[Evisceration, enucleation and exenteration-Indications, techniques, and postoperative care]. / Eviszeration, Enukleation, Exenteration ­ Indikationen, Techniken und postoperative Nachsorge.

Various surgical techniques are available for the extirpation of an eye, depending on the underlying disease. Typical indications encompass tumors, inflammatory and infectious processes, glaucoma, trauma as well as congenital malformations. Surgical procedures include evisceration (resection of the intraocular space with preservation of the sclera), enucleation (extirpation of the entire eyeball including sclera and cornea) and exenteration (resection of the complete orbital soft tissue). The early detection of postoperatively manifesting complications, such as implant extrusion, conjunctivitis, postenucleation socket syndrome as well as the development of enophthalmus or ptosis, is of particular relevance in the context of postoperative care regarding functional, esthetic and social outcome. Special attention must be paid to ensuring a complication-free rehabilitation process, including the supply of a suitable, precisely fitting prosthesis or epithesis. This ensures the patient's psychosocial reintegration, in which an integrated interdisciplinary cooperation with ocularists and psychologists is essential. The latter play a particularly important role, as the psychological stress resulting from the procedure is often associated with a considerable reduction in the quality of life.

Demography, Clinical Settings and Outcomes in Evisceration with Implant: An Electronic Medical Records Driven Analytics of 2071 Cases.

PURPOSE: To describe the demography, clinical settings and outcomes in 2071 patients undergoing evisceration across a multi-tier ophthalmology hospital network and comparison of results with the global scenario of clinical settings for evisceration. METHODS: An analysis of 2071 patients undergoing evisceration and implant between 2013 and 2019. RESULTS: The mean age at surgery was 39 ± 22 years. Children constituted 303(15%) of the cases. The four leading indications for surgery included painful blind eye in 760(37%), phthisis bulbi in 552(27%), staphyloma in 215(10%) and open globe injury in 195(9%) patients. The clinical settings encountered were trauma in 852(41%), ocular infection in 714(34%), glaucoma in 198(10%), post ocular surgery in 146(7%), congenital in 95(5%) and uveitis in 21(1%). Trauma and infection remained the commonest clinical settings in the urban (843,75%), rural (622,77%) and metropolitan (101,71%) areas. Decade wise distribution suggested trauma to be the commonest clinical setting in the first 4 decades and infection in the next 6 decades. The mean follow-up period was 351 ± 386 days (median 194). While trauma remained one of the commonest clinical setting in both the developed and the developing economies, painful blind eye and intractable glaucoma were other common clinical settings in the developed economies and infection was one of the leading clinical setting in the developing economies. CONCLUSION: Most patients undergoing evisceration are young. The commonest indications for surgery include painful blind eye and phthisis bulbi. Trauma and infection remain the commonest clinical settings for evisceration in developed and developing economies.

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.

A three-dimensional printed photopolymer resin implant for orbital rehabilitation for evisceration / Implante de resina fotocurável para evisceração produzido por impressora tridimensional

ABSTRACT Purpose: To evaluate the biocompatibility of three-dimensional (3D) printed orbital spheres for evisceration. Materials: A total of 10 consecutive patients (eight females and two males; mean age, 46.8 ± 14.2 years) underwent evisceration of blind painful eyes. 3D spherical implants produced by a rapid prototype machine were used to restore orbital volume. The implants were produced from a commercially available photocurable resin (Fullcure®). Systemic toxicity was evaluated by comparing serum biochemical measurements (creatine phosphokinase, aspartate aminotransferase, alanine aminotransferase, albumin, creatinine, urea, alkaline phosphatase, and C-reactive protein) before and at 12 months after surgery. Local toxicity was assessed by the evaluation of signs of socket inflammation at the first postoperative month. Changes in implant size were determined by computed tomography scans at 2 and 12 months after surgery. Results: The postoperative evaluations were uneventful. The biochemical evaluation showed no significant changes after surgery. None of the patients presented signs of orbital implant inflammation, infection, exposure, or extrusion. Computed tomography scan evaluations revealed no changes in implant size. Conclusion: To the best of our knowledge, this is the first phase-1 clinical study to certify the biocompatibility of the Fullcure resin for orbital implants in humans. The 3D printing technology permits fast and accurate production of implants for this purpose.

