Clinicopathologic review of pediatric enucleations during the last 50 years

Enucleation in pediatric open globe injuries: demographics and risk factors

PURPOSE

The purpose of this study is to report the demographics and risk factors for undergoing primary enucleation in the setting of acute open globe injury (OGI) in the pediatric population in the USA.

METHODS

This retrospective, cross-sectional study of pediatric patients with OGIs in the USA between 2002 and 2014 was conducted utilizing data from the National Inpatient Sample Database. Descriptive statistics, chi-square testing, and univariate and multivariable analyses were performed.

RESULTS

In the USA, 8944 cases of pediatric OGI were identified between 2002 and 2014 in the NIS Database, of which 344 underwent primary enucleation. Blacks and Asian/Pacific Islanders made up higher proportions of enucleated cases compared to non-enucleated cases. Older age, male sex, being Black or Asian/Pacific Islander, OGI with an intraocular foreign body, rupture type OGI, and concurrent endophthalmitis were identified as risk factors for undergoing enucleation. There was no significant difference in insurance status among enucleated versus non-enucleated cases. Mean length of hospital stay (in days) was almost 3 times higher in enucleated OGIs. By hospital's geographic location, the Midwest hospitals had a greater proportion of enucleated versus non-enucleated cases compared to other regions.

CONCLUSION

Significant demographic differences were identified in OGI patients that underwent primary enucleation versus repair with regard to age, sex, race, the geographic location of hospital admission, mean length of hospital stay, type of ocular injury, and other ocular complications. Most pediatric traumatic enucleations between 2002 and 2014 were reported in teenagers (16-20 age group), in males, and in Blacks.

The Demography and Etiology of Pediatric Enucleation in a Tertiary Eye Center in North China, 2001-2015

PURPOSE

To review the demography and etiology of pediatric enucleation over time.

METHODS

Pediatric ophthalmic inpatients recruited and recorded (aged 0-14 years) at Shandong Eye Institute from January 2001 to December 2015 were reviewed. Changes during the three periods from 2001 to 2005, 2006 to 2010, and 2011 to 2015 were compared and analyzed.

RESULTS

A total of 9307 pediatric inpatients were reviewed. Of these, 71 patients (71 eyes) who had been treated by enucleation were analyzed; 46 were boys (64.79%) and 25 were girls (35.21%). The mean age at enucleation was 9 (0-14) years. The pediatric enucleation rate during this 15-year period was 0.76% (71/9307), with a decreasing trend (p < 0.001). From 2001 to 2005, the figure was 3.45% (43/1245); it dropped to 0.80% (26/3231) from 2006 to 2010 and then dropped further to 0.04% (2/4831) by 2015. Trauma (52.1%, 37/71) was the leading etiology. Overall, 89.2% (33 eyes) exhibited open globe injuries; 78.4% (29/37) of these involved boys. In the cases with open injuries, the mean age at the time of trauma was 6.0 (0-14) years and the mean age at enucleation was 11 (2-14) years. Retinoblastoma (RB) (22.5%, 16/71) was the second-most common etiology; 68.8% (11/16) of these cases involved girls and the mean age at enucleation was 2 (0-5) years.

CONCLUSION

A decrease in pediatric enucleation in North China, especially in Shandong Province, was observed over time, possibly because of better surgical techniques, improvements in the treatment of RB, and public health interventions in children.

Enucleation in Asian Indian patients: a histopathological review of 2009 cases

OBJECTIVE

To review the indications of enucleation in Asian Indian patients and study the trend over the 22-year period.

METHODS

Retrospective study of 2009 patients who underwent enucleation.

RESULTS

The mean age at presentation of patients who underwent enucleation was 155 months The histopathology diagnosis included a benign tumor (n = 22, 1%), malignant tumor (n = 1472, 73%), acute trauma (n = 93, 5%), retinal vascular disease (n = 50, 3%), inflammatory/infective pathology (n = 33, 2%), or other miscellaneous/non-specific diagnosis (n = 460, 23%). There was a good correlation between the clinical and histopathology diagnoses at 96%. The most common indication for enucleation in young patients ( ≤ 20 years) was retinoblastoma (n = 1257, 82%; p < 0.001), atrophic bulbi or phthisis bulbi (n = 163, 39%; p < 0.001) in middle-age adults, and uveal melanoma (n = 25, 42%; p < 0.001) in older adults. Over the years, there was a decreasing trend of enucleations for atrophic bulbi/phthisis bulbi/painful blind eye (33% from the years 1996 through 2000 to 7% from 2010 to 2018; p < 0.001) and acute trauma (3% from the years 1996 through 2000 to < 1% from 2010 to 2018; p < 0.001) and an increasing trend for intraocular tumors including retinoblastoma (56% from the years 1996 through 2000 to 73% from 2010 to 2018; p = 0.01) and uveal melanoma (3% from the years 1996 through 2000 to 11% from 2010 to 2018; p < 0.006).

CONCLUSION

In Asian Indian population, malignant tumors remain the most common indication for enucleation in young and older patients, while desire for better cosmesis with customized ocular prosthesis is the main indication for enucleation in middle-age adults.

Pathological findings in poststrabismus surgery endophthalmitis

Bacterial entry into the vitreous cavity via inadvertent scleral perforation is one postulated mechanism for poststrabismus surgery endophthalmitis. In a review of 746 cases, we identified 2 pediatric enucleation specimens related to complications of strabismus surgery. In both cases, the patients developed postoperative endophthalmitis and no light perception vision, and the eyes were enucleated when they became phthisical or painful. In both submitted cases, pathology showed a thick band of scar tissue emanating focally from the sclera into the vitreous. Although no needle tracts were visualized, pathological findings were consistent with scleral perforation.