Indications for ocular evisceration and orbital implant related complications in a tertiary eye hospital in Hungary over an 11-year period

AbstractPurposeOur aims were to evaluate the primary and clinical evisceration indications and to analyse orbital implant related complications.Materials/methodsWe included in our retrospective review all eviscerations between 2006 and 2016 at the Department of Ophthalmology of Semmelweis University, Budapest, Hungary. Primary evisceration indications were classified into six groups: trauma, surgical diseases, infections or inflammations, systemic diseases, tumours and unclassifiable diseases. Clinical immediate evisceration indications were also classified into six groups: painful blind eye due to glaucoma, atrophia/phthisis bulbi, endophthalmitis, cosmetic reasons, acute trauma and expulsive bleeding.ResultsEvisceration was performed in 46 eyes of 46 patients (54.3% males, age 43.0 ± 18.6 years). The most common primary evisceration indications were trauma (37%), surgical diseases (34.8%), infection or inflammation (10.9%), systemic diseases (6.5%), tumours (8.7%) and unclassifiable diseases (2.2%). Painful blind eye due to glaucoma (34.8%) was the most common clinical indication for evisceration, followed by atrophia/phthisis bulbi (26.1%), endophthalmitis (17.4%), cosmetic reasons (13.0%), acute trauma (6.5%) and expulsive bleeding (2.2%). After evisceration, 91.3% of the patients received orbital implant and during 26.8±28.9 months follow-up implant related complications were found in 14.3% of the cases, including implant extrusion (4.8%), partial wound dehiscence (4.8%), implant exposure (2.4%) and orbital inflammation (2.4%).ConclusionPainful blind eye and atrophia/phthisis bulbi due to ocular trauma and surgical diseases represent the most common indications for ocular evisceration. If malignant intraocular tumours can be excluded, evisceration surgery combined with a silicon-based orbital implant is a safe and effective procedure.

Download Full-text

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

Journal of Ophthalmology ◽

10.1155/2021/5588977 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Gábor Tóth ◽

Milán Tamás Pluzsik ◽

Béla Csákány ◽

Gábor László Sándor ◽

Olga Lukáts ◽

...

Keyword(s):

Ocular Trauma ◽

Care Center ◽

Clinical Indication ◽

Time Interval ◽

Eye Care ◽

Primary Indication ◽

Phthisis Bulbi ◽

Open Globe ◽

Department Of Ophthalmology ◽

The Mean

Purpose. To analyse the demographic and clinical characteristics of ocular traumas resulting in enucleation/evisceration in a large tertiary referral center in a developed country (Hungary) over a period of 15 years. Patients and Methods. A retrospective review of enucleated/eviscerated eyes that underwent surgery between 2006 and 2020 at the Department of Ophthalmology of Semmelweis University, Budapest, Hungary, due to ocular trauma as the primary indication for enucleation/evisceration. For each subject, clinical history, B-scan ultrasound report, and histopathology results were reviewed. Results. There were 124 enucleated/eviscerated eyes from 124 patients (91 males (73.4%)). The mean age at the time of trauma was 37.3 ± 26.0 years while the mean age at the time of enucleation/evisceration was 46.9 ± 20.3 years. The main clinical diagnoses after ocular trauma were open globe injury (n = 96; 77.4%), ocular burns (n = 6; 4.8%), traumatic optic neuropathy (n = 4; 3.2%), bulbar avulsion (n = 3; 2.4%), traumatic cataract (n = 2; 1.6%), retinal ablation (n = 1; 0.8%), and traumatic carotid-cavernous fistula (n = 1; 0.8%). Among the 124 patients, 98 (79.0%) underwent enucleation and 26 (21.0%) evisceration. Patients who underwent primary enucleation/evisceration (n = 24 19.4%) were significantly older at the time of the injury (57.7 ± 22.7 years) than people who underwent secondary eye removal (32.4 ± 24.4 years) ( p < 0.0001 ). The mean time interval between trauma and enucleation/evisceration was 114.9 ± 163.5 months. The main clinical indications for anophthalmic surgery were atrophia/phthisis bulbi (n = 56, 45.2%), acute trauma (n = 25, 20.2%), painful blind eye due to glaucoma (n = 17, 13.7%), endophthalmitis (n = 10, 8.1%), and cosmetic reasons (n = 7, 5.6%). One patient (0.8%) had sympathetic ophthalmia. Conclusions. Primary enucleation/evisceration was performed in one-fifth of all ocular trauma-related anophthalmic surgeries in our tertiary eye care center with enucleation being the most common procedure. Atrophia/phthisis bulbi was the most frequent immediate clinical indication for enucleation/evisceration.

