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Material risk: vitreoretinal surgery, evisceration, enucleation and sympathetic ophthalmia—where are we currently?

Eye volume 37, pages 3542–3550 (2023)Cite this article

Subjects

Abstract

Sympathetic ophthalmia (SO) is known to occur after severe penetrating eye injury, evisceration and even enucleation surgery. Recent evidence suggests that a greater risk lies after multiple vitreoretinal procedures. The risk of SO following evisceration is only minimally greater than that following enucleation surgery. This review evaluates literature on SO to date and provides figures for the risk of developing SO for the purposes of the consent process. The issue of SO and Material Risk following vitreoretinal surgery is reviewed and figures for the purposes of consent are outlined. This is of particular relevance for patients in whom the contralateral eye is and will likely remain the better seeing eye. Sympathetic ophthalmitis is known to occur after severe penetrating eye injury, after evisceration and enucleation. More recently, sympathetic ophthalmitis has been recognised to occur after vitreoretinal surgery. This article reviews the evidence on material risk when consenting patients for elective and emergency eye procedures after ocular trauma or surgery. When a globe needs to be removed because of irreparable ocular injury, previous publications dictated the procedure to be an enucleation because of the fear of an increased risk of SO after an evisceration. Perhaps the issue of material risk of sympathetic ophthalmia (SO) remains over-emphasised by ophthalmic plastic surgeons and under-recognised by vitreoretinal surgeons during the consent process for evisceration, enucleation and vitreoretinal surgery. Antecedent trauma and number of previous surgeries may actually be a more significant risk factor than the type of eye removal. Recent medicolegal cases also help us understand the importance of the discussion of this risk. We present our current understanding of the risk of SO after different procedures and suggest how this information may be included in a patient consent.

摘要

众所周知, 交感性眼炎 (SO) 发生在严重的眼部穿通伤、眼球内容物摘除术甚至全眼摘除术后。最近的证据表明, 在多次玻璃体视网膜手术后风险更高。眼球内容物摘除术后SO的风险仅略高于全眼摘除术后的风险。本文评估了迄今为止关于SO的文献, 提供了患SO的风险数据以供知情同意过程使用。本文还回顾了玻璃体视网膜手术后的SO和材料风险问题, 并提供相关数据以供知情同意过程中使用。

这与对侧眼现在或未来可能恢复更佳视力的患者尤为相关。

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Funding

Supported in part by an Unrestricted Grant from Research to Prevent Blindness, Inc., New York, NY, to the Department of Ophthalmology & Visual Sciences, University of Utah. KU and RM are currently or were previously employees of the National Health Service, UK.

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  1. Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, RH19 3DZ, UK

    K. Ullrich & R. Malhotra

  2. Department of Ophthalmology, Queen Elizabeth Hospital, 28 Woodville Road, Woodville, SA, Australia

    K. Ullrich

  3. Department of Ophthalmology, Division of Ophthalmic Plastic and Reconstructive Surgery, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA

    B. C. K. Patel

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Concept Design—RM, BCKP. Background research/Literature review—KU, RM, BCKP. Creation and revision of paper—KU, RM, BCKP. Statistical analysis/Risk Calculations—BCKP.

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Correspondence to K. Ullrich.

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Ullrich, K., Patel, B.C.K. & Malhotra, R. Material risk: vitreoretinal surgery, evisceration, enucleation and sympathetic ophthalmia—where are we currently?. Eye 37, 3542–3550 (2023). https://doi.org/10.1038/s41433-023-02562-4

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