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Daniel Upton, Xiaoqin Tang, Tamara Vrabec, Wells Reinheimer; Indications for and causes of enucleation in a rural United States population. Invest. Ophthalmol. Vis. Sci. 2013;54(15):890.
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Although indications for and causes of enucleation have been studied, the rural westernized population has eluded evaluation. The purpose of this investigation was to evaluate enucleation in a rural central and northeast Pennsylvania population, identify differences from urban populations, and explore potential improvements in rural health care which may decrease the need for this end stage procedure.
A retrospective clinicopathologic review of all enucleations, eviscerations, and exenterations (n=96) within the Geisinger Health System between January 1, 2000 and December 31, 2010 was performed.
Enucleations were categorized according to surgical indication and pathologic diagnosis. Indications included blind painful eye (79%), malignancy (12%), cosmesis (5%), and risk of sympathetic ophthalmia (4%). Pathologic diagnoses included trauma (37%), infection (17%), inflammation (7%), malignancy (12%), glaucoma (8%), corneal disease (7%), and other (12%). Overall mean age (56.8 years), age at surgery for trauma (46.3 years), and age at surgery for infection and inflammation (68.0 years) were older than previous data. Univarient analysis demonstrated, as in urban populations, enucleations for trauma had younger age (p=0.001), larger implant size (p=0.016), associated alcohol use (p <0.024) and male gender (p<0.001). In contrast, at this rural center enucleations for endophthalmitis were more prevalent and effected primarily elderly patients (12/14) and were related to recent or remote surgical intervention (10/14). Finally, half of all endophthalmitis cases (7/14) were either initially treated by non-ophthalmologists in their local community or presented several days to weeks after initial symptoms which included redness, pain, and/or vision loss.
There are similarities and differences in the demographics of enucleation in urban centers and this rural community. Improvements in rural health care systems including increasing awareness of the importance of protective eyewear, seeking prompt care for signs and symptoms of ocular inflammation, lowering threshold for specialty care referral, and providing low cost transportation particularly for the elderly may decrease the prevalence of enucleation.
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