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Jenny Dohlman, Krishna Kalyam, Michael Ehrlich; Retrospective review of ocular pain management with eye removal surgery at Yale New Haven Hospital. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5139.
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© ARVO (1962-2015); The Authors (2016-present)
Patients who require eye removal to alleviate pain have often had multiple treatments to save their eye. The purpose of this study is to measure time elapsed between initial presentations of pain and eventual eye removal for various etiologies of eye disease and to quantify this delay in definitive treatment.
Retrospective review of patients who underwent eye removal surgeries at Yale New Haven Hospital or Temple Medical Center over the past 3 years. Data collected included patient demographics, type and date of surgery, reason for surgery, date of first recorded pain and treatments done before surgery.
59 patients (37 males, 22 females) with an average age of 59 years (21 – 94) were included. Of the 59 cases, 6 were eviscerations and 53 were enucleations. Etiologies for eye removal included blind painful eye (30 cases), malignancy (16 cases), infection (6 cases), and ruptured globe (8 cases). Of the blind painful eye cases, 11 were secondary to glaucoma/diabetes and 4 were secondary to corneal ulcers. The average time elapsed between initial pain and eye removal for all etiologies was 13 weeks. In cases of blind painful eye, the average time elapsed was 21 weeks. For cases of blind painful eye secondary to glaucoma and/or diabetes the average was 18 weeks; for cases secondary to corneal ulcer the average was 35 weeks. Average time elapsed between initial pain and surgery for infectious causes was 1 week. For ruptured globe cases, the average time was 1 week. The time between initial ophthalmology consult and eye removal surgery for malignancy was 9 weeks. Treatments done prior to eye removal included ruptured globe repair, pars plana vitrectomy, intravitreal tap and injection, systemic and topical antibiotics, topical steroids, glaucoma drops, prokera, keratoprosthesis, Ahmed valve, and plaque radiotherapy. Post-operative complications occurred in 6 out of the 59 cases and included orbital cysts, pyogenic granuloma, ectropic eye, and additional surgery.
Patients who need eye removal to alleviate pain have often had multiple procedures in an attempt to save their eye and have been in pain for significant periods of time. Patients who have eye removal for infection, malignancy, and ruptured globe tend to have more expedient eye removal than patients with blind painful eye secondary to glaucoma, diabetes or corneal ulcer. Post-operative complications were rare.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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