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      Enucleation and evisceration at a tertiary care hospital in a developing country

      research-article
      , , ,
      BMC Ophthalmology
      BioMed Central

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          Abstract

          Background

          To analyze the demographics, indications, and surgical outcomes of anophthalmic surgery (enucleation and evisceration) at Jordan University Hospital during a 5-year period.

          Methods

          We conducted a retrospective chart review of patients who had undergone evisceration or enucleation between August 2006 and June 2011. The data collected included age at time of surgery, sex, affected eye, surgical indication, implant size, and postoperative complications.

          Results

          Anophthalmic surgery was performed for 68 eyes of 67 patients during the study period (42 (62 %) eviscerations and 26 (38 %) enucleations). Forty-three patients (64 %) were men, and 40 (59 %) eyes were right eyes. Trauma was the leading cause for anophthalmic surgery in 40 % of cases followed by a blind painful eye secondary to glaucoma (19 %) in the enucleation group and endophthalmitis (28.6 %) in the evisceration group. The most common anophthalmic surgery complication was wound dehiscence in 11.5 % of patients in the enucleation and 9.5 % in the evisceration groups. The mean and median sizes of the implants for evisceration were 16.6 and 18.0 mm, respectively; for enucleation, both were 20 mm.

          Conclusions

          Evisceration was the preferred anophthalmic surgery in our series unless contraindicated. Trauma was the most common predisposing factor for evisceration and enucleation in our tertiary care center followed by blind painful eyes and endophthalmitis. The most common complication was wound dehiscence in both groups.

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          Most cited references45

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          Vision survival after open globe injury predicted by classification and regression tree analysis.

          To assist ophthalmologists in treating ocular trauma patients, this study developed and validated a prognostic model to predict vision survival after open globe injury. Retrospective cohort review. Two hundred fourteen patients who sought treatment at the Wilmer Ophthalmological Institute with open globe injuries from January 1, 2001, through December 31, 2004, were part of the data set used to build the classification tree model. Then, to validate the classification tree, 51 patients were followed up with the goal to compare their actual visual outcome with the outcome predicted by the tree grown from the classification and regression tree analysis. Binary recursive partitioning was used to construct a classification tree to predict visual outcome after open globe injury. The retrospective cohort treated for open globe injury from January 1, 2001, through December 31, 2004, was used to develop the prognostic tree and constitutes the training sample. A second independent sample of patient eyes seen from January 1, 2005, through October 15, 2005, was used to validate the prognostic tree. Two main visual outcomes were assessed: vision survival (range, 20/20-light perception) and no vision (included no light perception, enucleation, and evisceration outcomes). A prognostic model for open globe injury outcome was constructed using 214 open globe injuries. Of 14 predictors determined to be associated with a no vision outcome in univariate analysis, presence of a relative afferent pupillary defect and poor initial visual acuity were the most predictive of complete loss of vision; presence of lid laceration and posterior wound location also predicted poor visual outcomes. In an independent cohort of 51 eyes, the prognostic model had 85.7% sensitivity to predict no vision correctly and 91.9% specificity to predict vision survival correctly. The open globe injury prognostic model constructed in this study demonstrated excellent predictive accuracy and should be useful in counseling patients and making clinical decisions regarding open globe injury management.
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            Sixty-five years of sympathetic ophthalmia. A clinicopathologic review of 105 cases (1913--1978).

            A retrospective clinicopathologic review of 105 cases of sympathetic ophthalmia showed histologic features of prognostic significance and evaluated the role of therapy. Classic descriptions omit retinal changes, but 58.0% of our cases had retinal detachment and 42.2% showed intraretinal inflammation. The optic nerve and/or meninges were inflamed in 51%. Optic atrophy was seen in 54.4%. Plasma cells are said to be characteristically absent, but 65.0% of steroid-treated and 85.7% of cases before the steroid era showed plasma cell infiltration. Severity of inflammation pathologically correlated with final visual outcome, and corticosteroid therapy changed both the character and severity of inflammation. Early enucleation of the exciting eye after onset of symptoms in the fellow eye was found to improve visual prognosis. Electron microscopy performed on fresh tissue and choroidal cell cultures revealed no viral particles, and viral and mycoplasma cultures all proved negative.
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              Enucleation versus evisceration.

              M Migliori (2002)
              Removal of the eye may be necessary after severe ocular trauma, to control pain in a blind eye, to treat some intraocular malignancies, in endophthalmitis unresponsive to medical therapy, and for cosmetic improvement of a disfigured eye. The choice of procedure to accomplish this is best made by an informed patient. Enucleation and evisceration can each achieve the desired goals, but several factors must be considered in choosing the most appropriate procedure.
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                Author and article information

                Contributors
                00962-79-9060794 , Ababneh99@yahoo.com
                emanabotaleb@yahoo.com
                mohammd_73@yahoo.com
                drjaqub@yahoo.com
                Journal
                BMC Ophthalmol
                BMC Ophthalmol
                BMC Ophthalmology
                BioMed Central (London )
                1471-2415
                11 September 2015
                11 September 2015
                2015
                : 15
                : 120
                Affiliations
                [ ]Department of Ophthalmology, Jordan University Hospital, The University of Jordan, Amman, Jordan
                [ ]Department of Ophthalmology, Sana’a University, Sana’a, Yemen
                [ ]Department of Surgery, King Hussein Cancer Center, Amman, Jordan
                Article
                108
                10.1186/s12886-015-0108-x
                4566484
                92ba60ab-c6a8-4e8a-83e7-e50b63722fb1
                © Ababneh et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 8 July 2015
                : 20 August 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Ophthalmology & Optometry
                Ophthalmology & Optometry

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