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Tarar N, Wladis EJ. Outcomes of planned versus emergent enucleation procedures with primary orbital implants. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e38-e40. [PMID: 36368407 DOI: 10.1016/j.jcjo.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/15/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The primary purpose of this study was to explore the outcomes of primary implant placement in patients who have undergone enucleation on either a planned or emergent basis. METHODS A retrospective chart review was performed of 128 enucleations with at least a 1-year postoperative follow-up between November 2008 and May 2019 by a single oculoplastic surgeon at Albany Medical Center. Emergent cases were categorized as those with an active, unclosed globe perforation, secondary to either acute trauma, dehiscence or failed closure of a previously opposed wound, or exposure of a surgical site with dehiscence of the underlying sclera. Patient demographics, clinical features, and postoperative findings were recorded. The incidence of implant exposure was used as an indication of patient outcomes, and the data were subsequently analyzed using t tests. RESULTS Of the 128 enucleations performed, 32 (25%) were carried out on an emergent basis, of which 2 patients (6.25%) developed implant exposure. In contrast, of the 96 enucleations that were carried out in a planned, nonemergent manner, 3 patients (3.1%) developed implant exposure. There was no significant relationship between implant exposure rates in the acute and planned enucleation groups (p = 0.4047). CONCLUSIONS Despite the implications of globe perforation, our analysis suggests no significant correlation of implant exposures in acute versus planned enucleations with primary orbital implants. As such, physicians may confidently place a primary implant at the time of enucleation in both groups, and they may use these data to counsel their patients about the risks of postoperative complications.
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Affiliation(s)
- Nazish Tarar
- Department of Ophthalmology, Albany Medical College, Albany, NY.
| | - Edward J Wladis
- Department of Ophthalmology, Albany Medical College, Albany, NY
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2
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Landau Prat D, Zvi D, Zloto O, Hartstein M, Vardizer Y, Ben Simon GJ. Acquired Anophthalmic Socket: Clinical Course and Treatment Options. Int Ophthalmol Clin 2023; 63:163-185. [PMID: 37439616 DOI: 10.1097/iio.0000000000000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
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3
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Parra-Tanoux D, Dussan-Vargas MP, Escandon MG. Painful-blind eye: A forgotten palliative care. Indian J Ophthalmol 2023; 71:2399-2408. [PMID: 37322649 PMCID: PMC10417970 DOI: 10.4103/ijo.ijo_3063_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 06/17/2023] Open
Abstract
Painful-blind eye (PBE) is a challenging and debilitating condition that greatly affects the quality of life of patients. Although PBE can result from a variety of etiologies, currently there is no guideline or consensus on how to approach therapeutically these patients, and most treatments are experience-based. We summarized the evidence from available studies to investigate the current state of PBE treatment strategies. This review revealed that the information available about therapeutic approaches in patients with PBE is insufficient and outdated, therefore, new experimental and larger studies are needed to reach an agreement about this condition.
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Affiliation(s)
- Daniela Parra-Tanoux
- Ophthalmology Department, Medicine School, Universidad de la Sabana, Chía, Cundinamarca, Colombia
| | - Maria P Dussan-Vargas
- Ophthalmology Department, Medicine School, Universidad de la Sabana, Chía, Cundinamarca, Colombia
| | - Martha Gonzalez Escandon
- Ophthalmology Department, Medicine School, Universidad de la Sabana, Chía, Cundinamarca, Colombia
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Svedberg K. Outcome of eviscerations and enucleations at a Swedish tertiary referral centre between 2008 and 2019: improved surgical management leading to reduced complication rate. Orbit 2023; 42:174-180. [PMID: 35611572 DOI: 10.1080/01676830.2022.2078844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to investigate the results of all eviscerations and enucleations performed at the Department of Ophthalmology, Sahlgrenska University Hospital, during 2008-2019 and to compare them with previously collected data from 1999 to 2007. METHODS This was a retrospective investigation using the medical records for all patients having had an evisceration or an enucleation at the Department of Ophthalmology, Sahlgrenska University Hospital, during the two defined periods of time. Main outcome measure was postoperative complications. RESULTS During 1999-2007, 181 surgeries were performed, 100 with implants, and 28/100 exposed implants and 9/100 removed implants were recorded during follow-up. During 2008-2019, 250 operations were performed with 158 implants, and there were 3/158 exposed implants and 2/158 extruded implants. Two ruptures of the surgical wound without implant exposure were noted, and one implant was exchanged. The reduction of exposed implants between the two periods was statistically significant (p < .001, Chi-square test). In enucleations, the use of one kind of porous polyethylene implant in the recent study period replaced a multitude of implants in the earlier study period. In eviscerations, the major change between the two study periods was the introduction of the split sclera technique and smaller implant size. CONCLUSION The change in surgical technique between the two periods led to a significant reduction in implant-related complications.
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Affiliation(s)
- Karin Svedberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Ophthalmology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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5
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Toiv A, Durrani AF, Zhou Y, Zhao PY, Musch DC, Huvard MJ, Zacks DN. Risk Factors for Enucleation Following Open Globe Injury: A 17-Year Experience. Clin Ophthalmol 2022; 16:3339-3350. [PMID: 36237492 PMCID: PMC9553313 DOI: 10.2147/opth.s377137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose At the time of open globe injury (OGI), it may be difficult for clinicians to predict which eyes are at highest risk for requiring enucleation. We performed a 17-year retrospective cohort study to report outcomes and risk factors for enucleation following open globe injuryto better aid clinicians counseling patients at OGI diagnosis. Methods A retrospective cohort study of all patients who presented to the University of Michigan with open globe injury (OGI) and were surgically managed between January 2000 and July 2017 was conducted. At least 30 days of follow-up was required. All eyes that ultimately underwent enucleation following OGI were identified and their clinical course analyzed. The main outcome measured was the rate of enucleation after OGI. Results There were 587 eyes meeting inclusion criteria. The mean patient age was 40.75 ± 25.1 (range 1-91). 441/585 (75.4%) patients were male. Average follow-up time was 1029.9 ± 1285.9 days. 116/587 eyes (19.8%) required enucleation after OGI, with 81.9% undergoing enucleation less than 30 days from injury. In enucleated eyes, the mean presenting logMAR vision was 2.91 ± 0.47 (Snellen equivalent between hand motion and light perception). The most common mechanism of injury requiring enucleation was globe rupture, 89/116 (76.7%), with 14/116 (12.1%) penetrating injuries and 13/116 (11.2%) perforating injuries. The mean age of patients that underwent enucleation was 45.6 ± 22.5 (range 3-91). Conclusion Open globe injuries are often visually devastating and a significant number of cases ultimately require enucleation. Despite emergent closure within 24 hours, 19.8% of eyes managed for OGI at our institution required eventual enucleation. 81.2% of these eyes required enucleation within 30 days of injury. Wound length greater than 10 mm, uveal prolapse, higher zone of injury, IOFB, and RAPD were identified as risk factors that predict future need for enucleation.