Download Full-text

Clinicopathological Review of 547 Bulbar Enucleations in Hungary (2006–2017)

Journal of Ophthalmology ◽

10.1155/2019/2042459 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Gábor Tóth ◽

Nóra Szentmáry ◽

Gábor László Sándor ◽

Béla Csákány ◽

Erika Maka ◽

...

Keyword(s):

Developed Countries ◽

Systemic Diseases ◽

Spontaneous Perforation ◽

Referral Centre ◽

Developed Country ◽

Acute Trauma ◽

Patient Demographics ◽

Phthisis Bulbi ◽

Department Of Ophthalmology ◽

Study Population

Purpose. To analyse current clinicopathological enucleation indications in a large third-referral centre in a developed country (Hungary) over a period of 12 years. Methods. Retrospective review was performed on 547 enucleated eyes of 543 patients (48.6% males, age 52.7 ± 24.5 years) who were operated on between 2006 and 2017 at the Department of Ophthalmology of Semmelweis University, in Budapest, Hungary. For each subject, clinicopathological data, including patient demographics, indications for enucleation, B-scan ultrasound reports, operative details, and histopathological analyses, were reviewed. Primary enucleation indications were classified into trauma, tumours, systemic diseases, surgical diseases, infections or inflammations, miscellaneous diseases, and unclassifiable groups. Clinical immediate enucleation indications were classified as tumours, atrophia or phthisis bulbi, infection or inflammation, painful blind eye due to glaucoma, acute trauma, threatening or spontaneous perforation, cosmetic causes, and expulsive bleeding. Results. The most common primary enucleation indications were tumours (47.3%), trauma (16.8%), surgical diseases (15.7%), infection or inflammation (11.6%), systemic diseases (5.1%), miscellaneous diseases (2.0%), and unclassifiable diseases (1.5%). Clinical immediate enucleation indications were tumours (46.1%), atrophia or phthisis bulbi (18.5%), infection or inflammation (18.5%), painful blind eye due to glaucoma (11.2%), acute trauma (3.7%), threatening or spontaneous perforation (1.3%), cosmetic reasons (0.5%), and expulsive bleeding (0.4%). Conclusions. Intraocular tumours represent the most common clinicopathological indication for ocular enucleation in our study population. Following ocular trauma and systemic diseases, the rate of enucleation decreased in the last decade, compared to those previously reported in other developed countries. However, changes were not observed for surgical diseases, infectious and inflammatory causes, or for miscellaneous and unclassified diseases. Orbital implant financing should be increased to ensure better postoperative aesthetic rehabilitation, following enucleation in Hungary.

Download Full-text

Traumatic scleral wound dehiscence with filtering bleb formation after surgical repair of penetrating globe injury

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v5i1.7843 ◽

2013 ◽

Vol 5 (1) ◽

pp. 136-137 ◽

Cited By ~ 2

Author(s):

A Ozkaya ◽

Z Alkin ◽

Y Acet ◽

U Yigit

Keyword(s):

Surgical Repair ◽

Ocular Trauma ◽

Anterior Segment ◽

Wound Dehiscence ◽

Rare Occurrence ◽

Filtering Bleb ◽

Bleb Formation ◽

The Right ◽

Blunt Ocular Trauma

Backgropund: Filtering bleb formation after surgical repair of penetrating globe injury is a rare occurrence. Case: A 45-year-old male who had undergone surgical repair of a corneoscleral laceration 16 months earlier presented to emergency room after blunt trauma to the left eye. His best-corrected visual acuities were 20/20 in the right eye and 20/25 in the left. An anterior segment examination found a conjunctival filtering bleb formation on scarred sclera at superotemporal location near the limbus. Anterior chamber was slightly shallow and the Seidel test was negative. Intraocular pressures were 17 mm Hg in the right eye, 7 mm Hg in the left. The fundus examination revealed no abnormal findings. The patient was treated with topical aplication of a steroid and a cycloplegic drop during three weeks. After 16 months follow-up, the visual acuity remained unchanged with the persistence of filtering bleb. IOP was 8 mm Hg in the left eye. Follow-up examinations showed no complications related to trauma. Conclusion: Blunt ocular trauma can cause dehiscence in old scleral scars and subsequent filtering bleb formation. Nepal J Ophthalmol 2013; 5(9):136-137 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7843

Download Full-text

Profile of ocular trauma in patients presenting to the department of ophthalmology at Hawassa University: Retrospective study

