Authors: Stuti M. Tanya, Bonnie He, Chao Wang, Abbas Kezouh, Nurhan Torun, Edsel Ing.

Author Disclosure Block: S.M. Tanya: None. B. He: None. C. Wang: None. A. Kezouh: None. N. Torun: None. E. Ing: None.

Abstract Body:

Purpose: Sympathetic ophthalmia (SO) is a rare panuveitis that occurs following accidental or surgical trauma to the eye. Estimates of incidence rates in the literature vary from 0.2% to 0.5%. A reliable incidence figure for SO following penetrating eye trauma is important to ascertain so that patients can be accurately informed of their risk of SO. This will help to guide shared physician-patient decision making in patients with severe ocular trauma if eye removal is being considered. The objective of this study was to determine the incidence rate of SO following penetrating ocular trauma.
Study Design: Systematic review and meta-analysis.
Methods: A systematic literature search of electronic databases including MEDLINE, EMBASE, Cochrane, and Google Scholar were searched up to August 20, 2020. No date, follow-up, or publication status restrictions were applied. Population-based studies with data on ocular trauma and sympathetic ophthalmia were included in this study. The study was registered with PROSPERO (ID# CRD42020198920). A random-effects meta-analysis was performed using the metarate command in RStudio (RStudio PBC, MA, USA). A log transformation of the incidence rates was used for continuity correction for any study-specific incidence rates that had zero events, but not for the meta-analysis.
Results: A total of 1,100 unique citations were retrieved from the literature search. Screening of the titles and abstracts resulted in the exclusion of 926 items. The remaining 174 studies underwent full-text screening resulting in the exclusion of 150 full-text studies. A final 24 studies were utilized in the meta-analysis. The incidence of sympathetic ophthalmia after penetrating trauma is estimated at 33 per 100,000 globe ruptures per year, (95% CI 19.61-56.64) with an I2 of 63%. There was no statistically significant difference in the incidence rate of pediatric versus adult SO. (p=0.222).
Conclusions: Overall, the incidence of SO after penetrating eye trauma is rare at 0.033% per year following penetrating ocular trauma. This incidence rate may be of use when counselling patients regarding management options after penetrating ocular trauma. Further studies are needed to examine the influence of age, the extent and location of the trauma, timing of repair, and prophylactic eye removal on the incidence of SO.