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

Uveitis epidemiology sympathetic ophthalmia trauma

Journal

Ophthalmology
ISSN: 1549-4713
Titre abrégé: Ophthalmology
Pays: United States
ID NLM: 7802443

Informations de publication

Date de publication:
10 Dec 2023
Historique:
received: 17 08 2023
revised: 06 12 2023
accepted: 06 12 2023
medline: 13 12 2023
pubmed: 13 12 2023
entrez: 12 12 2023
Statut: aheadofprint

Résumé

Sympathetic ophthalmia (SO) is a sight threatening granulomatous panuveitis caused by a sensitizing event. The use of primary enucleation or primary evisceration, versus primary repair, as a risk management strategy following OGI remains controversial. This systematic review was conducted to report the incidence of SO after primary repair compared to after primary enucleation or primary evisceration. This enabled the reporting of an estimated number needed to treat (NNT). Five journal databases were searched. This review was registered with PROSPERO: CRD42021262616. Searches were carried out on 29 Eight studies reporting SO as an outcome were included in total. The included studies contained 7500 patients and 7635 OGIs. In total 7620 OGIs met the criteria for inclusion in this analysis; 21 developed SO. When all included studies were pooled, the estimated SO rate was 0.12% (95% confidence interval (CI) 0.00% to 0.25%) after OGI. Out of 779 patients who underwent primary enucleation or primary evisceration no SO cases were reported, resulting in pooled SO estimate of 0.05% (95% CI 0.00% - 0.21%). For primary repair, the pooled estimate of SO rate was 0.15% (95% CI 0.00% to 0.33%). The ARR using a random effects model was -0.0010 (in favour of eye removal) (95% CI -0.0031 (in favour of eye removal) to 0.0011 (in favour of primary repair)). GRADE analysis highlighted a low certainty of evidence, as the included studies were observational and there was a risk of bias from missing data. Based on the available data, there is no evidence that primary enucleation or primary evisceration reduce the risk of secondary SO.

Identifiants

DOI: 10.1016/j.ophtha.2023.12.006 PMID: 38086434
pubmed: 38086434
pii: S0161-6420(23)00887-4
doi: 10.1016/j.ophtha.2023.12.006
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023. Published by Elsevier Inc.

Auteurs

Tim J Patterson (TJ)

Northern Ireland Medical and Dental Training Agency (NIMDTA).

Adam Kedzierski (A)

Frimley Health NHS Trust.

David McKinney (D)

Northern Ireland Medical and Dental Training Agency (NIMDTA).

Jonathan Ritson (J)

Cambridge University Hospitals NHS Trust; Royal Centre for Defence Medicine, Birmingham, UK.

Chris McLean (C)

Epsom and St Helier University Hospitals NHS Trust.

Weidong Gu (W)

Vision Center of Excellence, Research & Development Directorate, J-9, Defence Health Agency, Silver Spring, MD.

Marcus Colyer (M)

Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, USA.

Scott F McClellan (SF)

Vision Center of Excellence, Research & Development Directorate, J-9, Defence Health Agency, Silver Spring, MD.

Sarah C Miller (SC)

Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Grant A Justin (GA)

Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, USA; Duke Eye Center, Duke University Hospitals, Durham, NC, USA.

Annette K Hoskin (AK)

The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia; Lions Eye Institute, University of Western Australia, Perth, Australia.

Kara Cavuoto (K)

Bascom Palmer Eye Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.

James Leong (J)

The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia; The University of Sydney, Save Sight Institute, Faculty of Medicine and Health, Sydney, NSW, Australia.

Andrés Rousselot Ascarza (AR)

Consultorios Oftalmológicos Benisek-Ascarza, Ciudad Autónoma de Buenos Aires, C1115ABB Buenos Aires, Argentina.

Fasika A Woreta (FA)

Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Kyle E Miller (KE)

Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, USA; Department of Ophthalmology, Navy Medical Center Portsmouth, Portsmouth, Virginia.

Matthew C Caldwell (MC)

Department of Ophthalmology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX.

William G Gensheimer (WG)

Dartmouth-Hitchcock Medical Center, Lebanon, NH; White River Junction Veterans Administration Medical Center, White River Junction, VT, USA.

Tom Williamson (T)

Department of Ophthalmology, St Thomas Hospital, London, SE1 7EH, UK.

Felipe Dhawahir-Scala (F)

Manchester Royal Eye Hospital, Manchester, UK.

Peter Shah (P)

Birmingham Institute for Glaucoma Research, Birmingham, UK; Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

Andrew Coombes (A)

Department of Ophthalmology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, UK.

Gangadhara Sundar (G)

Department of Ophthalmology, National University Hospital, Singapore.

Robert A Mazzoli (RA)

Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, USA.

Malcolm Woodcock (M)

Worcestershire Acute Hospitals NHS Trust, Worcester, UK.

Stephanie L Watson (SL)

The University of Sydney, Save Sight Institute, Faculty of Medicine and Health, Sydney, NSW, Australia.

Ferenc Kuhn (F)

Helen Keller Foundation for Research and Education, Birmingham, AL, USA.

Sophia Halliday (S)

BRAVO VICTOR, Research & Innovation, 12-14 Harcourt Street, London, W1H 4HD, UK.

Renata S M Gomes (RSM)

BRAVO VICTOR, Research & Innovation, 12-14 Harcourt Street, London, W1H 4HD, UK; Northern Hub for Veterans and Military Families Research, Northumbria University, Newcastle, UK.

Rupesh Agrawal (R)

National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Singapore Eye Research Institute, Singapore; Lee Kong Chian School of Medicine, Singapore; Duke NUS Medical School, Singapore.

Richard J Blanch (RJ)

Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Neuroscience & Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK. Electronic address: blanchrj@bham.ac.uk.

Classifications MeSH