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V. Jurisic Friberg, M. Sefic, M. Ibisevic, E. Alimanovic, T. R. Friberg; Very Long-Term Monitoring for Sympathetic Uveitis Following Primary Enucleation for Open Globe Eye Injuries During the Sarajevo Siege. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5867.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate possible long term sequelae of the fellow eye(Sympathetic Ophthalmia) after primary enucleation for severe, irreparable open globe eye injuries during wartime.
In our retrospective, observational study, we evaluated patients who had suffered open globe Injury followed by an early enucleation, for the development of sympathetic uveitis. Enucleations were performed in the University Eye Clinic during the four-year Siege of Sarajevo, which took place from April 1992 to February 1996. Among buildings targeted and destroyed were hospitals and medical complexes. From a population of 300,000 of inhabitants, 10,000 persons were killed, 56,000 were wounded, and 1171 suffered various kinds of eye injuries. Because of direct shelling, daily bombardment, sniper-fire directed at civilians, disruption of vital lifelines, and shortage of medical supplies, the conditions under which surgery was performed were rather suboptimal. Further exacerbating eye care were dire shortages of medicines including steroids, antibiotics, and anesthetic agents. Our strategy was thus to restore the integrity of the eye whenever feasible, and to save the other eye from sympathetic uveitis when complex surgical repairs were deemed impossible to perform. Eyes with retained shrapnel and those suffering very severe damage to the internal ocular structures we enucleated primarily within one to seven days after presentation. Most eyes had no light perception. Patients were then subsequently followed annually, most for 17 years time.
Of 1171 eye injuries, 471 were open globe injuries, 403 were closed globe Injuries, and 297 had contusions according to standard classification categories (Birmingham Eye Trauma Terminology and the International Ocular Trauma Classification). Of the 471 open globe injuries, we performed 63 primary enucleations (13.4%). 59 of these 63 patients (94%) were followed over 17 years time. No cases of sympathetic uveitis developed in the contralateral eyes during this extended period of monitoring.
A psychologically difficult but decisive approach to ocular trauma in wartime can effectively protect the fellow eye from sympathetic ophthalmia over the long term.
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