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Affiliation(s)
- Avi Toiv
- Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Asad F Durrani
- Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Peter Y Zhao
- Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael J Huvard
- Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - David N Zacks
- Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
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Bunin LS. Reconstruction with umbilical amnion following ocular evisceration: A case study. Am J Ophthalmol Case Rep 2022; 26:101462. [PMID: 35265778 PMCID: PMC8899220 DOI: 10.1016/j.ajoc.2022.101462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To report the use of cryopreserved amniotic membrane from the umbilical cord (UC) in the reconstruction of a dehisced wound with the additional ability to increase orbital volume, expand superior and inferior fornices, and improve cosmesis following evisceration of a blind, painful, atrophic, sunken eye with ptosis. Observations Patient developed conjunctival wound dehiscence without implant exposure following evisceration. One month later, reconstruction was performed with UC to cover the defect, increase the orbital volume, and expand orbital fornices to allow placement of a large ocular prosthesis with superior lip for ptosis elevation. Post-operatively, at the 6th week, the socket was healthy and the globe had good movement. At the 7th week, the ocular prosthesis was sized and fitted. At the 8th month, the structural integrity of the socket was maintained with deep fornices, and the patient had excellent cosmetic result with natural appearance and movement of the prosthetic eye. Conclusions and importance This case highlights the successful utilization of UC graft to augment soft tissue volume, restore socket structural integrity and increase socket volume, and achieve good cosmesis and ocular motility following evisceration.
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Dave TV, Das AV, Mohapatra S, Bansal O, Ganguly A. Outcomes and complications of evisceration with primary implant: an electronic medical record driven analytics of 1800 cases. Orbit 2021; 41:717-725. [PMID: 34783616 DOI: 10.1080/01676830.2021.1998915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe the surgical outcomes and implant complications in 1,800 patients undergoing evisceration with primary implant. METHODS An Electronic Medical Record-driven analysis of 1,800 patients undergoing evisceration with primary implant between 2013 and 2019. Implant sizing was performed intra-operatively to place the largest implant without tension on the wound closure. Outcome measures included implant complications, prosthesis measurements, and incidence of a good aesthetic outcome. Good outcome was defined as <2 mm enophthalmos and grade 1 or less superior sulcus deformity with a custom ocular prosthesis. RESULTS Eighteen hundred eyes of 1800 patients were included. The mean age at surgery was 36 ± 21 years (median 32 years). Implants used were poly(methyl methacrylate) (PMMA) in 1737 (97%) and porous polyethylene in 63 (3%) patients. Two-petal sclerotomy was performed in 1512 (88%) and four-petal sclerotomy in 165 (10%) patients. The mean diameter of the implant used was 19.35 ± 1.18 mm (median 20, range 10-22 mm). The implant extrusion rate was 3% (56) and implant displacement was seen in none. The mean prosthesis volume and thickness were 2.22 ± 0.67 ml (median 2, range 1-6.5 ml) and 6 ± 1 mm (median 6, range 2-9 mm). The mean difference in prosthesis projection on Hertel's exophthalmometer was 0.28 ± 1 mm (median 0, range 0-1 mm). Good outcome was observed in 93%. The mean follow-up period was 351 ± 386 days (median 194). CONCLUSION Evisceration with empirically selected primary orbital implant placement is associated with minimal implant complications and gives a good aesthetic outcome in 93% of the patients.
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Affiliation(s)
- Tarjani Vivek Dave
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute, Hyderabad, India
| | - Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, India
| | - Sameer Mohapatra
- Ophthalmic Plastics, Orbit and Ocular Oncology, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - Oshin Bansal
- Ophthalmic Plastic and Facial Aesthetic, Orbit and Ocular Oncology, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, India
| | - Anasua Ganguly
- Ophthalmic Plastic and Facial Aesthetic, Orbit and Ocular Oncology, Kode Venkatadri Chowdary Campus, LV Prasad Eye Institute, Vijayawada, India
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Risk Factors for Orbital Implant Extrusion after Evisceration. J Clin Med 2021; 10:jcm10153329. [PMID: 34362115 PMCID: PMC8347078 DOI: 10.3390/jcm10153329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/01/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
This study analyzed risk factors for extrusion of orbital implants after evisceration by comparing patients with and without implant extrusion. METHODS We retrospectively reviewed the medical records of patients who underwent evisceration with primary implant placement by a single surgeon from January 2005 to December 2019 at the Chungnam National University Hospital. Age, sex, underlying systemic diseases, axial length of the fellow eye, the cause of evisceration, endophthalmitis type, implant type and size, and preoperative computed tomography findings were evaluated. Logistic regression analysis was used to identify the risk factors for implant extrusion. RESULTS Of the 140 eyes of 140 patients, extrusion occurred in five eyes (3.6%). Endophthalmitis (odds ratio (OR), 15.49; 95% confidence interval (CI), 1.70 to 2038.56; p = 0.010), endogenous endophthalmitis (OR, 18.73; 95% CI, 3.22 to 125.21, p = 0.002), orbital cellulitis (OR, 320.54; 95% CI, 29.67 to 44801.64; p < 0.001), implant size (OR, 0.50; 95% CI, 0.30 to 0.79; p = 0.004), and hydroxyapatite for the implant (OR, 0.07; 95% CI, 0.00 to 0.66; p = 0.016) were risk factors for implant extrusion in univariate logistic regression analysis. Multiple logistic regression analysis identified orbital cellulitis as the only risk factor for extrusion (OR, 52.98; 95% CI, 2.18 to 15367.34; p = 0.009). CONCLUSIONS Evisceration with primary orbital implantation is a feasible option in endophthalmitis, but the risk of extrusion should be taken into consideration. When performing evisceration in a patient with orbital cellulitis, secondary implantation should be carried out only after any infection is controlled.
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9
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Reed DS, Epstein A, Crouse E, Somogyi M. Bacillus cereus panophthalmitis with delayed dermis fat graft. Proc AMIA Symp 2021; 34:489-491. [PMID: 34219933 DOI: 10.1080/08998280.2021.1889296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Bacillus cereus panophthalmitis secondary to intravenous drug use typically leads to an explosive ocular and/or orbital infection. Though several cases of B. cereus panophthalmitis secondary to intravenous drug use have been reported, no clear consensus exists regarding preferred surgical technique and orbital reconstruction. Additionally, no cases describe delayed dermis fat graft placement following enucleation for such cases. Herein, a case of B. cereus panophthalmitis secondary to intravenous methamphetamine use is presented, where delayed dermis fat graft placement following enucleation and orbital washout provided an excellent functional and cosmetic outcome.
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Affiliation(s)
- Donovan S Reed
- Texas Oculoplastics Consultants (TOC) Eye & Face, Austin, Texas
| | - Aliza Epstein
- Texas Oculoplastics Consultants (TOC) Eye & Face, Austin, Texas
| | - Eloisa Crouse
- College of Medicine, University of Central Florida, Orlando, Florida
| | - Marie Somogyi
- Texas Oculoplastics Consultants (TOC) Eye & Face, Austin, Texas.,Department of Ophthalmology, Dell Medical School, University of Texas, Austin, Texas
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10
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Gauthier AC, Oduyale OK, Fliotsos MJ, Zafar S, Mahoney NR, Srikumaran D, Woreta FA. Clinical Characteristics and Outcomes in Patients Undergoing Primary or Secondary Enucleation or Evisceration After Ocular Trauma. Clin Ophthalmol 2020; 14:3499-3506. [PMID: 33149543 PMCID: PMC7602916 DOI: 10.2147/opth.s273760] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the frequency of primary versus secondary eye removal, frequency of enucleation versus evisceration, and characteristics and outcomes of patients undergoing these procedures after presenting with severe ocular trauma. Patients and Methods Retrospective chart review of patients presenting to the emergency department (ED) with severe eye trauma necessitating enucleation or evisceration between 2010 and 2018. Results There were 92 eyes from 90 patients included in our study. Twenty-seven percent of eyes underwent primary removal (n=25, 14 enucleation, 11 evisceration), while 73% of eyes underwent secondary removal (n=67, 50 enucleation, 17 evisceration). The mean patient age was 45.2 years (range 4.2–92.6); primary enucleation/evisceration patients were older on average than secondary eye removal patients [53.8 years (range 15.9–91.2) versus 42.2 years (range 4.2–91.6 years), p=0.04]. A median of 34 days passed between ED presentation and secondary enucleation/evisceration. Before undergoing secondary enucleation/evisceration, patients underwent a median of one ocular procedure (range 0–14) for various complications of trauma including orbital infection, choroidal or retinal tear or detachment, and wound dehiscence. Open globe injury repairs comprised 43 of the 92 total procedures (47%) performed prior to secondary enucleation/evisceration. Secondary enucleations/eviscerations required a median of seven clinic visits compared to two clinic visits required after primary surgeries (p<0.01). 10.7% of all patients (n=10) had at least one implant-related complication following enucleation/evisceration, with all but one of these patients being in the secondary enucleation/evisceration group. Conclusion Primary enucleation or evisceration was performed in 27% of all eye removals, and enucleation was performed in 69.6% of all eye removals. Future research is warranted to determine if primary eye removal may be appropriate and when to consider enucleation versus evisceration.
