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A. Savar, M. T. Andreoli, C. M. Andreoli, C. E. Kloek, P. A. D. Rubin; Enucleation After Traumatic Open Globe: The Massachusetts Eye and Ear Infirmary Experience. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5483.
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The indications for and rate of enucleation in the setting of traumatic open globe injuries vary considerably. We report the experience of enucleation after open globe injury at a large ophthalmic trauma referral center.
We carried out a retrospective review of all open globe injuries and enucleations for trauma between January 1, 2000 and November 10, 2006 at the Massachusetts Eye and Ear Infirmary. Variables assessed included age, sex, mechanism of injury, indication for and timing of enucleation.
During the study period 645 open globe injuries were evaluated and 52 (8%) enucleations were performed for trauma. Patients with open globe injuries requiring enucleation did not differ significantly from those not enucleated with respect to age and gender. Mechanisms of open globe injury included: 229 blunt, 205 sharp, 151 projectile, and 60 other. Among those enucleated there were: 24 blunt, 2 sharp (p<0.001), 20 projectile, and 6 other injuries. Eleven (21%) enucleations were performed primarily (at initial surgery) and 41 (79%) secondarily. Primary enucleations were performed due to inability to repair the globe: the contents of the eye were unrecognizable or the optic nerve had been avulsed. Of the open globe injuries that were repaired (not primarily enucleated), 59 of 634 (9.3%) had resulting no light perception vision. Of these, 35 (59%) went on to be enucleated: 6 for prophylaxis against sympathetic ophthalmia and 29 for painful eye. An additional 3 eyes with light perception vision and 3 with hand motion vision were enucleated for pain. During the study period there was 1 case of sympathetic ophthalmia (0.16%) and 2 cases in which the diagnosis was considered, but felt to be unlikely. None of these cases was in a patient with a blind eye or required enucleation.
Most patients with open globe injuries can be successfully surgically repaired, with only 11 of 645 (1.7%) requiring primary enucleation. Those injuries requiring primary enucleation were extremely severe such that repair was not possible. Injuries due to blunt mechanisms or projectiles were significantly more likely to result in enucleation than those due to sharp objects. The most common indication for secondary enucleation in this series was a blind painful eye. Although sympathetic ophthalmia is a well-known risk it was seen infrequently (0.16%) and responded well to treatment. The overall enucleation rate of 8% was less than that seen in previous reports. A large proportion of the post repair no light perception eyes (41%) have been observed without requiring enucleation.
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