<p>Clinical Characteristics and Outcomes in Patients Undergoing Primary or Secondary Enucleation or Evisceration After Ocular Trauma</p>

Abstract

Purpose To investigate the frequency of primary versus secondary eye removal, frequency of enucleation versus evisceration, and characteristics and outcomes of patients undergoing these procedures after presenting with severe ocular trauma. Patients and Methods Retrospective chart review of patients presenting to the emergency department (ED) with severe eye trauma necessitating enucleation or evisceration between 2010 and 2018. Results There were 92 eyes from 90 patients included in our study. Twenty-seven percent of eyes underwent primary removal (n=25, 14 enucleation, 11 evisceration), while 73% of eyes underwent secondary removal (n=67, 50 enucleation, 17 evisceration). The mean patient age was 45.2 years (range 4.2–92.6); primary enucleation/evisceration patients were older on average than secondary eye removal patients [53.8 years (range 15.9–91.2) versus 42.2 years (range 4.2–91.6 years), p=0.04]. A median of 34 days passed between ED presentation and secondary enucleation/evisceration. Before undergoing secondary enucleation/evisceration, patients underwent a median of one ocular procedure (range 0–14) for various complications of trauma including orbital infection, choroidal or retinal tear or detachment, and wound dehiscence. Open globe injury repairs comprised 43 of the 92 total procedures (47%) performed prior to secondary enucleation/evisceration. Secondary enucleations/eviscerations required a median of seven clinic visits compared to two clinic visits required after primary surgeries (p<0.01). 10.7% of all patients (n=10) had at least one implant-related complication following enucleation/evisceration, with all but one of these patients being in the secondary enucleation/evisceration group. Conclusion Primary enucleation or evisceration was performed in 27% of all eye removals, and enucleation was performed in 69.6% of all eye removals. Future research is warranted to determine if primary eye removal may be appropriate and when to consider enucleation versus evisceration.

Clinical Review of Ocular Traumas Resulting in Enucleation or Evisceration in a Tertiary Eye Care Center in Hungary

“…In our sample, mean age at the time of enucleation/ evisceration due to ocular trauma (46.9 years) was similar to the findings of de Gottrau et al in Germany [12] (44.2 years) and Gauthier et al [5] in the USA (45.2 years). Predominance of males (73.4%) was also similar to the international trends: 79% in Germany [12], 80.9% in Turkey [13], 81.3% in China, [14] and 75% in the USA [6].…”

“…Similar to the study by Sigurdsson et al in Iceland [ 19 ], most of the injuries occurred at home and at the workplace with assault being uncommon in our sample. In contrast, assault and gunshot accidents represent the most common etiological factors in trauma-related anophthalmic surgeries in the USA, as reported by Gauthier et al [ 5 ]. This difference can be explained with the different firearm regulations in the USA and Hungary, as purchase of handguns is very strictly regulated in Hungary.…”

“…Nevertheless, enucleation or evisceration (enucleation/evisceration) should be considered in cases with a visual acuity of no light perception (NLP) in order to prevent sympathetic ophthalmia or to reduce pain [ 4 ]. However, there are no available definitive guidelines when primary enucleation/evisceration should be performed in cases of ocular trauma [ 5 ].…”

“…Several previous studies have analysed ocular injuries that have resulted in enucleation/evisceration in different countries [ 5 – 7 ], but there is no current information available for European countries.…”

“…Several previous studies have analysed ocular injuries that have resulted in enucleation/evisceration in different countries [5][6][7], but there is no current information available for European countries. e primary aim of this study was to analyse the demographic and clinical characteristics of ocular traumas that resulted in enucleation/evisceration, as well as the frequency of enucleation versus evisceration, and the frequency of primary versus secondary enucleation/evisceration in a tertiary eye care center in a European developed country (Hungary) over a period of 15 years.…”