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Blanch RJ, McMaster D, Patterson TJ. Management of open globe injury: a narrative review. Eye (Lond) 2024:10.1038/s41433-024-03246-3. [PMID: 39085596 DOI: 10.1038/s41433-024-03246-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/04/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024] Open
Abstract
Open globe injuries are a significant global cause of visual loss, including unilateral and bilateral blindness. Prognosis is predicted by injury severity, with lower presenting visual acuity and more posterior injuries associated with poor visual outcomes, although even the most severely injured eyes with no perception of light vision may regain some visual function. In addition to severity of the primary injury, the secondary injuries and complications causing poor outcomes include proliferative vitreoretinopathy (PVR) and endophthalmitis. Endophthalmitis is common after open globe injury, affecting up to 16.5% of patients. Systemic antibiotic prophylaxis is commonly used, with a limited evidence base, while intraocular antibiotics are less commonly used but have stronger supporting evidence of efficacy. Endophthalmitis rates are also reduced by prompt primary repair, which may also support recovery of visual acuity. PVR is not prevented or treated by any pharmacologic interventions in current clinical practice, but the incidence of post-traumatic PVR may be reduced by early vitrectomy within the first 4-7 days after injury. Ocular trauma training is often limited in Western ophthalmic surgical training programmes, and patients with ocular trauma often require the input of multiple subspecialists. In this context, it is important that patients have an overview and coordination of the different aspects of their care, with ownership by one lead clinician.
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Affiliation(s)
- Richard J Blanch
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK.
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | | | - Tim J Patterson
- Northern Ireland Medical and Dental Training Agency, Belfast, UK
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Bondok MS, He B, Ka-Lok Tao B, Bondok M, Hussain A, Ing E. Incidence of Sympathetic Ophthalmia after Intraocular Surgery: A Systematic Review and Meta-analysis. Ophthalmology 2024; 131:836-844. [PMID: 38215990 DOI: 10.1016/j.ophtha.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/14/2024] Open
Abstract
TOPIC Sympathetic ophthalmia (SO) is a rare bilateral granulomatous panuveitis that can present after trauma or intraocular surgery (IOS). The incidence of SO after IOS varies among studies. The purpose of this review was to determine the incidence proportion of SO after IOS. CLINICAL RELEVANCE The incidence proportion of SO after IOS can provide physicians and patients with information on the risk of SO during the consent process before surgery. METHODS In this systematic review and meta-analysis, MEDLINE, EMBASE, and Cochrane databases were searched from inception to January 1, 2023 for population-based studies of SO after IOS. Two reviewers independently screened the results. Random-effects meta-analyses calculated incidence proportion. Subgroup analysis assessed SO incidence based on IOS type and technological advancements. Study quality and bias were assessed using the Newcastle-Ottawa scale and the Grades of Recommendation, Assessment, Development, and Evaluation framework. RESULTS The final meta-analyses included 19 studies, with 118 cases of SO occurring after 505 178 inciting events. The estimated overall incidence proportion of SO after IOS was 0.061% (95% confidence interval [CI], 0.033%-0.111%; I2 = 83%), and the estimated incidence rate was 9.24 cases per 100 000 person-years (95% CI, 4.03-21.19; I2 = 88%). The average study duration across these studies was 10.8 years. Within the reviewed literature, SO after glaucoma and vitreoretinal IOS was studied most, with 9 and 6 studies, respectively. Observed differences in incidence between glaucoma (0.098%; 95% CI, 0.042%-0.232%; I2 = 40%) and vitreoretinal (0.043%; 95% CI, 0.022%-0.085%; I2 = 88%) IOS were not statistically significant (P = 0.14). Also, no significant difference was found in the incidence proportion before and after 1975, when modern intraocular surgical techniques emerged (0.060% vs. 0.058%; P = 0.98). The outcome measures showed low-certainty Grades of Recommendation, Assessment, Development, and Evaluation evidence. DISCUSSION Sympathetic ophthalmia after IOS is rare and might not have changed over the past 5 decades. The estimated incidence proportion of SO may be useful during the consent process before surgery. Also, no significant difference may exist in the incidence of SO between glaucoma and vitreoretinal IOS, based on low-certainty evidence. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Mohamed S Bondok
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Bonnie He
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
| | | | - Mostafa Bondok
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ahsen Hussain
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
| | - Edsel Ing
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada; Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Canada.