PLoS ONE ◽

10.1371/journal.pone.0213893 ◽

2019 ◽

Vol 14 (3) ◽

pp. e0213893 ◽

Cited By ~ 1

Author(s):

Kindie Desta Alem ◽

Demoze Delelegn Arega ◽

Samson Tesfaye Weldegiorgis ◽

Bekalu Getahun Agaje ◽

Emebet Girma Tigneh

Keyword(s):

Retrospective Study ◽

Ocular Trauma ◽

Department Of Ophthalmology ◽

Hawassa University

Download Full-text

Profile vs Tubular Plate in Unimalleolar or Bimalleolar Fractures: is There a Real Difference in Wound complications?

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00158 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0015

Author(s):

Paolo Ceccarini ◽

Rosario Petruccelli ◽

Michele Bisaccia ◽

Giuseppe Rinonapoli ◽

Auro Caraffa

Keyword(s):

Wound Dehiscence ◽

Deep Infection ◽

Ankle Fractures ◽

Bone Union ◽

Wound Complications ◽

Fisher Exact Test ◽

Superficial Infection ◽

Operative Care ◽

Group B

Category: Ankle; Trauma Introduction/Purpose: The aim of our study is to compare two types of plates, one third tubular plate and LCP distal fibula plate, evaluating the clinical outcome and the skin complications associated with their use. Methods: We collected the data of 122 consecutive unimalleolar or bimalleolar fractures treated by internal fixation for a closed, displaced distal closed fibular fracture. Exclusion criteria were: 1) open ankle fractures,2) trimalleolar fractures, 3) previous ankle fractures 4) severe venous insufficiency, 5) ankleosteoarthritis previous to surgery, 6) associated ankle dislocation. After this selection, 93 patients were included in our study and assigned in two groups, based on using of different implant: in group A48 patients were treated with one-third tubular and in group B 45 patients were treated with LCP distalfibula plate. There were no significant differences in the baseline characteristics. Patients received the same surgical procedure and the same post-operative care, then they were radiologically evaluated at1-3-12 months and clinical examination was made at 24 (range 15-36) months using AOFAS clinical rating system. All data were evaluated using chi-square test. Results: At the final 24-month follow-up a comparison between the two groups showed no statistical significant differences in reduction accuracy and bone union ratio at radiological examination. The wound complications rate of the overall study group was 7.6%. There were no statistical differences in the rate of wound complications between the two groups. There were no differences between both group in percentage of hardware removal at follow-up (overall 5.4%). In the group A occurred 1 deep infection, 2 superficial infection, no wound dehiscence; in group B occured 1 deep infection, 1 superficial infection and 2 wound dehiscence. There were no statistical differences in the rate of wound complications between the two groups (p=0.70; Fisher exact test). Conclusion: Our study has shown no difference in radiographic bone union rate, no significant differences in terms of clinical outcomes, in time of bone reduction and wound complication rate between the LCP distalfibula plate and conventional one-third tubular plate. RCT or metanalasys are in this case useful to improve scientific evidence and give more information for the correct surgical treatment of ankle fractures.

Download Full-text

Preoperative multidisciplinary program for bariatric surgery: a proposal for the Brazilian Public Health System

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.2017v54n1-14 ◽

2017 ◽

Vol 54 (1) ◽

pp. 70-74 ◽

Cited By ~ 16

Author(s):

Elinton Adami CHAIM ◽

José Carlos PAREJA ◽

Martinho Antonio GESTIC ◽

Murillo Pimentel UTRINI ◽

Everton CAZZO

Keyword(s):

Public Health ◽

Bariatric Surgery ◽

Health System ◽

Public Health System ◽

Wound Dehiscence ◽

Pulmonary Complications ◽

Multidisciplinary Program ◽

The Impact ◽

Access To Surgery

ABSTRACT BACKGROUND Bariatric surgery has become the gold standard treatment for morbid obesity, but access to surgery remains difficult and low compliance to postoperative follow-up is common. To improve outcomes, enable access and optimize follow-up, we developed a multidisciplinary preoperative approach for bariatric surgery. OBJECTIVE To determine the impact of this program in the outcomes of bariatric surgery in the Brazilian public health system. METHODS A prospective evaluation of the individuals who underwent a preoperative multidisciplinary program for bariatric surgery and comparison of their surgical outcomes with those observed in the prospectively collected historical database of the individuals who underwent surgery before the beginning of the program. RESULTS There were 176 individuals who underwent the multidisciplinary program and 226 who did not. Individuals who underwent the program had significantly lower occurrence of the following variables: hospital stay; wound dehiscence; wound infection; pulmonary complications; anastomotic leaks; pulmonary thromboembolism; sepsis; incisional hernias; eventrations; reoperations; and mortality. Both loss of follow-up and weight loss failure were also significantly lower in the program group. CONCLUSION The adoption of a comprehensive preoperative multidisciplinary approach led to significant improvements in the postoperative outcomes and also in the compliance to the postoperative follow-up. It represents a reproducible and potentially beneficial approach within the context of the Brazilian public health system.