RESUMO Objetivos: Avaliar a biocompatibilidade das esferas produzidas por impressora tridimensional em evisceração. Pacientes e métodos: Evisceração por olho cego doloroso foi realizada em 10 pacientes consecutivos (8 mulheres, idade média: 46.8 ± 14.2 anos). Os implantes esféricos foram produzidos pelo sistema de prototipagem rápida utilizando dados tridimensionais computadorizados. O material utilizado para produção dos implantes foi a resina fotocurável Fullcure®. A avaliação da toxicidade sistêmica do material foi realizada por meio da dosagem de marcadores bioquímicos (creatina fosfoquinase, aspartato aminotransferase, alanina aminotransferase, albumina, creatinina, ureia, fosfatase alcalina, e proteína C-reactiva) antes da cirurgia e aos 12 meses de pós-operatorio. A avaliação da toxicidade local foi realizada por meio do registro qualitativo dos sinais inflamatórios no lado operado durante o primeiro mês de pós-operatório. O tamanho dos implantes foi medido em tomografias computadorizadas (CT) aos 2 e 12 meses de pós-operatório. Resultados: A avaliação bioquímica mostrou que os marcadores estudados não sofreram alterações significativas após a cirurgia. Nenhum paciente apresentou sinais de inflamação atípica, infecção, exposição ou extrusão. A avaliação tomográfica não demonstrou mudanças nos tamanhos dos implantes. Conclusão: O presente trabalho é o primeiro estudo clínico realizado para atestar a biocompatibilidade dos implantes orbitais de resina fotocurável Fullcure. A produção dos implantes pela técnica de impressão tridimensional, utilizando essa resina, permite a disponibilização rápida e acurada do produto final

Panophthalmitis associated with scleral necrosis in dengue hemorrhagic fever.

Dengue is a mosquito-borne flavivirus disease affecting humans. The Aedes aegypti mosquito spreads it. Ophthalmic manifestations of dengue range from subconjunctival hemorrhage to optic neuropathy. Panophthalmitis in dengue fever is a rare finding. We report a case of a 22-year-old male having dengue fever, who presented with pain, redness, swelling and loss of vision in his right eye. He was diagnosed as panophthalmitis with subretinal hemorrhage and required right eye evisceration.

A three-dimensional printed photopolymer resin implant for orbital rehabilitation for evisceration.

PURPOSE: To evaluate the biocompatibility of three-dimensional (3D) printed orbital spheres for evisceration. MATERIALS: A total of 10 consecutive patients (eight females and two males; mean age, 46.8 ± 14.2 years) underwent evisceration of blind painful eyes. 3D spherical implants produced by a rapid prototype machine were used to restore orbital volume. The implants were produced from a commercially available photocurable resin (Fullcure®). Systemic toxicity was evaluated by comparing serum biochemical measurements (creatine phosphokinase, aspartate aminotransferase, alanine aminotransferase, albumin, creatinine, urea, alkaline phosphatase, and C-reactive protein) before and at 12 months after surgery. Local toxicity was assessed by the evaluation of signs of socket inflammation at the first postoperative month. Changes in implant size were determined by computed tomography scans at 2 and 12 months after surgery. RESULTS: The postoperative evaluations were uneventful. The biochemical evaluation showed no significant changes after surgery. None of the patients presented signs of orbital implant inflammation, infection, exposure, or extrusion. Computed tomography scan evaluations revealed no changes in implant size. CONCLUSION: To the best of our knowledge, this is the first phase-1 clinical study to certify the biocompatibility of the Fullcure resin for orbital implants in humans. The 3D printing technology permits fast and accurate production of implants for this purpose.

Oftalmomiasis intraocular postraumática por Phormia sp / Post-traumatic intraocular ophthalmomyasis due to Phormia sp

Paciente varón de 18 años el cual presentaba lesión en el ojo izquierdo por arma de fuego. Permaneció inconsciente 2 días en una zona agrícola, luego fue llevado a un hospital local donde se le extrajeron larvas. En el ojo izquierdo presentó una agudeza visual de no percepción de luz, heridas con pérdida de sustancia en los párpados superior e inferior, atalamia, hipotonía, edema corneal, herida con exposición uveal y salida de larvas en zona II. Se le practicó evisceración del ojo izquierdo

An 18 year-old male patient presented with an injury to the left eye caused by a firearm. He remained unconscious for 2 days in an agricultural area, had a visual acuity of non-perception of light, wounds with loss of substance in upper and lower eyelid, atalamia, hypotonia, corneal oedema, wound with uveal exposure and exit of larvae in zone II. He was subjected to evisceration of the left eye

Effectiveness and safety comparison of three eye and orbital reconstruction techniques in facial plastic surgery.