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Patterson TJ, Kedzierski A, McKinney D, Ritson J, McLean C, Gu W, Colyer M, McClellan SF, Miller SC, Justin GA, Hoskin AK, Cavuoto K, Leong J, Rousselot Ascarza A, Woreta FA, Miller KE, Caldwell MC, Gensheimer WG, Williamson T, Dhawahir-Scala F, Shah P, Coombes A, Sundar G, Mazzoli RA, Woodcock M, Watson SL, Kuhn F, Halliday S, Gomes RSM, Agrawal R, Blanch RJ. The Risk of Sympathetic Ophthalmia Associated with Open-Globe Injury Management Strategies: A Meta-analysis. Ophthalmology 2024; 131:557-567. [PMID: 38086434 DOI: 10.1016/j.ophtha.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 02/12/2024] Open
Abstract
TOPIC Sympathetic ophthalmia (SO) is a sight-threatening granulomatous panuveitis caused by a sensitizing event. Primary enucleation or primary evisceration, versus primary repair, as a risk management strategy after open-globe injury (OGI) remains controversial. CLINICAL RELEVANCE This systematic review was conducted to report the incidence of SO after primary repair compared with that of after primary enucleation or primary evisceration. This enabled the reporting of an estimated number needed to treat. METHODS Five journal databases were searched. This review was registered with International Prospective Register of Systematic Reviews (identifier, CRD42021262616). Searches were carried out on June 29, 2021, and were updated on December 10, 2022. Prospective or retrospective studies that reported outcomes (including SO or lack of SO) in a patient population who underwent either primary repair and primary enucleation or primary evisceration were included. A systematic review and meta-analysis were carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Random effects modelling was used to estimate pooled SO rates and absolute risk reduction (ARR). RESULTS Eight studies reporting SO as an outcome were included in total. The included studies contained 7500 patients and 7635 OGIs. In total, 7620 OGIs met the criteria for inclusion in this analysis; SO developed in 21 patients with OGI. When all included studies were pooled, the estimated SO rate was 0.12% (95% confidence interval [CI], 0.00%-0.25%) after OGI. Of 779 patients who underwent primary enucleation or primary evisceration, no SO cases were reported, resulting in a pooled SO estimate of 0.05% (95% CI, 0.00%-0.21%). For primary repair, the pooled estimate of SO rate was 0.15% (95% CI, 0.00%-0.33%). The ARR using a random effects model was -0.0010 (in favour of eye removal; 95% CI, -0.0031 [in favor of eye removal] to 0.0011 [in favor of primary repair]). Grading of Recommendations, Assessment, Development, and Evaluations analysis highlighted a low certainty of evidence because the included studies were observational, and a risk of bias resulted from missing data. DISCUSSION Based on the available data, no evidence exists that primary enucleation or primary evisceration reduce the risk of secondary SO. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Tim J Patterson
- Northern Ireland Medical and Dental Training Agency (NIMDTA), Beflast, United Kingdom
| | | | - David McKinney
- Northern Ireland Medical and Dental Training Agency (NIMDTA), Beflast, United Kingdom
| | - Jonathan Ritson
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom; Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Chris McLean
- Epsom and St Helier University Hospitals NHS Trust, Epsom, United Kingdom
| | - Weidong Gu
- Vision Center of Excellence, Research & Development Directorate, J-9, Defence Health Agency, Silver Spring, Maryland
| | - Marcus Colyer
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Scott F McClellan
- Vision Center of Excellence, Research & Development Directorate, J-9, Defence Health Agency, Silver Spring, Maryland
| | - Sarah C Miller
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Grant A Justin
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Duke Eye Center, Duke University Hospitals, Durham, North Carolina
| | - Annette K Hoskin
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia; Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Kara Cavuoto
- Bascom Palmer Eye Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - James Leong
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia; Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrés Rousselot Ascarza
- Consultorios Oftalmológicos Benisek-Ascarza, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kyle E Miller
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Ophthalmology, Navy Medical Center Portsmouth, Portsmouth, Virginia
| | - Matthew C Caldwell
- Department of Ophthalmology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - William G Gensheimer
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; White River Junction Veterans Administration Medical Center, White River Junction, Vermont
| | - Tom Williamson
- Department of Ophthalmology, St. Thomas Hospital, London, United Kingdom
| | | | - Peter Shah
- Birmingham Institute for Glaucoma Research, Birmingham, United Kingdom; Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Coombes
- Department of Ophthalmology, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Gangadhara Sundar
- Department of Ophthalmology, National University Hospital, Singapore, Republic of Singapore
| | - Robert A Mazzoli
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Malcolm Woodcock
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - Stephanie L Watson
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, Alabama
| | | | - Renata S M Gomes
- Research & Innovation, BRAVO VICTOR, London, United Kingdom; Northern Hub for Veterans and Military Families Research, Northumbria University, Newcastle, United Kingdom
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore, Republic of Singapore; Lee Kong Chian School of Medicine, Singapore, Republic of Singapore; Duke NUS Medical School, Singapore, Republic of Singapore
| | - Richard J Blanch
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Neuroscience & Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom.