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Affiliation(s)
- Angela C Gauthier
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Oluseye K Oduyale
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael J Fliotsos
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nicholas R Mahoney
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
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11
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Ranno S, Serafino M, Nucci P. Four petal evisceration versus standard technique: A retrospective study. Eur J Ophthalmol 2020; 31:2156-2159. [PMID: 32799549 DOI: 10.1177/1120672120950160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the four-petal evisceration technique and the standard evisceration technique. METHODS In this retrospective, comparative case series study, sixteen charts of patients fulfilled the inclusion criteria and were were reviewed. Orbital implant exposition and complication rates between the two surgical techniques were evaluated. RESULTS A total of 16 eye of 16 patients fulfilled the inclusion criteria and were included in the analysis (eight in the four petal group and eight in the standard evisceration group).During postoperative follow-up there were no cases of implant exposure or migration in the four-petal group and two cases (25%) of implant exposure in the standard evisceration group.Exposed orbital implants dimension were both 16 mm and patients eviscerated for phtisis bulbiAll surgeries were uneventful, and there were no serious complications during the study. CONCLUSION Four petal evisceration technique seems particularly useful in patients with phtisis bulbi because it allowed the placement of an implant significantly larger than the standard technique with low rate of esposition.
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Affiliation(s)
| | | | - Paolo Nucci
- Universita degli Studi di Milano, Milano, Lombardia, Italy
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12
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Dave TV, Nayak A, Palo M, Goud Y, Tripuraneni D, Gupta S. Custom ocular prosthesis-related concerns: patient feedback survey-based report vis-à-vis objective clinical grading scales. Orbit 2020; 40:357-363. [PMID: 32744109 DOI: 10.1080/01676830.2020.1797826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose: To report the outcomes of a survey on patients' concerns and satisfaction with custom ocular prosthesis (COP) wear and compare with objective clinician grading scales.Methods: The questionnaire was answered by 156 participants. General social concerns and prosthesis-related concerns were plotted on a scale of 0 to 10, indicating least to maximum satisfaction and also not concerned to very concerned. Comparison between subjective patient and objective clinician scores was done.Results: The mean age at presentation was 27.53 ± 15.53 years (range 3-72 years).For patients that underwent a prior surgical procedure, mean satisfaction with the surgery was 9.42 ± 1.27. Mean satisfaction with the COP was 8.98 ± 1.75. The median satisfaction score for the primary surgery as well as for the outcome of the custom ocular prosthesis was 10. Commonest prosthesis-related concerns were reduced motility (mean 3 ± 2, median 3), watering, crusting and discharge (mean 2 ± 2, median 2), and difference in the size of the prosthetic eye relative to the other eye (mean 1 ± 2, median 1). Subjective patient concern responses and the objective clinician grading correlated strongly for movement of the prosthesis (r = -0.84, p < .0001), periocular fullness (r = 0.65, p < .0001), color of the prosthesis (r = -0.8, p < .0001) and size relative to the other eye (r = 0.7, p < .0001).Conclusion: Custom ocular prosthesis usage had a high satisfaction score with minimal concerns. Commonest prosthesis-related concerns correlated strongly with objective clinician grading.
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Affiliation(s)
- Tarjani Vivek Dave
- Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, Hyderabad, India
| | - Arpita Nayak
- Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, Hyderabad, India
| | - Mansha Palo
- Ocular Prosthesis Laboratory, LV Prasad Eye Institute, Hyderabad, India
| | - Yashwanth Goud
- Ocular Prosthesis Laboratory, LV Prasad Eye Institute, Hyderabad, India
| | | | - Sachin Gupta
- Ocular Prosthesis Laboratory, LV Prasad Eye Institute, Hyderabad, India
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13
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Risk Factors for Trauma-Related Eviscerations: Analysis of 821 Cases. J Ophthalmol 2019; 2019:6198368. [PMID: 31827911 PMCID: PMC6881570 DOI: 10.1155/2019/6198368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/06/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022] Open
Abstract
Evisceration is the end therapeutic approach for the treatment of severe ocular trauma cases, and it is a tremendous loss for patients. In this study, we explored the changing trends in the number of surgeries performed, demographic data and ocular features, and risks for early evisceration, aiming to provide more data for the additional prevention and management strategies for this catastrophic problem. This was a retrospective study that included patients who underwent ocular evisceration at the Zhongshan Ophthalmic Center between January 2013 and December 2017. A total of 1229 evisceration cases were reviewed, and only trauma-related eviscerations were analyzed. Etiology, demographic data, ocular features, and hospitalization time were evaluated. The total number of trauma-related eviscerations recorded in the past five years was 821 cases. The number of surgeries performed was almost constant each year (164 ± 17 cases); 35% of the patients were less than ten years old at the time of the original ocular injury and 69% of them were male. Endophthalmitis led to significantly early evisceration compared with cases without endophthalmitis (P < 0.05). The group with a history of silicone oil tamponade showed a significantly longer surgical interval between trauma and evisceration than did the nonsilicone oil tamponade group (P < 0.05). Day-case hospitalization for evisceration increased from 0% to 32% over the past five years. The results of the present study show that the number of ocular trauma-related eviscerations performed in the past five years was almost unchanged and boys under ten are highly susceptible. This study also demonstrates that endophthalmitis leads to significantly early evisceration, and silicone oil tamponade may postpone ocular atrophy. Based on the study data, day-case surgery is safe for evisceration management.
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14
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Erickson BP, Feng PW, Ko MJ, Modi YS, Johnson TE. Gun-related eye injuries: A primer. Surv Ophthalmol 2019; 65:67-78. [PMID: 31229522 DOI: 10.1016/j.survophthal.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 06/01/2019] [Accepted: 06/07/2019] [Indexed: 02/03/2023]
Abstract
Gun-related eye injuries are relatively common in the context of gunshot wounds to the head and neck. Many of the fundamental principles of gunshot wound management apply to the care of these patients, but the complex anatomy and functional relationships of the periocular region do pose special challenges. We provide a focused primer for physicians seeking a more in-depth understanding of gun-related eye injuries and present 3 representative cases outlining the spectrum of pathology, provide a focused review of the relevant ballistics concepts, and discuss the management of injuries to the periocular soft tissues, orbital structures, and globe. We found that good cosmetic and functional results can often be achieved with appropriate early intervention, but visual prognosis may remain guarded despite optimal treatment.
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Affiliation(s)
- Benjamin P Erickson
- Stanford Health Care, Byers Eye Institute at Stanford, Palo Alto, California, USA.
