The Risk of Sympathetic Ophthalmia Associated with Open-Globe Injury Management Strategies: A Meta-analysis

Tim J. Patterson; Adam Kedzierski; David McKinney; Jonathan Ritson; Chris McLean; Weidong Gu; Marcus Colyer; Scott F. McClellan; Sarah C. Miller; Grant A. Justin; Annette K. Hoskin; Kara Cavuoto; James Leong; Andrés Rousselot Ascarza; Fasika A. Woreta; Kyle E. Miller; Matthew C. Caldwell; William G. Gensheimer; Tom Williamson; Felipe Dhawahir-Scala; Peter Shah; Andrew Coombes; Gangadhara Sundar; Robert A. Mazzoli; Malcolm Woodcock; Stephanie L. Watson; Ferenc Kuhn; Sophia Halliday; Renata S.M. Gomes; Rupesh Agrawal; Richard J. Blanch

doi:10.1016/j.ophtha.2023.12.006

The Risk of Sympathetic Ophthalmia Associated with Open-Globe Injury Management Strategies: A Meta-analysis

Tim J. Patterson, Adam Kedzierski, David McKinney, Jonathan Ritson, Chris McLean, Weidong Gu, Marcus Colyer, Scott F. McClellan, Sarah C. Miller, Grant A. Justin, Annette K. Hoskin, Kara Cavuoto, James Leong, Andrés Rousselot Ascarza, Fasika A. Woreta, Kyle E. Miller, Matthew C. Caldwell, William G. Gensheimer, Tom Williamson, Felipe Dhawahir-ScalaPeter Shah, Andrew Coombes, Gangadhara Sundar, Robert A. Mazzoli, Malcolm Woodcock, Stephanie L. Watson, Ferenc Kuhn, Sophia Halliday, Renata S.M. Gomes, Rupesh Agrawal, Richard J. Blanch^*

^*Corresponding author for this work

Inflammation and Ageing

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Abstract

Topic: Sympathetic ophthalmia (SO) is a sight-threatening granulomatous panuveitis caused by a sensitizing event. Primary enucleation or primary evisceration, versus primary repair, as a risk management strategy after open-globe injury (OGI) remains controversial.

Clinical Relevance: This systematic review was conducted to report the incidence of SO after primary repair compared with that of after primary enucleation or primary evisceration. This enabled the reporting of an estimated number needed to treat.

Methods: Five journal databases were searched. This review was registered with International Prospective Register of Systematic Reviews (identifier, CRD42021262616). Searches were carried out on June 29, 2021, and were updated on December 10, 2022. Prospective or retrospective studies that reported outcomes (including SO or lack of SO) in a patient population who underwent either primary repair and primary enucleation or primary evisceration were included. A systematic review and meta-analysis were carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Random effects modelling was used to estimate pooled SO rates and absolute risk reduction (ARR).

Results: 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; SO developed in 21 patients with OGI. When all included studies were pooled, the estimated SO rate was 0.12% (95% confidence interval [CI], 0.00%–0.25%) after OGI. Of 779 patients who underwent primary enucleation or primary evisceration, no SO cases were reported, resulting in a 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%–0.33%). The ARR using a random effects model was −0.0010 (in favour of eye removal; 95% CI, −0.0031 [in favor of eye removal] to 0.0011 [in favor of primary repair]). Grading of Recommendations, Assessment, Development, and Evaluations analysis highlighted a low certainty of evidence because the included studies were observational, and a risk of bias resulted from missing data.

Discussion: Based on the available data, no evidence exists that primary enucleation or primary evisceration reduce the risk of secondary SO.

Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Original language	English
Pages (from-to)	557-567
Number of pages	11
Journal	Ophthalmology
Volume	131
Issue number	5
Early online date	10 Dec 2023
DOIs	https://doi.org/10.1016/j.ophtha.2023.12.006
Publication status	Published - May 2024

Keywords

Epidemiology
Sympathetic ophthalmia
Trauma
Uveitis

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Patterson, T. J., Kedzierski, A., McKinney, D., Ritson, J., McLean, C., Gu, W., Colyer, M., McClellan, S. F., Miller, S. C., Justin, G. A., Hoskin, A. K., Cavuoto, K., Leong, J., Rousselot Ascarza, A., Woreta, F. A., Miller, K. E., Caldwell, M. C., Gensheimer, W. G., Williamson, T., ... Blanch, R. J. (2024). The Risk of Sympathetic Ophthalmia Associated with Open-Globe Injury Management Strategies: A Meta-analysis. Ophthalmology, 131(5), 557-567. https://doi.org/10.1016/j.ophtha.2023.12.006

