Original article
Enucleation for Open Globe Injury

https://doi.org/10.1016/j.ajo.2008.10.017Get rights and content

Purpose

To report the experience of enucleation after open globe at an ophthalmic trauma referral center.

Design

Retrospective, observational study.

Methods

In an ophthalmic trauma referral center the charts of all patients having suffered an open globe injury between January 1, 2000 and June 30, 2007 were reviewed. Variables assessed were age, gender, type of injury (rupture or laceration [penetrating, intraocular foreign body, or perforating]), ocular trauma score, visual acuity, subsequent enucleation, indication for and timing of enucleation, presence of sympathetic ophthalmia, and length of follow-up.

Results

Among 660 open globe injuries, 55 have undergone enucleation (including 4 eviscerations), 11 primarily and 44 secondarily. Eyes with ruptures were significantly more likely to be enucleated than those with injuries attributable to lacerations (P < .001). The most common reason for secondary enucleation was a blind, painful eye. Two patients (0.3%) developed sympathetic ophthalmia and have maintained good vision in the sympathizing eye.

Conclusions

The vast majority of open globes can be repaired without requiring primary enucleation. Secondary enucleation is most commonly carried out for pain. Eyes with no light perception can be closely observed if the patient chooses.

Section snippets

Methods

The electronic and paper medical records of all patients with a diagnosis of open globe injury presenting to the Massachusetts Eye and Ear Infirmary between January 1, 2000 and June 30, 2007 were reviewed. Patients were identified in the hospital database by searching for patients with open globe codes and from the surgical logs of the trauma surgeons. Patients who underwent open globe repair at a separate institution were excluded. Variables assessed included age, gender, type of injury

Results

During the study period 660 open globe injuries were evaluated and 55 (8.3%) have undergone enucleation (including 4 eviscerations). Patients with open globe injuries requiring enucleation did not differ significantly from those not enucleated with respect to age and gender (Table 1).

Data on the OTS classification and injury type are presented in Table 2. An OTS could be calculated on 607 patients (92%). Patients with ruptures were significantly more likely to undergo enucleation than those

Discussion

Our data show that most patients with open globe injuries can be successfully surgically repaired, with only 11 of 660 (1.7%) requiring primary enucleation. The most common indication for secondary enucleation in this series was a blind, painful eye. Ruptures were significantly more likely to require enucleation than lacerations. Although sympathetic ophthalmia is a well-known risk, it was seen infrequently (0.3%) and responded well to treatment. A large proportion of the NLP eyes following

Aaron Savar, MD, is currently a fellow in ophthalmic plastic and reconstructive surgery at the University of Texas MD Anderson Cancer Center in Houston, Texas. He received his medical degree from Boston University School of Medicine and completed his ophthalmology residency at the Massachusetts Eye and Ear Infirmary in Boston, Massachusetts. His clinical interests include periocular malignancies, reconstructive surgery, and ocular trauma.

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    Aaron Savar, MD, is currently a fellow in ophthalmic plastic and reconstructive surgery at the University of Texas MD Anderson Cancer Center in Houston, Texas. He received his medical degree from Boston University School of Medicine and completed his ophthalmology residency at the Massachusetts Eye and Ear Infirmary in Boston, Massachusetts. His clinical interests include periocular malignancies, reconstructive surgery, and ocular trauma.

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