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marcus J Ko
- Nevada Centre for Eye Plastic Surgery, Reno, Nevada, USA
| | - Yasha S Modi
- Department of Ophthalmology, New York University School of Medicine, New York, New York, USA
| | - Thomas E Johnson
- Oculofacial Plastic Surgery, Bascom Palmer Eye Institute, Miami, Florida, USA
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15
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Holmes CJ, McLaughlin A, Farooq T, Awad J, Murray A, Scott R. Outcomes of ocular evisceration and enucleation in the British Armed Forces from Iraq and Afghanistan. Eye (Lond) 2019; 33:1748-1755. [PMID: 31165770 DOI: 10.1038/s41433-019-0480-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/29/2019] [Accepted: 03/25/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/OBJECTIVES To evaluate outcomes from all British military patients who underwent eye removal during the Iraq and Afghanistan wars. SUBJECTS/METHODS Retrospective case note review of all patients (n = 19) who had undergone either evisceration or enucleation, on a database of all military patients repatriated to the Royal Centre for Defence Medicine, Birmingham. RESULTS Twenty eye removals were performed on 19 patients, of which 14 (70%) were eviscerations and 6 (30%) were enucleations. Orbital wall fractures were seen in 12 (61%) patients, with orbital floor fractures being the most common. The eye removal was a primary procedure in five of fourteen eviscerations, and five of six enucleations. Complications were seen after four (28.6%) eviscerations patients and two (33.3%) enucleations. Postoperative pain was problematic after three (21.4%) eviscerations but no enucleations. Orbital implants were placed during three of the five primary enucleations, with good outcomes in two. One patient however required implant retrieval and wound washout due to a high risk of infection and communication with the intra-cranial space. CONCLUSIONS Evisceration and enucleation are both viable options in the management of severe ocular trauma in military patients. Evisceration and enucleation have similar complication rates and outcomes, and both have low rates of sympathetic ophthalmia. Primary orbital implants can be at high risk in cases with orbital roof fracture, but can provide good outcomes in select patients.
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Affiliation(s)
| | | | | | - John Awad
- University Hospitals, Birmingham, UK
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Roelofs KA, Aghazadeh H, Cheema M, Weis E, Badilla J. Enucleation and evisceration: an analysis of indications, histopathological findings, and surgical trends over 23 years at a tertiary care hospital in western Canada. Can J Ophthalmol 2019; 54:106-110. [DOI: 10.1016/j.jcjo.2018.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 02/22/2018] [Accepted: 02/27/2018] [Indexed: 10/28/2022]
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Affiliation(s)
- Marcelo Coelho Goiato
- Department of Dental Material and Prosthesis, Sao Paulo State University (UNESP), School of Dentistry, Araçatuba, Brazil
| | - Fernanda Pereira de Caxias
- Department of Dental Material and Prosthesis, Sao Paulo State University (UNESP), School of Dentistry, Araçatuba, Brazil
| | - Daniela Micheline dos Santos
- Department of Dental Material and Prosthesis, Sao Paulo State University (UNESP), School of Dentistry, Araçatuba, Brazil
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Zheng PF, You QS, Li Q, Deng HY, Wong IYH, Peng XY. Injectable silicone rubber for ocular implantation after evisceration. PLoS One 2018; 13:e0193448. [PMID: 29570703 PMCID: PMC5866100 DOI: 10.1371/journal.pone.0193448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 02/12/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate the usefulness of addition type liquid silicone rubber (ATLSR) as injectable implant after evisceration to maintain the eyeball volume in an animal experiment. METHODS Twelve adult New Zealand white rabbits were included. One eye of each rabbit was randomly selected for evisceration with the fellow eye as control. ATLSR was injected to fill the eyeball socket after evisceration. In vivo observation and photographs were performed up to 24 weeks post-op. Two rabbits were sacrificed respectively at post-operative week 1, 2, 4, 8, 12 and 24. After enucleation, the vertical, horizontal and sagittal diameters of the experimental eyeballs were measured and compared with the control eyes. Histopathological studies were performed to evaluate signs of inflammation. RESULTS Cornea remained clear throughout the observation period despite mild epithelial edema and neovascularization. Compared to the control eyes, the experimental eyes were significantly smaller in vertical diameter (17.00±1.17 vs. 17.54±1.11 mm, P<0.001), but larger in sagittal diameter (16.85±1.48 vs. 16.40±1.38 mm, P = 0.008), and had no significant difference in horizontal diameter (17.49±1.53 vs. 17.64±1.21 mm, P = 0.34). Postoperative inflammation was observed at one week after surgery, which peaked at 2-3 weeks, then regressed gradually. At week 12 and week 24, most of the inflammatory cells disappeared with some residual plasma cells and eosinophils. CONCLUSION Injectable addition type silicon rubber may be a good choice for ocular implantation after evisceration, maintaining eyeball volume and cosmetically satisfactory when compared to the fellow eye. Spontaneous regression of inflammation implied good biocompatibility for at least 24 weeks.
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Affiliation(s)
- Peng Fei Zheng
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Qi Sheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Qian Li
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hong Yan Deng
- Beijing Stomatology Hospital, Capital Medical University, Beijing, China
| | - Ian Y. H. Wong
- Department of Ophthalmology, University of Hong Kong, Hong Kong, Hong Kong
| | - Xiao Yan Peng
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
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A Single- Versus Double-Layered Closure Technique in Anophthalmic Surgery. Ophthalmic Plast Reconstr Surg 2017; 33:329-333. [PMID: 27608285 DOI: 10.1097/iop.0000000000000784] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the frequency of orbital implant exposure and extrusion following eye removal with a simplified closure technique, closing Tenon's capsule and conjunctiva in 1 layer versus the classic technique of closure in 2 separate layers. METHODS The authors conducted a retrospective case note review of patients who underwent evisceration or enucleation treated by 1 surgeon between 2001 and 2013. Between 2001 and 2004, Tenon's capsule and conjunctiva were closed in separate layers; after 2004, a simplified 1-layer closure following eye removal was used. The primary outcome parameters were presence or absence of implant exposure or extrusion. RESULTS One hundred fifty-seven patients who underwent evisceration and 172 patients who underwent enucleation were included. Following evisceration, 2.5% developed exposure or extrusion of the implant, this was 2.5% in the 1-layer closure technique and 2.7% in the 2-layer closure technique (p = 0.95). Following enucleation, 1.7% developed exposure or extrusion of the implant, this was 1.8% in the 1-layer closure technique and 1.7% in the 2-layer closure technique (p = 0.96). Overall implant exposure and extrusion was 2.1%, this was 2.2% in the 1-layer closure technique and 2.1% in the 2-layer closure technique (p = 0.96). CONCLUSIONS No difference was found in the frequency of spheric acrylic implant exposure or extrusion in patients who underwent eye removal with single-layer closure of Tenon's capsule and conjunctiva compared with patients treated with separate closure of these layers.
