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Shaam Mahasneh, Patrick Redmond, Ronald Mancini; Open Globe Injuries and the Incidence of Sympathetic Ophthalmia at a Large County Hospital. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5480.
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To investigate the incidence and characteristics of Sympathetic Ophthalmia (SO) at a Level I trauma center in an attempt to determine if enucleation should still be recommended within 2 weeks to avoid sympathetic ophthalmia (SO).
A retrospective case control study conducted by a computer database search based on International Classification of Disease-9 (ICD-9) codes for SO from 2005-2012. Additionally, given the historical link to ocular trauma, records with any ICD-9 diagnosis code that would be used for an open globe injury were identified and reviewed. Excluded were cases without a true open globe injury or with no follow-up in the ophthalmology clinic. Demographics, history, physical exam findings, medical and ocular history, time to surgical repair and clinical course were recorded.
Of the 432 included open globe cases, there were 361 males (83.5%) and 71 females (16.4%), with no racial predilection. Mean age was 40.4 years. There were 3 cases of SO reported (0.69%), all caused by trauma. Case 1 is a 27 year old female with SO which developed 5 weeks after corneoscleral laceration with uveal prolapse, repaired within 6 hours of injury. Patient self-discontinued steroids, refused enucleation, and was lost to follow-up. Case 2 is a 55 year old female who developed SO 5 months after a scleral perforation during perioperative peribulbar anesthesia at an unaffiliated hospital. Case 3 is a 41 year old male with posterior scleral rupture after blunt force trauma, repaired within 8 hours of injury and subsequently enucleated 21 days after injury. The patient was lost to follow-up and returned to the eye clinic 3 years later with light perception in sympathizing eye, after having been treated for SO by an outside uveitis specialist.
This study proves that, albeit rare, SO is a true threat to patients who are often functionally monocular. However, the very low incidence (0.69%) of SO among even severe traumatic injuries should still be considered with regards to enucleation within 2 weeks of the injury. Enucleation at the arbitrary 2 weeks cut off remains a controversial topic, however case 3 can argue for the importance and accuracy of this timeline. Ultimately, an individualized approach with adequate psychological support appears to be the best management approach given the devastating reality of SO.
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