PURPOSE: To compare the effectiveness and the safety of three eye reconstruction techniques with porous bioceramic implantation in facial surgery: the "four petals" eye evisceration (EE) technique, the "russian doll" EE technique and the enucleation with "on-the-table" evisceration technique. METHODS: Retrospective review of patients who underwent surgical orbit reconstruction with primary placement of a porous bioceramic orbital implant using three techniques at Quinze-Vingts National Center (Paris, France). We compared outcomes of three surgical orbit reconstruction techniques: the "four petal" EE technique, the "russian doll" EE technique and the enucleation with "on-the-table" evisceration technique. The primary endpoint was to determine the rate of implant exposure and the facial cosmetic result during the first year after surgery for each technique. The mean of the Numeric Pain Rating Scale (NRS) after surgery at day 1 was also a primary endpoint. In addition, data such as analgesic intake and rate of revision surgery were compared for each technique. RESULTS: One hundred and ten patients were included: 70 patients in the "four petals" procedure group, 31 in the "on-the-table" procedure group and 9 in the "russian doll" procedure group. NRS pain at day 1 was statistically significantly lower in the "four petals" procedure group 0.9 [standard deviation (SD)] (1.8) and in the "russian doll" procedure group 1 (1.7) than in the "on-the-table" procedure group 2.5 (2.4) (P=0.001). Implant exposure was statistically significantly lower in the "four petals" procedure group (2.9%) and in the "on-the-table" procedure group (3.2%) when compared to the "russian doll" procedure group (22.2%) (P=0.03). Rate of revision surgery was lower in the "four petals" procedure group (11.5%) than in the "russian doll" procedure group (33.3%) and the "on-the-table" procedure group (22.6%). "russian doll" evisceration procedure group had the highest orbital lipofilling rate due to the highest rate of enophthalmos. Therefore, the cosmetic result was better in the "four petals" and the "on-the-table" procedure group. CONCLUSION: The "four petals" EE technique for surgical eye and orbital reconstruction seems to be a method that reduce implant extrusion, postoperative pain and improve facial esthetic result.

Spontaneous globe rupture in a blind glaucomatous eye: A report of three cases.

This paper aims to report cases of spontaneous globe rupture in the blind eyes of three elderly patients with end-stage glaucoma some of which were possibly structurally compromised with topical traditional eye medications and steroids. These patients presented to the ophthalmology department of the University of Benin Teaching Hospital with a history of bleeding from one of their eyes and no antecedent history of trauma. They were known glaucoma patients who were blind with previously recorded high intraocular pressures. Evisceration was performed for two of the cases while enucleation was performed for one shortly after presentation.

Prophylactic Antibiotics for Enucleation and Evisceration: A Retrospective Study and Systematic Literature Review.

PURPOSE: To report surgical site infection (SSI) rates of eviscerations and enucleations with implants performed without perioperative intravenous (IV) antibiotics or postoperative oral antibiotics, and to give SSI prevention recommendations. METHODS: A single-center retrospective chart review was performed after obtaining institutional review board approval. Charts were found by Current Procedural Terminology codes. Demographics, surgical indication, procedure, implant, antibiotic use, and postoperative course were recorded. SSIs occurring within 30 days after surgery were reviewed and postoperative infection rates were determined. RESULTS: Four hundred eighty-one cases from January 1999 to December 2015 were analyzed. There were 102 eviscerations with implants, 314 enucleations with implants, 23 enucleations without implants, 23 implant exchanges, 15 implants placed secondarily after enucleation, and 4 implant removals. Seventy cases (14.6%) were given perioperative IV antibiotics, and in this group one periorbital infection occurred unrelated to orbital surgery (1.4%). Of the 411 cases (85.4%) not given perioperative IV antibiotics, 1 of 87 eviscerations with implants developed an SSI (1.1%), 2 of 273 enucleations with implants developed SSIs (0.7%), and none of the 13 enucleations without implants developed SSIs. CONCLUSIONS: To our knowledge, this is the first published case series reporting SSI rates of enucleations and eviscerations with implants performed without perioperative IV antibiotics or postoperative oral antibiotics. With infection rates comparing favorably to other case series where antibiotics were given, the routine use of perioperative IV antibiotics and postoperative oral antibiotics for enucleations and eviscerations may not be indicated.