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Zhang Y, Zhang MN, Wang X, Chen XF. Removal of the eye in a tertiary care center of China: a retrospective study on 573 cases in 20 years. Int J Ophthalmol 2015; 8:1024-30. [PMID: 26558221 DOI: 10.3980/j.issn.2222-3959.2015.05.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 12/25/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To investigate the original protopathy, direct indications, clinical characteristics, complications of orbit plants and visual conditions of eye enucleation/evisceration. METHODS A retrospective study of 573 eyes removed (573 inpatients) at Ophthalmology Department in a tertiary care center of China from January 1993 to December 2012 was completed. RESULTS Cases underwent removal of the eye accounted for 2.15% of total ophthalmology inpatients, whose annual frequency declined from 3.80% to 0.52%. There were 167 eyes (29.14%) being enucleated and 406 (70.86%) eviscerated. Annual proportion of evisceration rose from 16.67% in 1993 to 90.48% in later years. Trauma was the top one (65.62%) in original protopathies followed by neoplasm (13.44%) and ocular infections (5.76%). Phthisis bulbi (45.20%) was the most common direct indication, succeeded by malignant tumor (12.57%), loss/unreconstructed of intraocular tissues due to trauma (11.00%), untreatable inflammation (9.60%), intractable glaucoma (8.55%) and sclerocorneal staphyloma (5.24%). Exenteration was underwent in 20 (25.97%) cases (40% for recurrent carcinoma). Following evisceration, secondary prosthesis implantation was more and earlier, implant exposure occurred in less but earlier and infection and extraction/exchange of implants were more than those following enucleation. Male, phthisis bulbi, evisceration and secondary implantation meant lower risk of implant exposure; eyes removed within 24h following trauma was an independent risk factor. There were 14.37% of eyes with vision of light perception at least as been removed. In the residual contralateral eyes, low vision accounted 5.58% and blindness 3.14%. CONCLUSION Ocular trauma, tumor and infections were great threats to eyeball preservation. Early and effective controlling of any original protopathies was vital. Generally evisceration presented more superior and safe outcomes than enucleation did. Visual conditions of the sufferers should be focused on.
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Affiliation(s)
- Ying Zhang
- Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Mao-Nian Zhang
- Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Xin Wang
- Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Xiao-Fei Chen
- Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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Ababneh OH, AboTaleb EA, Abu Ameerh MA, Yousef YA. Enucleation and evisceration at a tertiary care hospital in a developing country. BMC Ophthalmol 2015; 15:120. [PMID: 26362425 PMCID: PMC4566484 DOI: 10.1186/s12886-015-0108-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/20/2015] [Indexed: 11/16/2022] Open
Abstract
Background To analyze the demographics, indications, and surgical outcomes of anophthalmic surgery (enucleation and evisceration) at Jordan University Hospital during a 5-year period. Methods We conducted a retrospective chart review of patients who had undergone evisceration or enucleation between August 2006 and June 2011. The data collected included age at time of surgery, sex, affected eye, surgical indication, implant size, and postoperative complications. Results Anophthalmic surgery was performed for 68 eyes of 67 patients during the study period (42 (62 %) eviscerations and 26 (38 %) enucleations). Forty-three patients (64 %) were men, and 40 (59 %) eyes were right eyes. Trauma was the leading cause for anophthalmic surgery in 40 % of cases followed by a blind painful eye secondary to glaucoma (19 %) in the enucleation group and endophthalmitis (28.6 %) in the evisceration group. The most common anophthalmic surgery complication was wound dehiscence in 11.5 % of patients in the enucleation and 9.5 % in the evisceration groups. The mean and median sizes of the implants for evisceration were 16.6 and 18.0 mm, respectively; for enucleation, both were 20 mm. Conclusions Evisceration was the preferred anophthalmic surgery in our series unless contraindicated. Trauma was the most common predisposing factor for evisceration and enucleation in our tertiary care center followed by blind painful eyes and endophthalmitis. The most common complication was wound dehiscence in both groups.
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Affiliation(s)
- Osama H Ababneh
- Department of Ophthalmology, Jordan University Hospital, The University of Jordan, Amman, Jordan.
| | - Eman A AboTaleb
- Department of Ophthalmology, Sana'a University, Sana'a, Yemen.
| | - Mohammad A Abu Ameerh
- Department of Ophthalmology, Jordan University Hospital, The University of Jordan, Amman, Jordan.
| | - Yacoub A Yousef
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan.
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Zhu Y, Zhang H, Song YW, Guo JM, Xu XL, Wang JM. Autologous sclera-muscle flaps technique in evisceration with hydroxyapatite implantation. Int J Ophthalmol 2015; 8:714-8. [PMID: 26309868 DOI: 10.3980/j.issn.2222-3959.2015.04.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 01/21/2015] [Indexed: 11/02/2022] Open
Abstract
AIM To provide superior cosmetic results and reduce complications, unlike traditional evisceration coupled with implant insertion technique and its modifications, we have developed a novel and simple technique for anophthalmic patients. METHODS All patients who underwent the scleral-muscle flaps procedure in evisceration with the placement of hydroxyapatite implant were included in the study. Main outcome measures were complications such as exposure, infection, chemosis, conjunctival inclusion cysts, granulomas. Meanwhile, implant motility was indirectly measured and the results were collected and analyzed. RESULTS A total of twenty-eight patients were enrolled in the study. Eighteen were men (64.29%) and ten were women (35.71%). Ages ranged from 18 to 65y (mean age, 32 years old). Mean follow-up was 12.32mo (range, 9-16mo). All patients received a hydroxyapatite implant. The average diameter of the implant was 19.29±1.36 mm (range, 18-22 mm). Minor complications occurred in 3 patients, and a major complication was observed in 1 patient. Mean motility were 11.04±1.45 mm horizontally (range, 7-14 mm) and 8.57±1.50 mm vertically (range, 5-12 mm). CONCLUSION The sclera-muscle flaps technique in evisceration with hydroxyapatite implantation is simple and practical that eases the surgical procedure, enables a proper size hydroxyapatite implantation, distinctively reduces complications and provides superior surgery results, especially the motility of the implant.
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Affiliation(s)
- Ying Zhu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Hong Zhang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Yin-Wei Song
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Jing-Min Guo
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xiao-Lan Xu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Jun-Ming Wang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Tripathy D, Rath S. Evisceration with Primary Orbital Implant in Fulminant Endophthalmitis/Panophthalmitis. Orbit 2015; 34:279-83. [PMID: 26308681 DOI: 10.3109/01676830.2015.1078366] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare the outcome of evisceration with primary orbital implant in blind eyes with and without fulminant infection (endophthalmitis/panophthalmitis). METHODS Retrospective nonrandomized comparative interventional case series. Patients with a minimum postoperative follow-up of 6 months were considered for inclusion. Thirty-four eyes of 34 patients were included. Sixteen eyes were infective and 18 noninfective. Nonporous silicone implants were used for all cases and the main outcome measure was successful retention of the primary implant. Major and minor complications and successful prosthesis fitting were also noted. RESULTS All except 3 cases were able to retain the primary implant successfully and all but 2 patients underwent successful prosthesis fitting. Major complications included implant extrusion in 3 cases (2 infective, 1 noninfective) and implant exposure in 1 case (noninfective). The difference in major complications between the groups was not statistically significant (p = 0.66, Fisher exact test). CONCLUSION Our data suggest that evisceration with primary orbital implant is a feasible option in fulminant endophthalmitis/panophthalmitis and provides a good postoperative cosmetic outcome to the anophthalmic socket at an economical cost.
