Das Auftreten der sympathischen Ophthalmie trotz erfolgter Präventivenucleation und seine Bedeutung für die Lehre von der Entstehung der Krankheit

Schieck, F.

doi:10.1007/bf01989411

Cited by 5 publications

(3 citation statements)

References 8 publications

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“…4,131,140 Later reports by Shaw (1898) 141 , Schirmer (1905) 142 , and Randolph (1898) 143 described SO as never coming on less than 2 weeks from the time of injury to the exciting eye, and enucleation within 14 days of the penetrating eye trauma (the 14-day rule) was established around this time period. 10,141–144 More recently, in 1931 Dor believed that if enucleation of the exciting eye was delayed too long (the maximum allowable interval being 2 weeks), the prophylactic effect of enucleation was lost. 136,145 Several years later in 1936, Woods 10 also suggested that enucleation within 2 weeks after injury was almost a certain preventative against SO developing in the other eye.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors reported cases of suspected SO following enucleation of the exciting eye even when the injured was excised as early as 48 h post-injury. 136,[144][145][146][147][148][149][150] More recently, Bellan 3 described a case of SO despite having the ruptured globe removed 5 days postinjury and challenged the concept that enucleation within 14 days eliminates the risk of SO. He also made some calculations based on 10,000 theoretical patients with penetrating ocular injury.…”

Section: Enucleation To Prevent Sympathetic Ophthalmiamentioning

confidence: 99%

“…It may also be a low estimate since the worst reported responses to treatment were used for all calculations, and there was an assumption that enucleation within 2 weeks was completely protective of SO which it is not. 3,136,[144][145][146][147][148][149][150][151][152] Bellan 3 suggested prophylactic enucleation of an unsalvageable eye following perforating injury should not be mandatory. In another review by Brackup et al 153 50 patients, with severe globe rupture and visual acuities of less than or equal to hand motion did not have the injured eye removed within 2 weeks to prevent SO.…”

Section: Enucleation To Prevent Sympathetic Ophthalmiamentioning

confidence: 99%

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The Ruptured Globe, Sympathetic Ophthalmia, and the 14-Day Rule

Jordan

Dutton

2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: Prophylactic enucleation of a ruptured globe with no light perception within 14 days of injury to prevent sympathetic ophthalmia (SO) has been an established dictum in academic teaching for more than 100 years. This treatment strategy was originally based on observation, speculation, and careful thought, but there was never any scientific proof. This review summarizes and updates the current state of our knowledge about globe rupture and SO, examines the origin and validity of the 14-day rule, and emphasizes the importance of trying to save the traumatized eye whenever possible.Methods: A comprehensive literature review of SO and globe rupture was performed.Results: SO is a rare disorder that may potentially occur following traumatic globe rupture as well as following a variety of other intraocular surgeries. Vitreoretinal surgery may be a more common cause than trauma according to some studies. SO may still occur despite having the eye removed within 14 days of the trauma. A variety of new medications including biologic agents are now available to treat SO with improved efficacy in suppressing the associated ocular inflammation and allowing retention of some useful vision. Removing the traumatized, blind eye may have other important psychological consequences associated with it that require consideration before eye removal is carried out. Retaining the blind, phthisical, disfigured eye avoids phantom vision and phantom pain associated with enucleation as well as providing a good platform to support and move an overlying prosthetic eye. Data on the occurrence of SO following evisceration and enucleation with and without predisposing factors confirms the exceedingly low risk. Conclusion:Most civilian open globe injuries can be successfully repaired with modern, advanced microsurgical techniques currently available. Because of the exceedingly low risk of SO, even with the severity of open globe trauma during military conflicts being more devastating as a result of the blast and explosive injuries, today every attempt is made to primarily close the eye rather than primarily enucleate it, providing there is enough viable tissue to repair. The 14-day rule for eye removal after severe globe ruptures is not scientifically supported and does not always protect against SO, but the safe time period for prophylactic eye removal is not definitively known. In the exceptional cases where SO does occur, several new medications are now available that may help treat SO. We advocate saving the ruptured globe whenever possible and avoiding prophylactic enucleation to prevent the rare occurrence of SO. When an eye requires removal, evisceration is an acceptable alternative to enucleation in cases that do not harbor intraocular malignancy.

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