","manuscriptTitle":"Ocular and Psychosocial Outcomes After Pediatric Open Globe Injury Repair","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-06 14:32:09","doi":"10.21203/rs.3.rs-9188151/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-13T17:44:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"287115879818364889617561993613513514596","date":"2026-05-04T13:39:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211631813336926641951543991015595492198","date":"2026-04-06T03:55:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-01T00:47:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-01T00:40:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-30T11:42:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-30T11:15:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2026-03-30T11:08:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5fbca819-364b-4adf-bcb0-c12d209783ac","owner":[],"postedDate":"April 6th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-13T17:44:54+00:00","index":51,"fulltext":""},{"type":"reviewerAgreed","content":"287115879818364889617561993613513514596","date":"2026-05-04T13:39:08+00:00","index":47,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-06T14:32:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-06 14:32:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9188151","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9188151","identity":"rs-9188151","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}