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Mavris N, Amer R. Long-term clinical outcomes of patients with sympathetic ophthalmia. Int Ophthalmol 2024; 44:19. [PMID: 38324101 PMCID: PMC10850007 DOI: 10.1007/s10792-024-03007-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/19/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE To present the long-term clinical outcomes of patients with sympathetic ophthalmia (SO). METHODS Retrospective review of patients' medical files between 2002 and 2022. RESULTS Included were seven patients (four males). The mean ± SD age at presentation was 37.9 ± 22.5 years. Four patients had co-morbidities: three had diabetes mellitus type 2 and one had Turner Syndrome. Trauma was the inciting event in six patients and postoperative endophthalmitis in one patient. Decreased visual acuity (VA) was the leading symptom in the sympathizing eye and all of the patients presented with panuveitis. The mean ± SD interval between the triggering incident and the onset of SO in six cases was 4.3 ± 4.2 months. One case presented 30 years following the eye injury. Five patients underwent enucleation/evisceration of the exciting eye. The mean ± SD presenting LogMAR BCVA in the sympathizing eye was 0.57 ± 0.82, and the final LogMAR BCVA was 0.61 ± 0.95. Inflammation was completely controlled in 5 patients at a mean ± SD of 8.55 ± 9.21 months following the institution of immunomodulatory therapy, and it was partially controlled in 2 patients. VA deteriorated in all 3 diabetic patients and improved or remained stable in the 4 young and healthy patients. The mean ± SD follow-up period after achieving drug-free remission was 28 ± 22.8 months. The mean ± SD follow-up time was 6.8 ± 5.6 years. CONCLUSIONS SO is one of the most sight-threatening conditions, affecting the healthy eye. In this cohort, the favorable visual outcome was especially seen in young and healthy individuals. Visual prognosis is directly related to prompt diagnosis and treatment.
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Affiliation(s)
- Neofytos Mavris
- Department of Ophthalmology, Hadassah Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Center, POB 12000, 91120, Jerusalem, Israel.
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Hall N, Douglas VP, Ivanov A, Ross C, Elze T, Kempen JH, Miller JW, Sobrin L, Lorch A. The Epidemiology and Risk Factors for the Progression of Sympathetic Ophthalmia in the United States: An IRIS Registry Analysis. Am J Ophthalmol 2024; 258:208-216. [PMID: 37726044 DOI: 10.1016/j.ajo.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To investigate the demographic and clinical characteristics of patients with sympathetic ophthalmia (SO) and define the risk factors for its incidence following trauma and ophthalmic procedures. DESIGN Retrospective cohort study. PARTICIPANTS Patients in the American Academy of Ophthalmology's (Academy) IRIS Registry (Intelligent Research in Sight) who were (n=1523) or were not diagnosed with SO following a documented procedure or trauma between January 1, 2013, and December 31, 2019. METHODS Multiple demographic and clinical factors were collected, descriptive statistics and prevalence were calculated, and multivariate linear regression models were fit to the data. MAIN OUTCOME MEASURES Prevalence of SO, demographic and clinical characteristics, and beta coefficient (β) estimates of demographic and clinical characteristics impacting time to SO onset after procedure (Procedure Only cohort) or trauma (Trauma cohort). RESULTS Of 65,348,409 distinct IRIS Registry patients, 1523 (0.0023%) were diagnosed with SO between 2013 and 2019, and also had a documented preceding trauma or procedure. Of these, 927 (60.87%) were female, 1336 (87.72%) belonged to the Procedure Only cohort, and 187 (12.28%) belonged to the Trauma cohort. The prevalence of SO after trauma was 0.0207%, whereas after procedures it was 0.0124%. The highest risk of procedure-related SO was seen in patients with history of "other anterior segment" (0.122%) followed by glaucoma (0.066%) procedures, whereas the lowest prevalence was noted with cataract surgeries (0.011%). The average time to onset of SO across both cohorts combined was 527.44 (±715.60) days, with statistically significant differences between the 2 cohorts (P < .001). On average, the time to onset from inciting event to SO was shorter with increasing age, by 9.02 (95% CI: -11.96, -6.08) days for every 1-year increase. CONCLUSIONS SO following trauma and ophthalmic procedure is potentially rarer than previously reported, as measured in this large ophthalmic medical record database. Female sex may be a risk factor for SO. Older age may be a risk factor for quicker onset. These findings can guide clinical decision-making and management.