Effect of Optic Nerve Disinsertion During Evisceration on Nonporous Implant Migration: A Comparative Case Series and a Review of Literature.

AIM: To determine whether evisceration with optic nerve disinsertion and nonporous implant placement increases the risk of implant migration. METHODS: This was a single-center, retrospective consecutive comparative interventional case series including patients undergoing evisceration with nonporous implant between January and December 2014. Patients were grouped into 2 groups: group I where the optic nerve was not disinserted (n = 37) and group II with optic nerve disinsertion (n = 50). Implant migration was assessed clinically and on patient photographs. Migration was subclassified as decentration that did not affect the prosthetic outcome and displacement that affected the prosthetic outcome. The secondary outcome measures were the mean implant diameter, volume of the custom ocular prosthesis, and implant-related complications like exposure and extrusion between the 2 groups. RESULTS: At a mean follow up of 12.5 months, none of the sockets in group I and 3 (6%) sockets in group II (p = 0.35) had evidence of implant decentration. There were no cases of implant displacement in both groups. The mean implant diameter in group I was 16.97 mm ± 0.65 mm and in group II 19.2 mm ± 0.83 mm (p = 0.0001). Implant extrusion was not different between the 2 groups. The mean custom ocular prosthesis volume in group I was 3.86 ml ± 0.52 ml and in group II 2.50 ml ± 0.68 ml (p < 0.0001). CONCLUSIONS: The rate of nonporous implant migration due to optic nerve disinsertion is not statistically or clinically significant in evisceration with optic nerve disinsertion, allowing placement of a larger implant and fabrication of a custom ocular prosthesis with an ideal weight.

The application of an acellular dermal allograft (AlloDerm) for patients with insufficient conjunctiva during evisceration and implantation surgery.

PurposeTo describe the use of an acellular dermal allograft (AlloDerm) for patients with insufficient conjunctiva during evisceration and implantation surgery.Patients and methodsThe medical records of six patients with insufficient conjunctiva during evisceration surgery were reviewed. It was not possible to close the Tenon's capsule and conjunctiva without wound tension in these patients, so AlloDerm was placed over the sclera, and the edges were sutured with adjacent conjunctiva without tension. The size of the bare AlloDerm graft was measured in all patients. The clinical outcome was the incidence of complications, and the percentage of patients needing additional surgery was also recorded.ResultsThe cause of evisceration was end stage glaucoma (four patients) and endogenous endophthalmitis (two patients). All six eyes of six patients (100%) had a successful outcome showing no complications. Four cases achieved full conjunctivalisation over the bare AlloDerm graft. Two cases had a bare AlloDerm until the last follow-up, but showed no implant exposure. It took a median of 11 weeks for the slow advance of the conjunctival edge to entirely cover the AlloDerm graft.ConclusionsAlloDerm is a promising material for covering sclera and implants in a tension-free manner after evisceration surgery in patients with insufficient conjunctiva.

Evisceration With Injectable Hydrogel Implant in a Rabbit Model.

PURPOSE: To determine the safety, durability, and biocompatibility of 2.5% polyacrylamide hydrogel (Aquamid, Specialty European Pharma, Ltd., London, UK) as an injectable viscoelastic implant following evisceration in a rabbit model. METHODS: The protocol was reviewed and approved by the Wake Forest Institutional Animal Care and Use Committee. Adult New Zealand rabbits underwent cornea-sparing evisceration of the right eye with injection of 2.5% polyacrylamide hydrogel implant. The rabbits were sacrificed after 2 weeks (n = 1), 5 weeks (n = 2), 12 weeks (n = 3), 25 weeks (n = 3), and 1 year (n = 3) to evaluate the implant volume and host reaction to the implant. Both eyes were enucleated and their diameters were measured. The eviscerated eyes were fixed in formalin and processed using routine histopathologic methods to assess inflammatory reaction and vascularization. RESULTS: The implant material was well tolerated with a moderate giant cell reaction seen at 6 weeks that improved over time. Extensive vascularization of the implant was noted starting at 6 weeks. There was excellent maintenance of globe volume that did not diminish over time. The relative diameters of the eviscerated eyes compared with control were 89 ± 6% (mean% ± SD) at 12 weeks (n = 3), 94 ± 2% at 25 weeks (n = 3), and 93 ± 4% at 1 year (n = 3). CONCLUSION: With further study, injectable 2.5% polyacrylamide hydrogel may provide an excellent alternative to solid orbital implants. The implant material was universally well tolerated and maintained appropriate volume in the orbit for the study period of 1 year. Extensive vascularization of the implant was noted indicating biointegration.