@article{571fdc19ab7d4f0ebe2bb2f938e3dd68,

title = "The Risk of Sympathetic Ophthalmia Associated with Open-Globe Injury Management Strategies: A Meta-analysis",

abstract = "Topic: Sympathetic ophthalmia (SO) is a sight-threatening granulomatous panuveitis caused by a sensitizing event. Primary enucleation or primary evisceration, versus primary repair, as a risk management strategy after open-globe injury (OGI) remains controversial.Clinical Relevance: This systematic review was conducted to report the incidence of SO after primary repair compared with that of after primary enucleation or primary evisceration. This enabled the reporting of an estimated number needed to treat.Methods: Five journal databases were searched. This review was registered with International Prospective Register of Systematic Reviews (identifier, CRD42021262616). Searches were carried out on June 29, 2021, and were updated on December 10, 2022. Prospective or retrospective studies that reported outcomes (including SO or lack of SO) in a patient population who underwent either primary repair and primary enucleation or primary evisceration were included. A systematic review and meta-analysis were carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Random effects modelling was used to estimate pooled SO rates and absolute risk reduction (ARR).Results: 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; SO developed in 21 patients with OGI. When all included studies were pooled, the estimated SO rate was 0.12% (95% confidence interval [CI], 0.00%–0.25%) after OGI. Of 779 patients who underwent primary enucleation or primary evisceration, no SO cases were reported, resulting in a 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%–0.33%). The ARR using a random effects model was −0.0010 (in favour of eye removal; 95% CI, −0.0031 [in favor of eye removal] to 0.0011 [in favor of primary repair]). Grading of Recommendations, Assessment, Development, and Evaluations analysis highlighted a low certainty of evidence because the included studies were observational, and a risk of bias resulted from missing data.Discussion: Based on the available data, no evidence exists that primary enucleation or primary evisceration reduce the risk of secondary SO.Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.",

keywords = "Epidemiology, Sympathetic ophthalmia, Trauma, Uveitis",

author = "Patterson, {Tim J.} and Adam Kedzierski and David McKinney and Jonathan Ritson and Chris McLean and Weidong Gu and Marcus Colyer and McClellan, {Scott F.} and Miller, {Sarah C.} and Justin, {Grant A.} and Hoskin, {Annette K.} and Kara Cavuoto and James Leong and {Rousselot Ascarza}, Andr{\'e}s and Woreta, {Fasika A.} and Miller, {Kyle E.} and Caldwell, {Matthew C.} and Gensheimer, {William G.} and Tom Williamson and Felipe Dhawahir-Scala and Peter Shah and Andrew Coombes and Gangadhara Sundar and Mazzoli, {Robert A.} and Malcolm Woodcock and Watson, {Stephanie L.} and Ferenc Kuhn and Sophia Halliday and Gomes, {Renata S.M.} and Rupesh Agrawal and Blanch, {Richard J.}",

year = "2024",

month = may,

doi = "10.1016/j.ophtha.2023.12.006",

language = "English",

volume = "131",

pages = "557--567",

journal = "Ophthalmology",

issn = "0161-6420",

publisher = "Elsevier",

number = "5",

}

Patterson, TJ, Kedzierski, A, McKinney, D, Ritson, J, McLean, C, Gu, W, Colyer, M, McClellan, SF, Miller, SC, Justin, GA, Hoskin, AK, Cavuoto, K, Leong, J, Rousselot Ascarza, A, Woreta, FA, Miller, KE, Caldwell, MC, Gensheimer, WG, Williamson, T, Dhawahir-Scala, F, Shah, P, Coombes, A, Sundar, G, Mazzoli, RA, Woodcock, M, Watson, SL, Kuhn, F, Halliday, S, Gomes, RSM, Agrawal, R & Blanch, RJ 2024, 'The Risk of Sympathetic Ophthalmia Associated with Open-Globe Injury Management Strategies: A Meta-analysis', Ophthalmology, vol. 131, no. 5, pp. 557-567. https://doi.org/10.1016/j.ophtha.2023.12.006

TY - JOUR

T1 - The Risk of Sympathetic Ophthalmia Associated with Open-Globe Injury Management Strategies

T2 - A Meta-analysis

AU - Patterson, Tim J.

AU - Kedzierski, Adam

AU - McKinney, David

AU - Ritson, Jonathan

AU - McLean, Chris

AU - Gu, Weidong

AU - Colyer, Marcus

AU - McClellan, Scott F.

AU - Miller, Sarah C.

AU - Justin, Grant A.

AU - Hoskin, Annette K.

