Article
Years of study
N of injured eyes
N of sympathetic ophthalmia
Rofail 2006 [14]
1992–2003
273
1 (0.4 %)
Casson 2002 [9]
1994–1998
109
1 (0.9 %)
Savar 2009 [15]
2000–2007
660
2 (0.3 %)
du Toit 2008 [16]
1995–2004
1392
2 (0.14 %)
Gürdal 2002 [10]
1970–2000
217
0 (0 %)
Zhang 2009 [17]
2001–2005
9103
18 (0.37 %)
Mansouri 2009 [18]
1998–2003
2340
2 (0.08 %)
Even when sympathetic ophthalmia develops, most patients can still retain good vision with proper treatment, including corticosteroid and immunomodulators [19]. Castiblanco summarized 86 cases reported in literature and found that 70 % patients had improved visual acuity in the sympathizing eye. Even in 58.2 % patients had a visual acuity of at least 20/40 [20]. Galor reported that within 85 cases with sympathetic ophthalmia, the vision outcome was better than 20/50 in 59 % of the sympathizing eyes and better than 20/200 in 75 % of the sympathizing eyes [19]. Therefore, prophylactic enucleations to prevent sympathetic ophthalmia may not be indicated. It has been reported that time trends in enucleating eyes showed the number of enucleations for trauma had dropped during the 10-year period 1986–1995 compared to 1976–1985 [21].
The second option is observation. Salehi-Had reported that in 88 cases with open globe injury with NLP, 23 (26.1 %) spontaneously recovered to light perception (LP) after primary repair. Among them, eight received vitreoretinal surgery. Finally, five of them gained vision, two remained LP, and the other one was NLP. All the other 15 eyes that did not receive vitrectomy lost light perception or became phthisical [7].
In situations in which the eyes become phthisical and there is persistent pain in the eye, enucleation or evisceration seems inevitable. However, before making a final decision, possible options should be discussed with the patient. Some patients may want to keep their useless eye rather than enucleation or evisceration because the latter option would cause great psychological impact on the patient.
The third option is vitreoretinal surgery. The cause of NLP after open globe injury may be reversible and can be restored by vitreoretinal surgery, such as dense vitreous hemorrhage, retinal detachment, subretinal hemorrhage, etc. With the advances in equipment and techniques in vitreoretinal surgery, these conditions can be successfully managed. It has been reported that some eyes with NLP after severe open globe injury may recover to at least light perception after vitreoretinal surgery. Table 7.2 summarized the literature revealing that 23–88.9 % of patients regained light perception after vitreoretinal surgery. Up to 33.4 % of the patients could even gain vision equal or better than 20/200 [22]. Figures 7.1 and 7.2 demonstrate two cases which recovered from NLP after vitreoretinal surgery for open globe injury.
Table 7.2
Summary of literature reports on visual outcome of vitreoretinal surgery for open globe ocular injuries with no light perception
Articles | n | > = LP | LP | HM | CF-20/400 | > = 20/400 |
|---|---|---|---|---|---|---|
Hui 1996 [23] | 10 | 6 (60 %) | NR | NR | NR | NR |
Dong 2002 [24] | 11 | 7 (63.6 %) | 1 (9 %) | 3 (27 %) | 2 (18 %) | 1 (9 %) |
Yan 2006 [25] | 7 | 5 (71.4 %) | 1 (14.3 %) | 2 (28.6 %) | 1 (14.3 %) | 1 (14.3 %) |
Wang 2007 [26] | 38 | 21 (55.3 %) | 10 (26.3 %) | 3 (7.9 %) | 5 (13.2 %) | 3 (7.9 %) |
Heidari 2010 [22] | 18 | 16 (88.9 %) | 3 (16.7 %) | 4 (22.2 %) | 3 (16.7 %) | 6 (33.3 %) |
Feng 2011 [27] | 33 | 18 (54.50 %) | 4 (12.1 %) | 1 (3 %) | 8 (24.2 %) | 5 (15.2 %) |
Agrawal 2012 [28] | 27 | 9 (33.30 %) | NR | NR | NR | NR |
Soni 2013 [29] | 73 | 17 (23 %) | 5 (6.8 %) | 9 (12.3 %) | 2 (2.7 %) | 1 (1.4 %) |
Yang 2013 [30] | 19 | 12 (63.2 %) | 3 (15.8 %) | 1 (5.3 %) | 6 (31.6 %) | 2 (10.5 %) |
Han 2015 [31] | 5 | 4 (80 %) | 1 (20 %) | 3 (60 %) | 0 | 0 |
Fig. 7.1
A case recovered from no light perception (NLP) after surgery for open globe injury. A 59-year-old male presented with NLP after assaulted by fist. A scleral rupture was identified 15 mm posterior to the limbus with measured length of 20 mm (a, b). The wound was repaired immediately. Ultrasound showed signs indicating intraocular hemorrhage, retinal detachment, and choroidal detachment (c). Four weeks later, vitreoretinal surgery was performed. After clear of vitreous hemorrhage, retinal incarceration was found at temporal side (d). Retinotomy (e) and laser photocoagulation (f) were performed followed by silicone oil tamponade. The retina was reattached successfully (g). Six months later, retina remained attached but an epiretinal membrane developed (h, j). Five months after silicone oil removal and epiretinal membrane peeling, the retina remained attached (i, k), and the best corrected visual acuity was 20/160
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