Sympathetic Uveitis Following Glaucoma Surgery

Shammas, Hanna F.; Zubyk, Nicholas A.; Stanfield, Thomas F.

doi:10.1001/archopht.1977.04450040104015

Cited by 13 publications

(3 citation statements)

References 22 publications

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“…It is also seen after 23-guage vitrectomy, cataract extraction, retinal detachment surgery, penetrating keratoplasty and trabeculectomy [2][3][4][5][6][7] . The injured eye is called exciting eye and the fellow eye which also develops uveitis is called sympathizing eye.…”

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confidence: 44%

Sympathetic ophthalmitis: A rare case presentation

Panjiyar

Parihar

2016

J. Kathmandu Med. Coll.

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confidence: 44%

Sympathetic ophthalmitis: A rare case presentation

Panjiyar

Parihar

2016

J. Kathmandu Med. Coll.

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“…15,16,38,[52][53][54][55][56][57][58][59] The incidence of SO following intraocular surgery has always been less than that associated with nonsurgical trauma with reported rates of 0.1%-0.13%. 6,7,9,15,38,[60][61][62][63][64][65][66][67][68][69][70] Vitreoretinal surgery is the most common intraocular surgery that may potentially cause SO with some authors suggesting it may be a more common cause than trauma. 15,38,54 SO may occur in up to1 in 800 (0.13%) pars plan vitrectomy procedures, yet the performance of this procedure rarely raises concern about SO since vitrectomy is usually carried out to salvage visual function.…”

Section: Sympathetic Ophthalmiamentioning

confidence: 99%

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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“…Because of the increased awareness of this complication and the wide usage of antibiotics and corticosteroids the incidence of typical sympathetic ophthalmitis appears to have fallen considerably, though there are still occasional reports of such complications even after sterile wounds such as are made in routine intraocular surgery (Shammas et al, 1977). It is possible, however, that this apparent decrease in incidence may be due to the failure of clinical and histological diagnosis, at least in some unilateral cases, either because of early enucleation before the characteristic histological changes have appeared, or because the tissue response has been substantially modified by better wound repair and possible concomitant steroid therapy.…”

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confidence: 99%