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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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Lai KKH, Au AKH, Kuk AKT, Tsang A, Tai JHC, Wang T, Ko STC, Chan E, Ko CKL. Surgical outcomes of orbital evisceration with primary orbital implant placement in patients with endophthalmitis. Eye (Lond) 2023; 37:1361-1364. [PMID: 35739246 PMCID: PMC10170096 DOI: 10.1038/s41433-022-02135-x] [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: 01/06/2022] [Revised: 05/10/2022] [Accepted: 06/09/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study reports the surgical outcomes of evisceration with primary orbital implant placement in patients with endophthalmitis and analyses the association with implant exposure and extrusion. METHODS A retrospective, multicentre, Chinese cohort study. Review of medical records and orbital images of patients who underwent evisceration with primary orbital implant placement between January 2005 and January 2021. RESULTS Out of 79 patients who underwent orbital evisceration with primary orbital implant placement, 26 (26 eyes) of them (male = 13) suffered from endophthalmitis. The duration from endophthalmitis diagnosis (19 = exogenous, 7 = endogenous) to evisceration was 9 standard deviation ± 5 (range: 1-15) days. The follow-up was 70 ± 46 (24-180) months after operation. The orbital implant size was 17 ± 3 (14-20) mm, and silicone was the most used material (69%, 18/26 of patients). The most frequent post-operative complication was orbital implant exposure (42%, 11/26), followed by orbital implant extrusion (12% 3/26) and ptosis (8%, 2/26). Implant exposure or extrusion was more commonly associated with endophthalmitis in comparison to non-endophthalmitis patients that required evisceration and primary orbital implant placement (54% versus 17%, P < 0.05). Univariate analysis showed single scleral closure technique (100% versus 58%, P < 0.05) and endogenous endophthalmitis (50% versus 0%, P < 0.05) were associated with implant exposure or extrusion, and only endogenous endophthalmitis was significant with multivariate analysis (P < 0.05). CONCLUSIONS Primary implant placement during evisceration should be avoided in eyes with endophthalmitis especially in those with an endogenous source, and double scleral closure technique may be a better alternative for primary orbital implant placement in infected eyes.
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Affiliation(s)
- Kenneth Ka Hei Lai
- Department of Ophthalmology, Tung Wah Eastern Hospital Causeway Bay, Hong Kong, Hong Kong.
| | - Alvin K H Au
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital Sha Tin, Hong Kong, Hong Kong
| | - Andrew K T Kuk
- Department of Ophthalmology, Tung Wah Eastern Hospital Causeway Bay, Hong Kong, Hong Kong
| | - Alan Tsang
- Department of Ophthalmology, Tung Wah Eastern Hospital Causeway Bay, Hong Kong, Hong Kong
| | | | - Ting Wang
- Department of Ophthalmology, Tung Wah Eastern Hospital Causeway Bay, Hong Kong, Hong Kong
| | - Simon T C Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital Causeway Bay, Hong Kong, Hong Kong
| | - Edwin Chan
- Department of Ophthalmology, Tung Wah Eastern Hospital Causeway Bay, Hong Kong, Hong Kong
| | - Callie K L Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital Causeway Bay, Hong Kong, Hong Kong
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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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Qi Q, Li R, Wu Y, Yu Y, Lin M, Shao C, Li J. A Sandwich-Like Oral Mucosa Graft–Conjunctiva In Situ–Dermis-Fat Graft for Reconstruction of the Anophthalmic Socket with Ocular Infection History. Ophthalmol Ther 2022; 11:1261-1271. [PMID: 35435605 PMCID: PMC9114179 DOI: 10.1007/s40123-022-00500-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/16/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction A novel technique
of using a sandwich-like structure, namely, an oral mucosa graft (OMG)–conjunctiva in situ–dermis-fat graft (DFG) (OMG-C-DFG), to reconstruct a contracted and low-capacity anophthalmic socket for a patient with ocular infection history was evaluated. Methods This was retrospective case study of four patients (cases) who underwent anophthalmic socket reconstruction surgery in which the OMG-C-DFG technique was applied. The procedures were performed in the Department of Ophthalmology at the Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine (Shanghai, China). Postoperative cosmetic appearance, graft outcome, the ability to wear an ocular prosthesis, and postoperative complications were evaluated. Results The median (± standard deviation) age of patients was 41.5 ± 22.1 (range 10–60) years. All patients suffered from contracted and low-capacity anophthalmic sockets. Three patients had a history of orbital implant infection and one patient had a history of enucleation due to exogenous endophthalmitis after globe rupture. The DFG and OMG were harvested from the abdominal region and lower lip, respectively. All four patients achieved a good postoperative appearance, with dermal surfaces appearing pink and smooth, the orbital areas showing good fullness, the ocular prosthesis showing good wearability, and no narrowing of the sockets. There was no lipid secretion, fat lysate outflow, or infection in the graft bed. There were only small amounts of scars and no infection of the donor site. Conclusion The sandwich-like structure can be effectively used to reconstruct the contracted and low-capacity anophthalmic socket with a history of orbital infection in one stage.
