Purpose: 

Prophylactic enucleation of a ruptured globe with no light perception within 14 days of injury to prevent sympathetic ophthalmia (SO) has been an established dictum in academic teaching for more than 100 years. This treatment strategy was originally based on observation, speculation, and careful thought, but there was never any scientific proof. This review summarizes and updates the current state of our knowledge about globe rupture and SO, examines the origin and validity of the 14-day rule, and emphasizes the importance of trying to save the traumatized eye whenever possible.

Methods: 

A comprehensive literature review of SO and globe rupture was performed.

Results: 

SO is a rare disorder that may potentially occur following traumatic globe rupture as well as following a variety of other intraocular surgeries. Vitreoretinal surgery may be a more common cause than trauma according to some studies. SO may still occur despite having the eye removed within 14 days of the trauma. A variety of new medications including biologic agents are now available to treat SO with improved efficacy in suppressing the associated ocular inflammation and allowing retention of some useful vision. Removing the traumatized, blind eye may have other important psychological consequences associated with it that require consideration before eye removal is carried out. Retaining the blind, phthisical, disfigured eye avoids phantom vision and phantom pain associated with enucleation as well as providing a good platform to support and move an overlying prosthetic eye. Data on the occurrence of SO following evisceration and enucleation with and without predisposing factors confirms the exceedingly low risk.

Conclusion: 

Most civilian open globe injuries can be successfully repaired with modern, advanced microsurgical techniques currently available. Because of the exceedingly low risk of SO, even with the severity of open globe trauma during military conflicts being more devastating as a result of the blast and explosive injuries, today every attempt is made to primarily close the eye rather than primarily enucleate it, providing there is enough viable tissue to repair. The 14-day rule for eye removal after severe globe ruptures is not scientifically supported and does not always protect against SO, but the safe time period for prophylactic eye removal is not definitively known. In the exceptional cases where SO does occur, several new medications are now available that may help treat SO. We advocate saving the ruptured globe whenever possible and avoiding prophylactic enucleation to prevent the rare occurrence of SO. When an eye requires removal, evisceration is an acceptable alternative to enucleation in cases that do not harbor intraocular malignancy.

中文翻译：

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破裂的地球、交感性眼炎和 14 天规则

目的： 

100 多年来，在受伤后 14 天内对没有光感的破裂眼球进行预防性摘除以预防交感性眼炎 (SO) 已成为学术教学中的既定格言。这种治疗策略最初是基于观察、推测和深思熟虑的，但从未有任何科学证据。这篇综述总结和更新了我们对眼球破裂和 SO 的当前认识，检查了 14 天规则的起源和有效性，并强调了尽可能挽救受伤眼睛的重要性。

方法： 

对 SO 和球体破裂进行了全面的文献回顾。

结果： 

SO 是一种罕见的疾病，可能发生在创伤性眼球破裂后以及各种其他眼内手术后。根据一些研究，玻璃体视网膜手术可能是比创伤更常见的原因。尽管在创伤后 14 天内摘除了眼睛，但 SO 仍可能发生。包括生物制剂在内的多种新药物现在可用于治疗 SO，在抑制相关眼部炎症和保留一些有用视力方面具有更高的功效。摘除受过创伤的盲眼可能会产生其他重要的心理后果，需要在摘除眼睛之前加以考虑。留住瞎子，phthisical，畸形眼避免了与眼球摘除相关的幻觉和幻痛，并提供了一个良好的平台来支撑和移动上覆的假眼。在有或没有易感因素的情况下，内脏和去核后发生 SO 的数据证实了极低的风险。

结论： 

大多数平民开放性眼球损伤可以通过目前可用的现代先进显微外科技术成功修复。由于 SO 的风险极低，即使在军事冲突期间由于爆炸和爆炸性伤害而造成的开放性全球创伤的严重性更具破坏性，今天的每一次尝试都是主要关闭眼睛而不是主要摘除它，提供有足够的活组织来修复。严重的眼球破裂后 14 天的眼球摘除规则没有科学依据，也并不总能预防 SO，但预防性摘除眼球的安全时间尚不明确。在 SO 确实发生的特殊情况下，现在有几种新的药物可以帮助治疗 SO。我们主张尽可能保存破裂的球体，并避免预防性摘除，以防止 SO 的罕见发生。当眼睛需要切除时，在不存在眼内恶性肿瘤的情况下，内脏是一种可接受的替代摘除方法。