Photo Credit: Pawel Kacperek

The following is a summary of “Risk of sympathetic ophthalmia associated with open-globe injury management strategies: A meta-analysis,” published in the May 2024 issue of Ophthalmology by Patterson et al.

Sympathetic ophthalmia (SO) is a severe eye condition caused by a triggering event. Debate exists over whether it’s better to remove the eye or repair it after an open-globe injury (OGI).

Researchers conducted a retrospective study reviewing whether SO happens more after repairing the eye or removing it post-OGI.

They searched five journal databases and registered the review with the International Prospective Register of Systematic Reviews (identifier CRD42021262616). The searches were done on June 29, 2021, and updated on December 10, 2022. Prospective or retrospective studies were included if they reported outcomes in patients with primary repair, primary enucleation, or evisceration. Random effects modeling was used to estimate pooled SO rates and absolute risk reduction (ARR).

The results included Eight studies reporting SO as an outcome along with 7,500 patients and 7635 OGIs. Among these 7,620 OGIs criteria-met patients analyzed, 21 resulted in SO. The estimated SO rate after OGI was 0.12% (95% CI: 0.00%-0.25%). No SO cases were reported among the 779 patients undergoing primary enucleation or evisceration (0.05%, 95% CI: 0.00%-0.21%). For primary repair, the SO rate was 0.15% (95% CI, 0.00%-0.33%). The ARR was -0.0010 (indicating a slight advantage for eye removal; 95% CI, -0.0031 [in favor of eye removal] to 0.0011 [in favor of primary repair]). The certainty of evidence could have been higher due to observational studies and missing data bias. 

Investigators concluded that, based on the data, there is no proof that removing the eye initially lowers the risk of secondary SO.

Source: sciencedirect.com/science/article/pii/S0161642023008874