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Affiliation(s)
- Qiaoran Qi
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, 200011, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Rui Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, 200011, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yue Wu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, 200011, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yu Yu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, 200011, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Ming Lin
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, 200011, Shanghai, China.
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
| | - Chunyi Shao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, 200011, Shanghai, China.
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
| | - Jin Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, 200011, Shanghai, China.
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
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Quaranta-Leoni FM, Fiorino MG, Quaranta-Leoni F, Di Marino M. Anophthalmic Socket Syndrome: Prevalence, Impact and Management Strategies. Clin Ophthalmol 2021; 15:3267-3281. [PMID: 34393477 PMCID: PMC8354770 DOI: 10.2147/opth.s325652] [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: 06/24/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
Anophthalmic socket syndrome determines functional deficits and facial deformities, and may lead to poor psychological outcomes. This review aims to comprehensively evaluate the features of the syndrome, based on literature review and authors’ clinical and surgical experience. An electronic database (PubMed,MEDLINE and Google Scholar) search of all articles written in English and non-English language with abstract translated to English on anophthalmic socket syndrome was performed. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. Different types of orbital implants were evaluated; the management of implant exposure was examined; different orbital volume enhancement procedures such as secondary implantation, subperiosteal implants and the use of fillers in anophthalmic patients were described; the problems related to socket contraction were outlined; the treatment options for chronic anophthalmic socket pain and phantom eye syndrome were assessed; the most recent advances in the management of congenital anophthalmia were described. Current clinical evidence does not support a specific orbital implant; late exposure of porous implants may be due to pegging, which currently is seldom used; filler absorption in the orbit appears to be faster than in the dermis, and repeated treatments could be a potential source of inflammation; socket contraction results in significant functional and psychological disability, and management is challenging. Patients affected by anophthalmic socket pain and phantom eye syndrome need specific counseling. It is auspicable to use a standardized protocol to treat children affected by clinical congenital anophthalmia; dermis fat graft is a suitable option in these patients as it helps continued socket expansion. Dermis fat graft can also address the volume deficit in case of explantation of exposed implants and in contracted sockets in both children and adults. Appropriate clinical care is essential, as adequate prosthesis wearing improves the quality of life of anophthalmic patients.
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Affiliation(s)
- Francesco M Quaranta-Leoni
- Orbital and Adnexal Service, Villa Tiberia Hospital - GVM Care & Research, Rome, 00137, Italy.,Oftalmoplastica Roma, Rome, 00197, Italy
| | - Maria Grazia Fiorino
- Orbital and Adnexal Service, Villa Tiberia Hospital - GVM Care & Research, Rome, 00137, Italy
| | | | - Matteo Di Marino
- Orbital and Adnexal Service, Villa Tiberia Hospital - GVM Care & Research, Rome, 00137, Italy
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