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Donovan Stephen Reed, Wesley Brundridge, Aditya Mehta, Brett Davies; Evisceration versus enucleation following ocular trauma, a retrospective analysis at a level one trauma center. Invest. Ophthalmol. Vis. Sci. 2018;59(9):110.
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Penetrating and perforating ocular trauma may lead to visual loss and subsequent compromise of the fellow eye. Enucleation remains the gold standard in the management of a non-salvageable eye following penetrating and perforating ocular injuries. As a technically easier alternative, evisceration offers several advantages to the ocular trauma surgeon. Debate persists whether evisceration is a viable option in the management of a non-salvageable eye following trauma. A retrospective analysis at a level 1 trauma center was performed to evaluate the practicality of evisceration in ocular trauma.
A retrospective analysis was performed to determine the clinical outcomes following evisceration and enucleation for a non-salvageable eye due to trauma. Eyes that underwent evisceration or enucleation at San Antonio Military Medical Center between 01 January 2014 and 30 April 2017 were examined. Specific factors evaluated include mechanism, defect size, associated orbital trauma, ocular trauma score, zone of injury, and time from injury to surgical intervention. Surgical outcomes were assessed.
In total, 29 eyes were examined, 15 having undergone evisceration and 14 enucleation. Mechanism of injury included both blunt and penetrating trauma. Defect size, zone of injury, ocular trauma score, and presence of orbital trauma did not affect surgical construction of the scleral shell during evisceration. One patient developed a post-operative infection following evisceration. Wound dehiscence occurred in one patient after evisceration, and one patient required a buccal mucosa graft for forniceal shortening. Implant exposure and forniceal shortening occurred in one patient following enucleation. No cases of sympathetic ophthalmia were reported. Post-operative pain was adequately controlled in all patients. No cases of post-operative hematoma were identified.
Though enucleation remains the gold standard in the management of a blind eye following ocular trauma, this analysis demonstrates evisceration is a viable surgical alternative. The post-operative outcomes demonstrated are comparable to enucleation and consistent with the recent literature. Additional factors to include patient characteristics and surgeon preference should be considered when determining the appropriate operative technique for management of a non-salvageable eye following ocular trauma.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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