AU - Cavuoto, Kara

AU - Leong, James

AU - Rousselot Ascarza, Andrés

AU - Woreta, Fasika A.

AU - Miller, Kyle E.

AU - Caldwell, Matthew C.

AU - Gensheimer, William G.

AU - Williamson, Tom

AU - Dhawahir-Scala, Felipe

AU - Shah, Peter

AU - Coombes, Andrew

AU - Sundar, Gangadhara

AU - Mazzoli, Robert A.

AU - Woodcock, Malcolm

AU - Watson, Stephanie L.

AU - Kuhn, Ferenc

AU - Halliday, Sophia

AU - Gomes, Renata S.M.

AU - Agrawal, Rupesh

AU - Blanch, Richard J.

PY - 2024/5

Y1 - 2024/5

N2 - Topic: Sympathetic ophthalmia (SO) is a sight-threatening granulomatous panuveitis caused by a sensitizing event. Primary enucleation or primary evisceration, versus primary repair, as a risk management strategy after open-globe injury (OGI) remains controversial.Clinical Relevance: This systematic review was conducted to report the incidence of SO after primary repair compared with that of after primary enucleation or primary evisceration. This enabled the reporting of an estimated number needed to treat.Methods: Five journal databases were searched. This review was registered with International Prospective Register of Systematic Reviews (identifier, CRD42021262616). Searches were carried out on June 29, 2021, and were updated on December 10, 2022. Prospective or retrospective studies that reported outcomes (including SO or lack of SO) in a patient population who underwent either primary repair and primary enucleation or primary evisceration were included. A systematic review and meta-analysis were carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Random effects modelling was used to estimate pooled SO rates and absolute risk reduction (ARR).Results: 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; SO developed in 21 patients with OGI. When all included studies were pooled, the estimated SO rate was 0.12% (95% confidence interval [CI], 0.00%–0.25%) after OGI. Of 779 patients who underwent primary enucleation or primary evisceration, no SO cases were reported, resulting in a 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%–0.33%). The ARR using a random effects model was −0.0010 (in favour of eye removal; 95% CI, −0.0031 [in favor of eye removal] to 0.0011 [in favor of primary repair]). Grading of Recommendations, Assessment, Development, and Evaluations analysis highlighted a low certainty of evidence because the included studies were observational, and a risk of bias resulted from missing data.Discussion: Based on the available data, no evidence exists that primary enucleation or primary evisceration reduce the risk of secondary SO.Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

AB - Topic: Sympathetic ophthalmia (SO) is a sight-threatening granulomatous panuveitis caused by a sensitizing event. Primary enucleation or primary evisceration, versus primary repair, as a risk management strategy after open-globe injury (OGI) remains controversial.Clinical Relevance: This systematic review was conducted to report the incidence of SO after primary repair compared with that of after primary enucleation or primary evisceration. This enabled the reporting of an estimated number needed to treat.Methods: Five journal databases were searched. This review was registered with International Prospective Register of Systematic Reviews (identifier, CRD42021262616). Searches were carried out on June 29, 2021, and were updated on December 10, 2022. Prospective or retrospective studies that reported outcomes (including SO or lack of SO) in a patient population who underwent either primary repair and primary enucleation or primary evisceration were included. A systematic review and meta-analysis were carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Random effects modelling was used to estimate pooled SO rates and absolute risk reduction (ARR).Results: 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; SO developed in 21 patients with OGI. When all included studies were pooled, the estimated SO rate was 0.12% (95% confidence interval [CI], 0.00%–0.25%) after OGI. Of 779 patients who underwent primary enucleation or primary evisceration, no SO cases were reported, resulting in a 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%–0.33%). The ARR using a random effects model was −0.0010 (in favour of eye removal; 95% CI, −0.0031 [in favor of eye removal] to 0.0011 [in favor of primary repair]). Grading of Recommendations, Assessment, Development, and Evaluations analysis highlighted a low certainty of evidence because the included studies were observational, and a risk of bias resulted from missing data.Discussion: Based on the available data, no evidence exists that primary enucleation or primary evisceration reduce the risk of secondary SO.Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

KW - Epidemiology

KW - Sympathetic ophthalmia

KW - Trauma

KW - Uveitis

U2 - 10.1016/j.ophtha.2023.12.006

DO - 10.1016/j.ophtha.2023.12.006

M3 - Article

C2 - 38086434

SN - 0161-6420

VL - 131

SP - 557

EP - 567

JO - Ophthalmology

JF - Ophthalmology

IS - 5

ER -

The Risk of Sympathetic Ophthalmia Associated with Open-Globe Injury Management Strategies: A Meta-analysis

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