Download Full-text

The Impact of Combat Ocular Trauma and Traumatic Brain Injury on Vision- and Health-Related Quality of Life Among U.S. Military Casualties

Military Medicine ◽

10.1093/milmed/usab233 ◽

2021 ◽

Author(s):

Rose K Sia ◽

Denise S Ryan ◽

Daniel I Brooks ◽

Janice M Kagemann ◽

Kraig S Bower ◽

...

Keyword(s):

Quality Of Life ◽

Traumatic Brain Injury ◽

Ocular Trauma ◽

Health Related Quality ◽

Sf 36 ◽

Related Quality ◽

Health Related ◽

Composite Scores

ABSTRACT Purpose The purpose of this study was to assess visual and health-related quality of life (QOL) among U.S. military service members who sustained combat ocular trauma (COT) with or without associated traumatic brain injury (TBI). Methods This was a single-center, prospective observational study of U.S. service members (n = 88) with COT who were treated at Walter Reed National Military Medical Center. Participants completed the National Eye Institute Visual Function Questionnaire (VFQ-25) at enrollment and at follow-up (>1 year) and supplemental surveys: Neurobehavioral Symptom Inventory, the Medical Outcomes 36-item Short Form Survey (SF-36), and Mayo-Portland Adaptability Inventory. Results Initial and follow-up VFQ-25 showed a statistically significant increase in median scores for near activities (initial: 75.0, follow-up 83.3; P = .004) and peripheral vision (initial: 50.0, follow-up: 75.0; P = .009) and in composite scores (initial: 79.5, follow-up: 79.8; P = .022). Comparing those who did (n = 78) and did not (n = 8) have a TBI history, there were no significant differences in median change in VFQ-25 composite scores (with TBI: 2.3 vs. no TBI: 10.7; P = .179). Participants with a TBI history had a significantly lower median SF-36 General Health score (with TBI: 67.5 vs. no TBI: 92.5; P = .009) Conclusions Vision-related QOL of COT patients is generally good in the long term. However, those with both COT and a history of TBI conditions showed significantly worse functioning in several domains than those without TBI. As TBI is a common finding in COT, this association is an important factor impacting this population’s overall clinical presentation and daily functions.

Download Full-text

Pattern of Intra Ocular Foreign Bodies in a Tertiary Care Hospital of Punjab

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v37i1.1071 ◽

2020 ◽

Vol 37 (1) ◽

Author(s):

Usama Iqbal ◽

Irfan Qayyum Malik ◽

Zeeshan Hameed ◽

Sadia Hameed

Keyword(s):

Retinal Detachment ◽

Foreign Bodies ◽

Operative Procedure ◽

Tertiary Care ◽

Hand Movement ◽

College Teaching ◽

Care Hospital ◽

Phthisis Bulbi ◽

Department Of Ophthalmology ◽

Epidemiological Characteristics

Purpose: To describe the epidemiological characteristics, management strategies and outcomes of intraocular foreign bodies (IOFB) presented in a tertiary care setup of Punjab. Study Design: Descriptive retrospective study. Place and Duration: Department of ophthalmology, Gujranwala medical college/teaching hospital, from January 2017 to December 2019. Methods: A retrospective review, of all the patients who had IOFB removal, was performed. Information regarding the nature and circumstances of injury, types of IOFB, operative procedure performed and patient’s pre-operative and post-operative Best Corrected Visual Acuity (BCVA) were analyzed. Descriptive statistics were used for analysis of data. Results: Record of 22 patients was retrieved. Out of which 18 (81.81%) were male and 4 (18.18%) were female. Mean age was 27.95 ± 9.325 years. Occupational trauma was the leading cause of injury (66.6%). Metallic objects were among the most common type of IOFB (66.6%) followed by glass, concrete stone (each 13.3%) and lead pencil (6.6%). Serious complications seen due to retained IOFB were phthisis bulbi (9.09%), retinal detachment (13.63%) and endophthalmitis (9.09%). On follow-up, 10 patients had BCVA less than hand movement (HM). 5 patients had BCVA of CF to 6/60, 3 patients had BCVA of 6/60-6/24 and 4 patients had better than 6/18. Conclusion: Most common cause of IOFB was occupational trauma and young age group of working class was the most common population affected. Treatment delay and complications contributed to poor prognosis. Ocular safety measures during high-risk work can reduce the risk of trauma. Key Words: Intra-ocular foreign Bodies, Retinal Detachment, Phthisis Bulbi.