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Affiliation(s)
- Nathan Hall
- From the Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Vivian Paraskevi Douglas
- From the Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Ivanov
- From the Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Connor Ross
- From the Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Tobias Elze
- From the Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - John H Kempen
- From the Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Joan W Miller
- From the Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lucia Sobrin
- From the Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Alice Lorch
- From the Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
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6
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Zhou Y, Zhou A, Philip AM, Margolis M, Babiker F, Chang PY, Anesi SD, Foster CS. Vision Outcomes of Long-Term Immunomodulatory and Steroid Therapy in Sympathetic Ophthalmia. Am J Ophthalmol 2023; 253:152-159. [PMID: 37150338 DOI: 10.1016/j.ajo.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To compare vision acuity outcomes of long-term steroid therapy compared with immunomodulatory therapy for treatment of sympathetic ophthalmia. DESIGN Single-center, retrospective, comparative clinical study. METHODS Patients with sympathetic ophthalmia treated from March 2005 to October 2022 with at least 1 year of follow-up were included. Visual acuity outcomes were compared by steroid and immunomodulatory treatment modality. RESULTS Thirty-five patients with sympathetic ophthalmia were included in the study, with follow-up ranging from 1 to 17 years. Higher rates of vision loss correlated with longer periods of active uveitis and steroid treatment. Lower rates of vision loss correlated with longer periods of uveitis remission on immunomodulatory therapy alone and drug-free remission. Treatment with alkylating agents or combination therapy with an antimetabolite, a biologic-response modifier, and cyclosporine are more likely to result in sympathetic ophthalmia remission. CONCLUSION Immunomodulatory therapy leads to superior vision outcomes in cases of steroid-resistant or recurrent sympathetic ophthalmia. Steroid therapy may be useful for acute or recalcitrant sympathetic uveitis but is insufficient for long-term inflammatory control. PRéCIS: This manuscript describes a retrospective analysis of vision outcomes in patients with sympathetic ophthalmia. Results indicate that long-term immunomodulatory therapy is associated with better vision outcomes than long-term steroid therapy for sympathetic ophthalmia treatment.
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Affiliation(s)
- Yujia Zhou
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Avery Zhou
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Andrew M Philip
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Michael Margolis
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Fatima Babiker
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Peter Y Chang
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Stephen D Anesi
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - C Stephen Foster
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); Department of Ophthalmology, Harvard Medical School, Boston, MA, USA (C.S.F).
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Chen SC, Sheu SJ, Wu TT. Changing etiology of sympathetic ophthalmia: A 10-year study from a tertiary referral center in Taiwan. Taiwan J Ophthalmol 2023. [DOI: 10.4103/tjo.tjo-d-22-00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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8
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Risk factors for globe removal after open-globe injury in agricultural regions. Sci Rep 2022; 12:17122. [PMID: 36224319 PMCID: PMC9556698 DOI: 10.1038/s41598-022-21666-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/29/2022] [Indexed: 01/04/2023] Open
Abstract
This study aimed to identify the prevalence and risk factors for globe removal among patients with open-globe injuries (OGIs) in agricultural regions. A retrospective chart review of patients with OGIs was performed between January 2010 and December 2019. Univariable and multivariable logistic regression models were used to identify the factors associated with globe removal in OGI. This study included 422 patients (422 eyes). The highest prevalence of OGI was observed in the middle age group (> 20 to 40 years). The most common cause of OGIs was agriculture-related injury (54.7%), followed by industry or workplace-related injury (20.4%), and assault (5.0%). Intraocular foreign bodies, endophthalmitis, and panophthalmitis were reported in 57.6%, 28.4%, and 5.7% of cases, respectively. Eight eviscerations and 43 enucleations were performed, accounting for 12.1% of OGIs. The most common indication for globe removal was panophthalmitis. Multivariable analysis revealed that the predictive factors significantly associated with globe removal were assault injuries (adjusted odds ratio (aOR) = 5.53; p = 0.026), presenting logarithm of the minimum angle of resolution visual acuity (aOR = 311.79; p < 0.001), and endophthalmitis and panophthalmitis (aOR = 3.58 and 734.94, respectively; p < 0.001). This knowledge would aid in patient counseling and encourage health promotion.
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