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Affiliation(s)
- Devjyoti Tripathy
- a Oculoplastics, Orbit & Ocular Oncology Services, Priyamvada Birla Aravind Eye Hospital , Kolkata , West Bengal , India and
| | - Suryasnata Rath
- b Oculoplastics, Orbit & Ocular Oncology Services, LV Prasad Eye Institute , Bhubaneswar , Odisha , India
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Abstract
PURPOSE To describe the results and potential benefit of placement of a porous orbital implant (aluminum oxide) posterior to posterior sclera and compare the exposure rate with a former evisceration technique involving a posterior sclerotomy with placement of a porous implant partly within the scleral shell and partly within the intraconal space. METHODS Single-center, retrospective, interventional case series. A chart review of 93 patients undergoing evisceration with placement of an aluminum oxide orbital implant in conjunction with 2 different posterior sclerotomy techniques between 1999 and 2013 was carried out. Seventy-one patients met the inclusion criteria having 1 of 2 posterior sclerotomy techniques with an aluminum oxide orbital implant, a normal or near normal size eye and at least 6 months follow-up. Retrospective data analysis included demographic profile and treatment outcomes of the different posterior sclerotomy techniques. This study was performed with Institutional Review Board Approval and in compliance with the Declaration of Helsinki. RESULTS Thirty patients underwent the posterior radial sclerotomy technique, while 41 patients underwent implant placement posterior to posterior sclera technique. The average size implant used in the posterior radial sclerotomy technique was 18 mm versus 20 mm in the implant placement posterior to posterior sclera technique (p < 0.001) with the implant placed posterior to posterior sclera. The exposure rate with the posterior radial sclerotomy technique was 5 of the 30 patients (16.7%) and 0 of 41 (0%) for the implant placement posterior to posterior sclera technique (p = 0.006). CONCLUSION Placement of an aluminum oxide orbital implant posterior to posterior sclera allowed the placement of larger implants which allowed enhancement of socket volume. In addition, it appeared to have a decreased risk of implant exposure during the study period. Porous implant placement posterior to posterior sclera is an alternate posterior sclerotomy technique that allows coverage of the implant surface with 3 layers of autogenous sclera.
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Koh V, Chiam N, Sundar G. Survey of common practices among oculofacial surgeons in the Asia-Pacific region: evisceration, enucleation and management of anophthalmic sockets. Orbit 2014; 33:477. [PMID: 25207840 DOI: 10.3109/01676830.2014.950293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Victor Koh
- Department of Ophthalmology, National University Health System , Singapore
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Abstract
OBJECTIVES To examine orbital implant exposure rates following enucleation and evisceration. METHODS A retrospective chart review of all patients who underwent an evisceration or enucleation in a single centre over a 5-year period was performed. The indication for surgery, the type and size of orbital implant used, details of the surgical technique adopted and the postoperative complications observed, in particular orbital implant exposure, were recorded. RESULTS Over a 5-year period 24 patients had enucleation and 14 had evisceration; 22 of these procedures were performed by an ophthalmic surgeon with a special interest in orbit and oculoplastics while the remaining 16 procedures were performed by 5 ophthalmic surgeons with other sub-specialty interests. Orbital implant exposure occurred in 8 cases. One case had been performed by the first of these surgeons described. Implant exposure occurred in 4% of cases performed by this surgeon. The remaining 7 cases had been performed by the group of surgeons with sub-specialty interests outside of orbit and oculoplastics. Implant exposure occurred in 48% of cases performed by this group. CONCLUSIONS Orbital implant exposure remains a significant cause of morbidity in patients undergoing enucleation and evisceration. Rates of orbital implant exposure were significantly lower when surgery was performed by an orbital surgeon. Differences in surgical technique are the most likely explanation.
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Affiliation(s)
- Elizabeth M McElnea
- Department of Ophthalmology, Mater Misericordiae University Hospital , Dublin , Ireland
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Zheng C, Wu AY. Enucleation versus evisceration in ocular trauma: a retrospective review and study of current literature. Orbit 2013; 32:356-61. [PMID: 23909276 DOI: 10.3109/01676830.2013.764452] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare variables and outcomes from ocular trauma leading to either enucleation or evisceration to better inform surgical decision making. DESIGN Retrospective chart review. METHODS We reviewed 441 patients between 2001 and 2012 presenting with ocular trauma to a Level 1 trauma center in Queens, New York; of these, there were 16 enucleations and 6 eviscerations. Retrospective chart review noted age, gender, mechanism of injury, initial and final visual acuity, time to surgery, length of follow-up, pain, degree of motility, and complications. A review of literature in the context of our study was performed. RESULTS 20 patients were male and 2 patients were female; average age was 44 (SD: 20.0, range 18-91). 9/16 patients were enucleated to prevent sympathetic ophthalmia, whereas only 1/5 patient was eviscerated for this indication (p = 0.1619). No cases of sympathetic ophthalmia were reported over an average follow-up of 316 days. Average length of follow-up varied significantly between the two groups, with an average of 370.4 days (SD: 566.9, range 0-1870) for enucleated eyes and 172.7 days (SD: 146.3, range 0-422) for eviscerated eyes (p = 0.42). Medpor implants were preferred in eviscerations (5/6 eviscerations), whereas hydroxyapatite implants were preferred in enucleations (10/16 enucleations, p = 0.04). CONCLUSIONS Surgical decision-making in ocular trauma is largely based on surgeon preference and experience, with minimal evidence in the literature to support either enucleation or evisceration. We recommend evisceration over enucleation in cases of reliable patient follow-up due to the low incidence of sympathetic ophthalmia.
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Affiliation(s)
- Chengjie Zheng
- Department of Ophthalmology, Mount Sinai School of Medicine , New York , USA
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Kim JH, Jang SY, Kim MJ, Lee SY, Yoon JS. Comparison of pain-relieving effects of fentanyl versus ketorolac after eye amputation surgery. KOREAN JOURNAL OF OPHTHALMOLOGY 2013; 27:229-34. [PMID: 23908567 PMCID: PMC3730063 DOI: 10.3341/kjo.2013.27.4.229] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 10/23/2012] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the analgesic effect and incidence of postoperative nausea and vomiting (PONV) between the opioid fentanyl and the non-steroidal anti-inflammatory drug ketorolac in patients who underwent eye amputation surgery. Methods Retrospective observational case series. Eighty-two patients underwent evisceration or enucleation surgery by one surgeon over a 2-year period. Fentanyl by intravenous patient-controlled analgesia (IV-PCA) at 20 µg/kg with 12 mg/kg ondansetron or intravenous ketorolac at 2 mg/kg/day was administered to patients at postoperative days 0, 1, and 2. The pain score was measured using an 11-point visual analog scale (VAS). The incidence of severe nausea requiring anti-emetics and the incidence of vomiting were reviewed. Results The mean postoperative VAS in the fentanyl group was significantly lower than that in the ketorolac group on the day of operation for both types of surgery (p = 0.001 and p = 0.004, respectively). At postoperative days 1 and 2, the mean VAS was not different between the two groups for either surgical type (p > 0.05 for both days). The mean VAS was significantly higher in eviscerated patients than in enucleated patients at postoperative days 0 and 1 in the fentanyl group (p = 0.023 and p = 0.016, respectively). However, this was not observed in the ketorolac group. The incidence of PONV was higher in the fentanyl group than in the ketorolac group, although this was not statistically significant for either surgical type (p > 0.05 for both groups). Conclusions Fentanyl was more effective as an analgesic than was ketorolac on the day of operation for both surgical types. There was no difference between the two analgesics on postoperative day 1. The analgesic effect of fentanyl in enucleated patients was significantly higher than in eviscerated patients at postoperative days 0 and 1. The use of fentanyl by IV-PCA was associated with greater PONV despite co-administration with anti-emetics, although this finding was not significant.