Download Full-text

Complete reconstruction of anterior segment surgery for a patient with traumatic cataract and iris defects: a case report

10.21203/rs.2.227/v1 ◽

2019 ◽

Author(s):

Zhenyu Wang ◽

Xuemin Li

Keyword(s):

Ocular Trauma ◽

Anterior Segment ◽

Posterior Segment ◽

Traumatic Cataract ◽

Case Presentation ◽

Iris Defect ◽

Uncorrected Visual Acuity ◽

Posterior Synechia ◽

Anterior Segment Surgery

Abstract Background: Ocular trauma has relationship with variable damage towards anterior segment or posterior segment. Among them, cornea, iris and lens are vulnerable to injury. For patients with traumatic cataract and other anterior segment trauma， complete reconstruction of anterior segment surgery can be a good option to restore patients’ anterior segment that helps them regain their vision. Case presentation: We presented a case of traumatic cataract with iris defects after explosive trauma. A surgery was done to fully reconstruct the anterior segment of the patient’s left eye including separating posterior synechia of iris, removing cataract and implantation of IOL. Postoperatively, the patient didn’t complain about photophobia anymore and the uncorrected visual acuity (UCVA) of the patient reached from counting fingers to 20/25 and remained stable on follow-up at 1 week and 1 month. Conclusion: Our case suggested the importance of completely reconstruct anterior segment for patients who have traumatic cataract with traumatic iris defects and its benefits for society. Keywords: Traumatic cataract; Traumatic iris defect; Surgery

Download Full-text

Comparison of Snodgross and para-meatal based flap technique for hypospadiasis

Annals of King Edward Medical University ◽

10.21649/akemu.v12i2.900 ◽

2016 ◽

Vol 12 (2) ◽

Author(s):

Jaffry S A H ◽

Naveed Iqbal ◽

Muhammad Nazir ◽

Khuda Dad Tarrar

Keyword(s):

Clinical Intervention ◽

Wound Dehiscence ◽

University Hospital ◽

Flap Technique ◽

External Meatus ◽

Good Cosmetic ◽

Watertight Closure ◽

The Mean ◽

Complications Rate

Objective: To compare the two surgical procedures Snod gross & parameatal based flap technique for mid & distal penile hypospadias including cosmosis. Study design: Randomized Clinical interventional trail. Place of study: This study was conducted in the Urology Department of Assir Central University Hospital ABHA, KSA and Department of Urology & Renal transplantation, Jinnah Hospital, Lahore from June 2002 to Dec 2004. Material & Methods: Thirty-two patients were selected for this randomized clinical intervention study with mid shaft & distal hypospadias fulfilling the inclusion criteria. Snod Gross and parameatal based flap technique was assigned randomly to patients comprising of two groups of sixteen each. Watertight closure was made with 6/0 vicryl. Tourniquet or 1:10000 epinephrine were used. Follow up at 2 weeks, three months; 6 months post catheter or stent removal and the patient were assessed on criteria of cosmosis, time for surgery and complications associated with the procedure. Results: Th irty-two patients who underwent procedure of Snodgross & parameatal-based flap in the management of mid shaft & distal penile Hypospadias. Age ranged from 2-12 years. The mean age was 5.23+4 years. The presentation of patients was dystocia of external meatus with misdirected stream in sixteen (50%) patients, spraying of urine in six (25%) and narrow stream in 4(13%) patients. Eighteen patients were having distal penile and fourteen were having mid shaft hypospadias. Following Snod grass technique all patients had good cosmetic results without any complication. Following parameatal based flap, one patients (6.3%) develop wound dehiscence, three patients (18.8%) develop urethral fistula, two patients (12.5%) showed metal retrieval and twenty patients showed good cosmosis. In our study, comparison between Snodgross & parameatal-based flap, the success rate was 100% and 62.4% respectively. Conclusions: Success with Snod gross procedure is better with no complications and good cosmosis. Complications rate was 37.6 % in-patient with para-meatal technique.

Download Full-text