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Lee Teak Tan, Paul Kabasele, Patricio Pacheco, Hazlita Isa, Norshamsiah Md Din, Simon Taylor, Susan Lightman; Phthisis Bulbi In Patients With Ocular Inflammation. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4214.
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The aim of this study was to determine the prevalence and main causes of phthisis in patients attending a uveitis clinic in a tertiary referral centre, and to identify any factors associated with its development.
Ethical approval was obtained from the Research Governance Committee of Moorfields Eye Hospital (protocol LIGS1021). Cross-sectional case-notes study of 2,500 patients attending a uveitis clinic at Moorfields Eye Hospital. Ocular phthisis was defined as a soft shrunken globe on clinical examination with evidence of structural disorganisation.
We identified 64 patients with 65 phthisical eyes in the uveitis clinic. The most common cause of phthisis was non-infective uveitis, accounting for 18 of 64 patients (28%). Trauma was responsible in 17 patients (27%), ocular infection in 15 patients (23%) and ocular surgery in six patients (9%). Other less frequent causes included chronic retinal detachment, neovascular glaucoma and orbital vasculitis. Phthisis occurred a mean of 6.4 years (range 0-23 years) after the diagnosis of uveitis compared to 1.5 years (range 0-17 years) for phthisis from other causes (P=0.03). 51/65 eyes were NPL; 13 of these had been eviscerated or enucleated, with the majority of enucleations following penetrating eye injuries (65%). 27 patients (42%) had visual loss in the other eye, of whom 14 patients (22%) had severe visual loss, rendering them legally blind. The most common cause of severe visual loss in the contralateral eye was ocular inflammation, including three cases of sympathetic ophthalmia (21%). 11 patients were diagnosed with sympathetic ophthalmia. In eight of these (73%), this followed a penetrating eye injury to the other eye, which had led to an enucleation in seven patients. SO followed multiple surgeries for retinal detachment in the other three patients. Four patients (36%) with SO suffered visual loss, of whom three patients (27%) had severe visual loss. None of the exciting eyes maintained vision, and 55% of them had been enucleated, all within two years of the causative event.
Uveitis is an important cause of phthisis, and the interval to phthisis is significantly longer compared to phthisis from other causes. 42% of patients with phthisis had visual loss in the other eye, with 22% being legally blind.
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