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Affiliation(s)
- Jin Hyung Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Shah RD, Singa RM, Aakalu VK, Setabutr P. Evisceration and Enucleation: A National Survey of Practice Patterns in the United States. Ophthalmic Surg Lasers Imaging Retina 2012; 43:425-30. [DOI: 10.3928/15428877-20120725-01] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 06/07/2012] [Indexed: 11/20/2022]
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Abstract
OBJECTIVE To determine the indications, relative frequencies, surgical times, and complications for enucleation and evisceration performed at a single academic center. METHODS Medical records of all patients who underwent an enucleation or evisceration between January 1st, 1990 and December 31st, 2009 at a single academic center were reviewed. Patient demographics and surgical indications, times, and complications were recorded. RESULTS A total of 85 eyes in 85 patients underwent enucleation (n = 31; 36%) or evisceration (n = 54; 64%) during the study period. Almost all patients were of African descent (96%). The most common underlying cause leading to eye removal was trauma. On average, eviscerations (47.3 ± 10.3 minutes) took significantly less time to perform than enucleations (89.6 ± 10.1 minutes; p < 0.01). Complications included implant exposure, infection, lower lid laxity, fornix insufficiency, and need for subsequent surgery; the occurrence of these complications was found to be similar between the two groups (p = 0.77). No case of sympathetic ophthalmia or inadvertent evisceration of an eye with an occult intraocular malignancy was noted. From the first decade for which data were available (1990- 1999) to the second decade (2000- 2009), the average number of enucleations decreased (p = 0.02) and the average number of eviscerations (p = 0.04) increased. CONCLUSION Evisceration was found to be a safe and quicker alternative to enucleation in our study. A change in surgical preference from enucleation to evisceration was seen during the 20-year study period.
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Affiliation(s)
- Salman J Yousuf
- Department of Ophthalmology, Howard University, Washington, D.C., USA
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Lemaire A, Dakpé S, Lafitte J, Sorrel-Déjerine E, Testelin S. [Enophtalmos of the anophtalmic socket: incidence of the orbital morphology and therapeutic implications. Clinical study of 86 cases]. ANN CHIR PLAST ESTH 2012; 57:549-57. [PMID: 22841413 DOI: 10.1016/j.anplas.2012.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 05/30/2012] [Indexed: 11/18/2022]
Abstract
AIM OF THE STUDY From a light asymmetry to a sunken eye aspect, a great disparity between the results after anophtalmic socket rehabilitation is noticeable: what are the factors involved in the degree of residual enophtalmos following excision of the eye? The litterature's response is based on physiopathological considerations around intraorbital architectural disturbance. We propose a geometrical approach related to the existence of different morphological types of orbit. PATIENTS AND METHOD Eighty-six records of eviscerated and enucleated patients have been studied and submitted to a statistical analysis. A preliminary study has defined four types of orbit depending on the shape and operture of the orbital "window": two opposite types IA and III, a type II intermediate and a particular one, the type IB. A classification of enophtalmos' degree allows to analyze the parameters chosen and to identify the predictive factors. RESULTS The statistical analysis confirms the incidence of the orbital morphology on the degree of enophtalmos but do not support the theories based on the intraorbital septal architecture changes. Depending on the orbital shape and the container-content relation, the volume loss is more visible on the whole orbitopalpebral surface of opened and high orbit but remains centered on the anteroposterior position of the implant of a closed and lengthened orbit. At the contrary to the type III, the type IA is not favorable for the anophtalmic patient and predispose to a higher degree of enophtalmos. This new approach has therapeutic implications on primary and secondary surgery for volume loss replacement. CONCLUSION The success of anophtalmic socket rehabilitation is influenced by the orbital morphological type that has to be considered in the therapeutic strategy.
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Affiliation(s)
- A Lemaire
- Service de chirurgie maxillo-faciale et stomatologie, CHU d'Amiens, place Victor-Pauchet, Amiens, France.
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Followup of a Dog with an Intraocular Silicone Prosthesis Combined with an Extraocular Glass Prosthesis. Case Rep Vet Med 2012. [DOI: 10.1155/2012/762452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Because of unpredictable corneal changes, evisceration and implantation of a silicone prosthesis does not always lead to a satisfying cosmetic result. This paper describes the use of an intraocular silicone prosthesis in combination with an extraocular glass prosthesis and shows a followup of two and a half years in a nonexperimental study. An intraocular silicone prosthesis was implanted after evisceration of the left eye in a five-month-old Bernese mountain dog. A glass prosthesis was fitted four weeks after evisceration. Two and a half years after the operation, the dog is in good health and free of medication. No short-term or long-term complications were seen. The owners do not have trouble with handling the glass prosthesis. The combination of both prostheses shows a perfect solution to retrieve a normal looking and moving eye after evisceration.
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Ramey N, Gupta D, Price K, Husain A, Richard M, Woodward J. Comparison of Complication Rates of Porous Anophthalmic Orbital Implants. Ophthalmic Surg Lasers Imaging Retina 2011; 42:434-40. [DOI: 10.3928/15428877-20110812-03] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 06/24/2011] [Indexed: 11/20/2022]
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Abstract
PURPOSE To evaluate the potential advantages of closing mid-posterior Tenon's capsule during enucleation surgery by comparing its thickness and relative tissue strength with anterior Tenon's capsule. To evaluate surgical outcomes of enucleation using mid-posterior Tenon's capsule closure. METHODS This is an experimental laboratory study and retrospective surgical case series. Histologic examination of Tenon's capsule was performed on permanently fixated human orbital specimens. Suture pull-out testing as a measure of tissue strength was performed on anterior and mid-posterior Tenon's capsule in nonfixated human cadaver orbits. A retrospective review of enucleations with primary orbital implant placement performed by the authors between 1998 and 2008 was conducted to determine the surgical outcomes of enucleation using closure of mid-posterior Tenon's capsule. RESULTS Histologic analysis showed the average thickness of mid-posterior Tenon's capsule to be 121% greater than that of the anterior portion (518 vs. 234 μ, p < 0.001). Suture pull-out strength was 84% higher in mid-posterior versus anterior Tenon's capsule (741 vs. 1298 g, p = 0.016). Of the 103 enucleations performed by the authors (54 with unwrapped silicone implants and 49 with unwrapped porous polyethylene), there were 2 cases (1.9%) of implant extrusion and 1 case (1%) of implant exposure. CONCLUSION From a structural and biomechanical standpoint, mid-posterior Tenon's capsule is significantly thicker and stronger than anterior Tenon's capsule, theoretically providing a superior barrier to orbital implant exposure and extrusion after enucleation.
