Günalp I, Gündüz K, Ozkan M
Ocular Oncology Department, Faculty of Medicine, Ankara University, Turkey.
Eur J Ophthalmol. 1997 Jul-Sep;7(3):223-8. doi: 10.1177/112067219700700304.
Enucleation is an approach used for unresponsive end-stage ocular disease often resulting in blind, painful or cosmetically unacceptable eyes.
We reviewed the clinicopathological data on 3506 enucleations performed over a 50-year period, 1945-1995. Histopathological data were divided into eight groups according to the causes leading to enucleation: trauma, phthisis, corneal disease, inflammation, vitreoretinal disease, glaucoma, tumors and infections.
The study considered 3506 enucleated eyes of 3482 patients, 2467 (70.8%) males and 1011 (29.1%) females (4 sex unspecified). The z-test showed there were significantly more enucleations in males for phthisis (p < 5.05), infections (p < 0.01), trauma (p < 0.01) and inflammation (p < 0.01) and more enucleations for tumors in females (p < 0.01). There were no differences between males and females with regard to enucleations for glaucoma, vitreoretinal and corneal diseases (p > 0.05). The 0-9 years age group was most frequently affected, accounting for 29.7% of the cases. Patients aged less than 30 years constituted 53.6% of all enucleations. The primary or underlying causes leading to enucleation were tumors (1185 eyes, 33.8%), phthisis (587 eyes, 16.7), glaucoma (561 eyes, 16.0%), vitreoretinal diseases (320 eyes, 9.1%), infections (259 eyes, 7.4%), corneal disease (229 eyes, 6.5%), trauma (209 eyes, 6.0%) and inflammation (156 eyes, 4.4%). Time trends in enucleating eyes with different causes showed the number of enucleations for phthisis, infections, corneal diseases, trauma and inflammations had dropped during the ten-year period 1986-1995 compared to 1976-1985 (z-test, p < 0.01). There were no real changes in enucleations for glaucoma and vitreoretinal diseases and there was an increase in the number of enucleations for tumors (p < 0.01).
Improved diagnostic and therapeutic methods, widespread use of photocoagulation in vascular disorders and vitreoretinal surgery in traumas, effective antimicrobial treatment, increasing use of corticosteroids and immunosuppressants, have contributed to the decreasing frequency of enucleation. Tumor patients generally presented late with advanced tumors totally filling the eye, not salvageable by other non-invasive treatment methods. Prompt diagnosis of intraocular malignant tumors (retinoblastoma and malignant melanoma) may reduce the need for enucleation.
眼球摘除术是用于治疗无反应性终末期眼病的一种方法，这类眼病常导致眼睛失明、疼痛或外观难以接受。
我们回顾了1945年至1995年这50年间3506例眼球摘除术的临床病理数据。组织病理学数据根据导致眼球摘除的原因分为八组：外伤、眼球痨、角膜疾病、炎症、玻璃体视网膜疾病、青光眼、肿瘤和感染。
该研究纳入了3482例患者的3506只摘除眼球，其中男性2467例（70.8%），女性1011例（29.1%）（4例性别未注明）。z检验显示，男性因眼球痨（p<0.05）、感染（p<0.01）、外伤（p<0.01）和炎症（p<0.01）进行眼球摘除的比例显著更高，女性因肿瘤进行眼球摘除的比例更高（p<0.01）。男性和女性在因青光眼、玻璃体视网膜疾病和角膜疾病进行眼球摘除方面无差异（p>0.05）。0至9岁年龄组受影响最频繁，占病例的29.7%。年龄小于30岁的患者占所有眼球摘除术的53.6%。导致眼球摘除的主要或潜在原因是肿瘤（1185只眼，33.8%）、眼球痨（587只眼，16.7%）、青光眼（561只眼，16.0%）、玻璃体视网膜疾病（320只眼，9.1%）、感染（259只眼，7.4%）、角膜疾病（229只眼，6.5%）、外伤（209只眼，6.0%）和炎症（156只眼，4.4%）。不同原因导致的眼球摘除的时间趋势显示，与1976年至1985年相比，1986年至1995年这十年间，因眼球痨、感染、角膜疾病、外伤和炎症进行的眼球摘除数量有所下降（z检验，p<0.01）。青光眼和玻璃体视网膜疾病的眼球摘除数量没有实际变化，而肿瘤的眼球摘除数量有所增加（p<0.01）。
诊断和治疗方法的改进、血管疾病中光凝术的广泛应用以及外伤中玻璃体视网膜手术的应用、有效的抗菌治疗、皮质类固醇和免疫抑制剂的使用增加，都导致了眼球摘除频率的降低。肿瘤患者通常就诊较晚，肿瘤晚期完全占据眼球，无法通过其他非侵入性治疗方法挽救。眼内恶性肿瘤（视网膜母细胞瘤和恶性黑色素瘤）的及时诊断可能会减少眼球摘除的需求。
