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  • Repair Rather Than Enucleation May Be Better for Preventing Sympathetic Ophthalmia

    Oculoplastics/Orbit

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    Review of: The risk of sympathetic ophthalmia associated with open-globe injury management strategies: A meta-analysis

    Patterson T, Kedzierski A, McKinney D, et al. Ophthalmology, May 2024

    A systematic review and meta-analysis compared the incidence of sympathetic ophthalmia (SO) after primary repair vs after primary enucleation/evisceration in patients with full-thickness open-globe injury (OGI).

    Study Design

    Eight studies examining SO as an outcome after full-thickness OGI, encompassing 7620 OGIs, were included in this analysis. Studies with <10 patients were excluded.

    Outcomes

    The pooled estimated SO rate for all included studies was 0.12%. In those patients who underwent primary enucleation or primary evisceration for OGI, no SO cases were reported, for a pooled estimated SO rate of 0.05%. The pooled estimated SO rate in the primary repair population was 0.15%. Estimated absolute risk reduction calculation yielded a number-needed-to-treat of 323 enucleations/eviscerations needed to prevent 1 case of SO.

    Limitations

    Due to the rare nature of SO, there were no prospective or randomized studies that met inclusion criteria.

    Clinical Significance

    Given the generally low rates of SO seen in the primary repair group and the typically good prognosis if SO is treated early and effectively, many physicians and patients may want to consider primary repair rather than removal of the eye as the first step in treating a full-thickness OGI. With close monitoring, this could present a less emotionally charged and more optimistic approach to managing these challenging situations.

    Financial Disclosures: Dr. Anne Barmettler discloses no financial relationships.