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Rasmussen MLR. The eye amputated - consequences of eye amputation with emphasis on clinical aspects, phantom eye syndrome and quality of life. Acta Ophthalmol 2010; 88 Thesis 2:1-26. [PMID: 21108770 DOI: 10.1111/j.1755-3768.2010.02039.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In this thesis the term eye amputation (EA) covers the removing of an eye by: evisceration, enucleation and exenteration. Amputation of an eye is most frequently the end-stage in a complicated disease, or the primary treatment in trauma and neoplasm. In 2010 the literature is extensive due to knowledge about types of surgery, implants and surgical technique. However, not much is known about the time past surgery. THE PURPOSE OF THE PHD THESIS WAS To identify the number of EA, the causative diagnosis and the indication for surgical removal of the eye, the chosen surgical technique and to evaluate a possible change in surgical technique in Denmark from 1996 until 2003 (paper I); To describe the phantom eye syndrome and its prevalence of visual hallucinations, phantom pain and phantom sensations (paper II); To characterise the quality of phantom eye pain, including its intensity and frequency among EA patients. We attempted to identify patients with increased risk of developing pain after EA and investigated if preoperative pain is a risk factor for a later development of phantom pain (paper III); In addition we wanted to investigate the health related quality of life, perceived stress, self rated health, job separation due to illness or disability and socio-economic position of the EA in comparison with the general Danish population (paper IV). THE STUDIES WERE BASED ON Records on 431 EA patients, clinical ophthalmological examination and an interview study of 173 EA patients and a questionnaire answered by 120 EA patients. CONCLUSIONS The most frequent indications for EA in Denmark were painful blind eye (37%) and neoplasm (34%). During the study period 1996-2003, the annual number of eye amputations was stable, but an increase in bulbar eviscerations was noticed. Orbital implants were used with an increasing tendency until 2003. The Phantom eye syndrome is frequent among EA patients. Visual hallucinations were described by 42% of the patients. The content were mainly elementary visual hallucinations, with white or colored light as a continuous sharp light or as moving dots. The most frequent triggers were darkness, closing of the eyes, fatigue and psychological stress. Fifty-four percent of the patients had visual hallucinations more than once a week. Ten patients were so visually disturbed that it interfered with their daily life. Approximately 23% of all EA experience phantom pain for several years after the surgery. Phantom pain was reported to be of three different qualities: (i) cutting, penetrating, gnawing or oppressive (n=19); (ii) radiating, zapping or shooting (n=8); (iii) superficial burning or stinging (n=5); or a mixture of these different pain qualities (n=7). The median intensity on a visual analogue scale, ranging from 0 to 100, was 36 [range: 1-89]. One-third of the patients experienced phantom pain every day. Chilliness, windy weather and psychological stress/fatigue were the most commonly reported triggers for pain. Factors associated with phantom pain were: ophthalmic pain before EA, the presence of implant and a patient reported high degree of conjunctival secretion. A common reason for EA is the presence of a painful blind eye. However, one third of these patients continue to have pain after the EA. Phantom sensations were present in 2% of the patients. The impact of an eye amputation is considerable. EA patients have poorer health related quality of life, poorer self-rated health and more perceived stress than does the general population. The largest differences in health related quality of life between the EA patients and the general population were related to role limitations due to emotional problems and mental health. Patients with the indication painful blind eye are having lower scores in all aspects of health related quality of life and perceived stress than patients with the indication neoplasm and trauma. The percentage of eye amputated which is divorced or separated was twice as high as in the general population. Furthermore, 25% retired or changed to part-time jobs due to eye disease and 39.5% stopped participating in leisure activities due to their EAs.
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Affiliation(s)
- Marie Louise Roed Rasmussen
- University of Copenhagen, Department of Neuroscience and Pharmacology, Section of Eye Pathology, Frederik den V's vej 11, DK-2100 Copenhagen, Denmark.
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Evisceration With Equatorial Sclerotomy for Phthisis Bulbi and Microphthalmos. Ophthalmic Plast Reconstr Surg 2010; 26:165-7. [DOI: 10.1097/iop.0b013e3181b8c895] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
The case is presented of a 12-year old boy who sustained severe penetrating ocular trauma while playing on a domestic trampoline. A main spring broke under tension and the hook had struck the eye at high velocity and penetrated the sclera. Primary repair was undertaken but on review it became apparent the eye could not be salvaged. Evisceration was carried out and an orbital implant was placed. Post-operative cosmesis is acceptable. This type of injury has not been reported before. Adult supervision of children on trampolines is recommended to minimise the chance of serious injury.
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Affiliation(s)
- David Spokes
- Hull & East Yorkshire Eye Hospital, Ophthalmology, Hull, UK.
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[Anterior surface breakdown following evisceration : "Classic", "scleral modification", and "scleral patch techniques"]. Ophthalmologe 2009; 107:246-50. [PMID: 19578857 DOI: 10.1007/s00347-009-1988-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND To evaluate the frequency of anterior surface breakdown for three techniques of evisceration with primary implant placement: the "classic" technique, the "scleral modification" technique, and the novel "scleral patch" technique. METHODS Retrospective comparative case series with 73 consecutive eviscerations with primary implants that were performed in the Eye Clinic Rotterdam between January 2003 and January 2007. RESULTS The operations involved the classic technique for 55% of the patients, scleral modification for 29%, and the novel scleral patch technique for 16%. In all, 9.6% of the patients had conjunctival breakdown: six in the classic group and one in the patch group. Although the frequency of this complication was higher in the classic group, the difference was not significant (P>0.05, chi-square test). Anterior surface breakdown was not related to implant size or prior eye surgery. CONCLUSION Compared with the scleral modification and scleral patch techniques, conjunctival breakdown and implant extrusion were seen more frequently after classic evisceration with implant placement. Implant size or indication for surgery were not related to the frequency of these complications.
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Late exposure of the bioceramic orbital implant. Am J Ophthalmol 2009; 147:162-170.e1. [PMID: 18571617 DOI: 10.1016/j.ajo.2008.05.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 04/30/2008] [Accepted: 05/01/2008] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the long-term outcome of the Bioceramic orbital implant. DESIGN A retrospective, comparative, nonrandomized study. METHODS Data were collected from the patients receiving Bioceramic orbital implants at National Taiwan University Hospital between June 1, 2001 and November 1, 2005. The implant was wrapped with Vicryl mesh, adding anteriorly with a scleral patch graft following enucleation with primary or secondary implantation. The unwrapped implant was inserted into an eviscerated globe with posterior sclerotomy and cornea preserved. Primary or secondary placement of sleeve was performed in some patients. RESULTS A total of 112 cases were reviewed. Four patients were excluded attributable to insufficient follow-up. The other 108 patients had a mean follow-up period of 35.8 +/- 10.6 months (range, 24 to 70 months). Fifty patients (46.3%) received the pegging procedure. Eight of 108 (7.4%) cases of late exposure were identified on average 20.7 months after implantation. We identified no cases of implant exposure in 30 cases of enucleation and eight cases of secondary implant when the implant was wrapped in Vicryl mesh and an anterior scleral cap was used. All exposures developed in eviscerated patients (70 cases): two without pegging, three with primary placement, and three with secondary placement of the sleeve. The exposure rate was higher in patients with eviscerated globes, pegged implants, and prior ocular operations (P < .005). CONCLUSIONS Late exposures of Bioceramic implants were found after long-term follow-up, associated with evisceration, pegging, and prior ocular surgeries. The modified wrapping technique can prevent exposure following secondary implantation and enucleation.
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Kim MJ, Choung HK, Kim NJ, Khwarg SI. Congenital corneal staphyloma treated by evisceration and primary implant placement: 3 cases. Can J Ophthalmol 2008; 43:111-3. [DOI: 10.3129/i07-183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Bernardino CR. Evisceration vs. enucleation. Ophthalmology 2007; 114:1959; author reply 1959-60. [PMID: 17908611 DOI: 10.1016/j.ophtha.2007.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 06/29/2007] [Indexed: 11/16/2022] Open
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Goisis M, Guareschi M, Miglior S, Giannì AB. Evisceration vs. enucleation. Ophthalmology 2007; 114:1960; author reply 1959-60. [PMID: 17908612 DOI: 10.1016/j.ophtha.2007.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Revised: 02/20/2007] [Accepted: 03/01/2007] [Indexed: 10/22/2022] Open
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Abstract
The philosophy and design of orbital enucleation implants have evolved significantly over the past 50 years. Animal studies and improved imaging techniques have changed our understanding about the physiology and anatomy of the post-enucleation orbit. Changes in implant design and biomaterials have reduced complication rates. It is our impression that for many ophthalmic professionals in training, the rational behind the current thinking in implant design and biomaterials is unclear. This is in part related to the older literature on orbital enucleation implants, which is scattered and at times contradictory. This review aims to present the historical information in a coherent and concise form; provide evidence based review of changes in the practice patterns of enucleation; identify areas of continuing controversy; and highlight gaps in the scientific literature about orbital implants, in particular, the poor understanding of implant and prosthesis motility.
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Affiliation(s)
- David Sami
- Division of Ophthalmology, Pediatric Subspecialty Faculty, Children's Hospital of Orange County, Orange, California 92868, USA
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