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M.L. Allen, P.H. Blomquist, K.M. Itani; Enucleation and Evisceration: A Review of the Indications and Demographics . Invest. Ophthalmol. Vis. Sci. 2003;44(13):787.
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Purpose: To determine the indications and demographics for enucleation and evisceration over a ten year period. Methods: We reviewed the records of patients who underwent enucleation or evisceration at Parkland Memorial Hospital and Zale Lipshy University Hospital between 1992 and 2002. Patients age 14 years and older were included. An attempt was made to classify eyes to the original underlying disorder that led to the need for removal. Acute open globe injuries were defined as eyes removed less than 2 months from the time of injury. Results: The records of 264 patients were reviewed, and 250 (95%) underwent enucleation and 14 (5%) underwent evisceration. Among all patients, the mean age was 46 years, the left eye was removed in 54% of cases, and 66% of the patients were male. 14 eviscerations were performed, and the most common indications for evisceration were infection (6 eyes, 43%), trauma (5, 36%), and tumor (2, 14%). A total of 250 enucleations were performed. Trauma was the most frequent indication and represented 148 (59%) of the cases. The most common types of trauma were acute open globe injuries (88 eyes, 60%), remote open globe injuries (34, 23%), and phthisis due to remote trauma (15, 10%). Among patients with traumatized eyes, 80% were male, the mean age was 38 years, and 53% of the traumas were a result of aggravated assault. The most frequent modalities of aggravated assault were gunshot wound (29 eyes), hit with fist (7), hit with unknown object (7), and stab wound (6). Among the 67 accidentally traumatized eyes, the common indications were falls (13 eyes), motor vehicle collision (13), stick (7), and BB gun (6). Other indications for enucleation included infection (29 eyes, 12%), diabetic complications (18, 7%), corneal disease (16, 6%), tumors (15, 6%), retinal disease (11, 4%), and phthisis bulbi with unclear etiology (3, 1%). Conclusions: Enucleation was performed much more frequently than evisceration over the study period (250 cases vs. 14). Surgeon preference for the enucleation procedure is the most likely cause of this disparity. Not enough eviscerations were performed to identify specific indications or trends that would favor evisceration instead of enucleation. Among patients who underwent enucleation, trauma was by far the most common indication (59%) with most cases due to sequelae of acute (60%) or chronic (23%) open globe injury. Aggravated assault was regrettably the cause of most of the trauma cases (53%). The large number of primary enucleations (26%) among eyes enucleated for acute open globe injury attests to the volume of severely injured eyes in this series.
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