Evisceration With Implant Placement Posterior to Posterior Sclera.

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.

Globe Loss From Intraocular Invasion of MIRAgel Scleral Buckle Components.

PURPOSE: To describe intraocular invasion of MIRAgel scleral buckles requiring evisceration. METHODS: This is an Institutional Review Board-approved retrospective consecutive case series of eyes requiring evisceration secondary to intraocular intrusion of MIRAgel implants performed at the Cole Eye Institute from 2000 to 2014. Charts were reviewed for age at surgery, gender, laterality, time between MIRAgel placement and evisceration, preoperative examination and imaging results, intraoperative findings, postoperative complications, and duration of follow up. RESULTS: Five eyes of 5 patients underwent evisceration due to a blind, painful eye secondary to MIRAgel expansion. The mean time between MIRAgel placement and evisceration was 21 years (range: 17-30 years). Preoperative ultrasound identified intraocular MIRAgel in 3 of 5 cases; however, intraocular MIRAgel was identified during surgery in all 5 cases. A transocular-approach orbitotomy was performed at the time of evisceration in an effort to remove the MIRAgel. Postoperative complications included ptosis and inability to retain an ocular prosthesis. No cases of orbital implant extrusion occurred. CONCLUSION: Scleral invasion and intraocular penetration of MIRAgel may occur decades after placement. This may result in a blind, painful eye requiring evisceration and orbitotomy to remove residual material. Suspicion of intraocular penetration of implant should be high in blind, painful eyes. Surgical removal can be difficult due to MIRAgel fragmentation. Conjunctival insufficiency may result in the need for further surgery after evisceration.

Evisceración ocular: diez años de estudio / Eye evisceration: ten years of research

Objetivos: determinar la frecuencia de evisceración según edad, sexo, ojo afectado, criterio quirúrgico y causa más frecuente. Métodos: se realizó un estudio descriptivo, longitudinal y retrospectivo a través de la revisión de las historias clínicas de 89 pacientes a quienes se les realizó la evisceración en el período de enero 2002 a diciembre 2011 en el Hospital Militar Central Dr. Luis Díaz Soto. Se aplicaron métodos de estadística descriptiva para el procesamiento de los datos. Resultados: predominó el grupo de edad de 31-40 años con frecuencia absoluta (20), que constituyó el 22,4 por ciento de la muestra; el sexo masculino representó el 67,4 por ciento; predominó el ojo izquierdo en los casos eviscerados con 53 por ciento y la forma electiva de tratamiento con 78,7 por ciento. La causa más frecuente fue la ptisis bulbi con 32,7 por ciento. Conclusiones: son eviscerados con mayor frecuencia los ojos izquierdos de adultos jóvenes del sexo masculino, con criterio electivo de tratamiento quirúrgico. La ptisis bulbi es la causa más frecuente de evisceración(AU)

Objectives: to determine the evisceration frequency according to age, sex, affected eye, surgical approach and more frequent cause. Methods: descriptive, longitudinal and retrospective study was done through the revision from the clinical histories of 89 patients to all of them were applied the evisceration in the period of January 2002 to December 2011 in the Central Military Hospital Dr. Luis Díaz Soto. Methods of descriptive statistic were applied for the prosecution of the data. Results: there was bigger incidence in the 31-40 year-old group representing 22,4 percent of the sample, the male sex represented 67,4 percent, the left eye prevailed with 53 percent in the cases evisceration and the elective way of treatment with 78,7 percent. The most frequent cause was the ptisis bulbi occupying 32,7 percent. Conclusions: evisceration was done frequently in left eyes of young men, with elective approach of surgical treatment. The ptisis bulbi was the most frequent cause in evisceration(AU)