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Kathryn Ortmann, John Anderson, Alice Chuang, Lauren Blieden; Primary enucleation in the treatment of traumatic open globe injuries. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6044.
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We performed a retrospective chart review to estimate the incidence of traumatic open globes resulting in enucleation, average number of surgical procedures occurring after primary open globe repair, and identify prognostic indicators leading to enucleation. We suspected primary enucleation may save some eyes from multiple surgeries before ultimately undergoing secondary enucleation.
We reviewed charts of patients treated for traumatic open globe injuries over 7 years (2008 - 2014) with at least 3 months of follow-up at the Robert Cizik Eye Clinic. Exclusion criteria include missing data points for presenting visual acuity (VA) or whether the injury was completely closed. Collected data included date of injury, VA at presentation, location of laceration, presence of complete primary closure, presence of intraocular foreign body, date and type of subsequent ocular surgery sessions including enucleation, and VA at last recorded follow-up. Baseline clinical data were summarized by mean or frequency. Logistic regression analysis was used to identify risk factors for enucleation.
711 charts were reviewed and of 190 traumatic open globes that met eligiblity criteria, 52 eyes (27.4%) underwent enucleation. Of those, 25 eyes (48.2%) had primary and 27 eyes (51.9%) had secondary enucleation. Excluding enucleations, 93 eyes (49.0%) had 0 subsequent surgical sessions following primary repair, 86 eyes (45.3%) had 1 to 3 sessions, and 11 eyes (5.8%) had more than 3 sessions. Of the 27 eyes that underwent secondary enucleation, 25 eyes (92.6%) had no additional surgical sessions between primary repair and secondary enucleation, and 2 eyes (7.4%) had one additional surgical session. The odds ratio for requiring enucleation was 10.4 for a presenting VA of no light perception (NLP) (P<0.001), 14.1 for incomplete primary closure (P<0.001), 3.5 for unable to take VA at the presentation (P=0.031), and 2.8 for a posterior laceration (P=0.044).
The majority of patients who underwent secondary enucleation had 1 or fewer surgeries between primary repair and enucleation; thus, primary enucleation would not be saving these patients from numerous subsequent surgical procedures. We recommend attempting primary closure of traumatic open globes and counseling patients presenting with VA of NLP or unable to assess VA , incomplete primary closure, or posterior laceration that enucleation may be required in the future.
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