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      Indications for destructive eye surgeries at the Yaounde Gynaeco-Obstetric and Paediatric Hospital

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          Abstract

          Objective:

          To determine the indications and rate of acceptance for destructive eye surgeries at the ophthalmology unit of the Yaoundé Gynaeco-Obstetric and Paediatric Hospital.

          Methods:

          A retrospective consecutive case series in which the medical records of all patients consulting in this unit over a 9-year period (2002 to 2010) were reviewed. Records in which destructive surgery was recommended were retained. Information collected included demographic data, eye affected, clinical diagnosis, acceptance or refusal of surgery, and the outcome in those in whom surgery was performed.

          Results:

          A total of 48 patients had a recommendation for destructive eye surgery, of whom 30 (62.5%) were males and 18 (37.5%) were females. Mean age was 43.78 (SD = 28.11; range 1 month to 91 years). Children <10 years comprised 23.10%. The leading causes were endophthalmitis/panophthalmitis (47.9%), neoplasm (20.8%), and absolute glaucoma (14.6%). Surgery was done in 20 cases (41.7%). Evisceration was the most performed surgical procedure (50%), with endophthalmitis/panophthalmitis and neoplasm combined accounting for 65% of surgeries.

          Conclusion:

          The high rate of refusal is an indication of the psychological devastation undergone by patients or the families of children in whom eye removal is recommended. Awareness should be raised on preventive measures and the need to rapidly seek eye care.

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          Most cited references12

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          Inadvertent evisceration of eyes containing uveal melanoma.

          To report an important complication of ocular evisceration therapy for blind, painful eyes that has been unreported in the literature, and to stress the need for careful preoperative evaluation to exclude occult neoplasms prior to therapy. Multicenter, retrospective, nonrandomized clinicopathological case series of patients found to have previously unsuspected uveal malignant melanoma during histopathological examination of blind, painful eyes treated by evisceration. Histopathological examination of evisceration specimens disclosed previously unsuspected uveal melanoma in 7 patients who were treated for blind, painful eyes. Inflammation caused by necrosis of the tumor and other ocular tissues led to misdiagnosis as endophthalmitis, orbital cellulitis, or idiopathic orbital inflammation in several cases. Preoperative imaging was not performed in 3 cases and failed to detect tumors in the remaining 4 cases. Failure of necrotic tumors to enhance contributed to misdiagnosis. The presence of a malignant intraocular neoplasm should be excluded prior to evisceration of any blind eye or blind, painful eye, particularly with opaque media. Necrosis-related inflammation can confound the clinical diagnosis of occult lesions, as can failure of necrotic tumors to enhance on imaging studies.
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            Severe eye injuries in the war in Iraq, 2003-2005.

            To document the incidence and treatment of patients with severe ocular and ocular adnexal injuries during Operation Iraqi Freedom. Retrospective hospital-based observational analysis of injuries. All coalition forces, enemy prisoners of war, and civilians with severe ocular and ocular adnexal injuries. The authors retrospectively examined severe ocular and ocular adnexal injuries that were treated by United States Army ophthalmologists during the war in Iraq from March 2003 through December 2005. Incidence, causes, and treatment of severe ocular and ocular adnexal injuries. During the time data were gathered, 797 severe eye injuries were treated. The most common cause of the eye injuries was explosions with fragmentation injury. Among those injured, there were 438 open globe injuries, of which 49 were bilateral. A total of 116 eyes were removed (enucleation, evisceration, or exenteration), of which 6 patients required bilateral enucleation. Injuries to other body systems were common. Severe eye injuries represent a significant form of trauma encountered in Operation Iraqi Freedom. These injuries were most commonly caused by explosion trauma.
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              Causes and incidence of destructive eye procedures in north-eastern ghana.

              To determine the causes and incidence of destructive ophthalmic procedures as seen at a major reference eye centre in northern Ghana Retrospective case series involving a review of surgical records of all evisceration and enucleation procedures done between January 2002 and December 2006 at the Bawku Hospital Eye Department. Information collected included basic demographic data, diagnosis, visual acuity at diagnosis and the eye affected. The aetiology responsible was determined from history, clinical examination and investigations as contained in the existing records. The primary clinical indications for evisceration were categorized into degenerative lesions, infections, trauma, neoplasms, and others. Statistical analysis was done using the Epi Info software. A total of 337 eyes of 336 patients made up of 217 (64.6%) males and 119 (35.4%) females were removed during the study period. Mean age was 36.4 with a range of 1-90 years. Children under 15 years constituted 25.1% of whom 9.3% were under 5 years. The elderly (>/=60 years) comprised 26.3%. The most common cause of destructive procedure was endophthalmitis /panophthalmitis (47.9%), ocular injuries (23.2%), degenerative lesions (8.9%) and neoplasms (5.1%). Regarding neoplasms, females were more likely to be enucleated while the reverse was so for traumas (p=0.04 and p=0.02, Chi(2) test, respectively). Compared to the total number of surgeries done each year the crude incidence was computed at 26.6% per 1000 cases per year. Most causes of destructive procedures in this part of Ghana are preventable and serious preventive strategies are needed to reverse this trend.
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                Author and article information

                Journal
                Clin Ophthalmol
                Clinical Ophthalmology
                Clinical Ophthalmology (Auckland, N.Z.)
                Dove Medical Press
                1177-5467
                1177-5483
                2011
                2011
                05 May 2011
                : 5
                : 561-565
                Affiliations
                [1 ]Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon;
                [2 ]Gynaeco-Obstetric and Paediatric Hospital, Yaoundé, Cameroon;
                [3 ]Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
                Author notes
                Correspondence: André Omgbwa Eballé, Ophthalmology Unit, Gynaeco-Obstetric and Paediatric Hospital, Yaoundé, PO Box 4362, Yaoundé, Cameroon, Tel +237 99 65 44 68, Fax +237 22 21 24 30, Email andyeballe@ 123456gmail.com
                Article
                opth-5-561
                10.2147/OPTH.S18449
                3096618
                21607025
                4c466d4e-e7c1-4530-9dc4-cf04a1983600
                © 2011 Eballé et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                History
                : 5 May 2011
                Categories
                Original Research

                Ophthalmology & Optometry
                destructive eye surgery,neoplasm,endophthalmitis
                Ophthalmology & Optometry
                destructive eye surgery, neoplasm, endophthalmitis

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