Single or double? A comparison of evisceration techniques.

PURPOSE: We compared the rates of implant exposure and extrusion after evisceration with single and double scleral closure techniques. METHODS: This retrospective cohort study included all patients who underwent evisceration with an implant insertion over the past 18 years at Tung Wah Eastern Hospital and Pamela Youde Nethersole Eastern Hospital. Clinical documents and operation records were reviewed. RESULTS: A total of 81 ethnic Chinese patients (44 male) who underwent evisceration with primary implant insertion were reviewed. 39 (48%) patients underwent the double scleral closure technique with an implant placed posterior to the posterior sclera, and 42 (52%) patients underwent the single scleral closure technique with an implant inserted in the intra-scleral cavity. The follow-up interval was 70 months. The surgical indications were endophthalmitis (35%), painful blind eye (23%), traumatic disfigured globe (22%) and phthisis bulbi (20%). Silicone was the most used implant material (69%). The patients who underwent double scleral closure had a larger size of the implant (19.7 vs 17.9 mm, p < 0.05). Both implant exposure (26% vs 3%, p < 0.05) and implant extrusion (26% vs 0%, p < 0.05) were more common in patients who underwent single scleral. CONCLUSIONS: Double scleral closure technique allows a larger implant, and it is associated with a lower rate of implant exposure and extrusion. The double scleral closure technique is a superior technique of choice in these patients with primary implant placement.

UVEAL EFFUSION SYNDROME. CASE REPORT.

PURPOSE: Purpose of this article is to present a case report of a patient with uveal effusion syndrome who underwent deep posterior sclerotomy. CASE REPORT: A 73-year-old patient with unilateral decrease in the best corrected visual acuity, ablation of choroid and secondary retinal detachment in the right eye was admitted to our clinic for examination in November 2017. At the first examination, the best corrected visual acuity in the right eye was 0.3, in the left eye 1.0. Intraocular pressure was 16 mmHg in the right eye and 21 mmHg in the left eye. After performing ultrasound biomicroscopy of the anterior segment (Accutome, Keeler, USA), ultrasound sonography of the affected eye (Accutome, Keeler, USA), magnetic resonance imaging, computed tomography, abdominal ultrasound and blood tests, we concluded the finding as uveal effusion syndrome. We initiated a conservative treatment consisting of oral administration of carbonic anhydrase inhibitor in combination with topical use of prostaglandin analogue. Despite conservative treatment the best corrected visual acuity of the affected eye decreased to 0.05 so we proceeded to a surgical procedure - deep posterior sclerotomy with perioperative scleral sampling for histological examination (detection of glycosaminoglycans in the sclera wall by Alcian blue staining), which was negative. This histological result ranks the patient as the third type of uveal effusion syndrome (ie, non-nanophthalmic with a normal sclera). After the operation both the ablation of choroid and retinal detachment reattached and the best corrected visual acuity in the right eye improved to 0.3. After the subsequent cataract surgery, the ablation of choroid and retinal detachment occurred again, this time with spontaneous recovery. Postoperatively, the best corrected visual acuity in the right eye was 0.5 and at the last check-up at our clinic 0.6. CONCLUSION: Deep posterior sclerotomy is a method of choice of surgical treatment for uveal effusion syndrome that does not respond to conservative therapy.

Evisceration with Hydroxyapatite Implant

In contrast to the literature on the use of hydroxyapatite orbital implants with enucleation, reports of the use of hydroxyapatite implants with evisceration are limited and those that have been published reported high exposure rates. The authors described modified surgical technique of primary evisceration with hydroxyapatite implant and evaluated its effects on cosmetic appearance and the prevention of implant exposure. All 28 consecutive patients underwent evisceration with hydroxyapatite implant between December 1994 and April 1998. To place an appropriate hydroxyapatite implant into the scleral shell without tension we made a saw-tooth shaped large posterior sclerotomy around the optic nerve sparing 6-o`clock position to minimize the inferior displacement of the implant. In cases with very small globes we made 3 to 4 additional radial posterior sclerotomies. During the mean follow-up of 13.5 months, none of the patients experienced complications such as conjunctival erosion, hydroxyapatite exposure, implant extrusion, significant enophthalmos, or superior sulcus deformity. The authors have had good success without major complications using our modified surgical technique for hydroxyapatite orbital implants with evisceration.

Evisceration with Hydroxyapatite Implant

In contrast to the literature on the use of hydroxyapatite orbital implants with enucleation, reports of the use of hydroxyapatite implants with evisceration are limited and those that have been published reported high exposure rates. The authors described modified surgical technique of primary evisceration with hydroxyapatite implant and evaluated its effects on cosmetic appearance and the prevention of implant exposure. All 28 consecutive patients underwent evisceration with hydroxyapatite implant between December 1994 and April 1998. To place an appropriate hydroxyapatite implant into the scleral shell without tension we made a saw-tooth shaped large posterior sclerotomy around the optic nerve sparing 6-o`clock position to minimize the inferior displacement of the implant. In cases with very small globes we made 3 to 4 additional radial posterior sclerotomies. During the mean follow-up of 13.5 months, none of the patients experienced complications such as conjunctival erosion, hydroxyapatite exposure, implant extrusion, significant enophthalmos, or superior sulcus deformity. The authors have had good success without major complications using our modified surgical technique for hydroxyapatite orbital implants with evisceration.

Serous Retinal Detachment Following Trabeculectomy in a Case of Sturge-Weber Syndrome with Glaucoma

A trabeculectomy with mitomycin (0.2mg/ml, 5 minutes) was performed in a 28-year-old man with glaucoma associated with Sturge-Weber syndrome. Two prophylactic posterior sclerotomies were made in an attempt to prevent sudden uveal effusion. The surgery was uncomplicated. On the first postoperative day, however, the anterior chamber became shallow with hypotony (<4mmHg). A 360 degrees choroidal detachment with serous retinal detachment encroaching upon macula was recognized. On the third postoperative day, evacuation of the suprachoroidal space was performed. However, the eye remained hypotonus and choroidal expansion with overlying retinal detachment occured again. The bleb decreased in size with time and the intraocular pressures(IOPs) rose gradually (10-14mmHg). The choroidal and retinal detachment resolved spontaneously with the increased IOP in 40 days. Twenty seven monthes after trabeculectomy, he has a small localized. bleb. The IOP is maintained in the high-teens(15-20mmHg) without any medication.