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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.

Aim: To evaluate current clinical practice in the UK in the management of the anophthalmic socket; choice of enucleation, evisceration, type of orbital implant, wrap, motility pegging and complications. Methods: All consultant ophthalmologists in the UK were surveyed by postal questionnaire. Questions included their practice subspecialty and number of enucleations and eviscerations performed in 2003. Specific questions addressed choice of implant, wrap, motility pegging and complications. Results: 456/896 (51%) consultants responded, of which 162 (35%) had a specific interest in oculoplastics, lacrimal, orbits or oncology. Only 243/456 (53%) did enucleations or eviscerations. 92% inserted an orbital implant after primary enucleation, 69% after non-endophthalmitis evisceration, whereas only 43% did so after evisceration for endophthalmitis (50% as a delayed procedure). 55% used porous orbital implants (porous polyethylene, hydroxyapatite or alumina) as their first choice and 42% used acrylic. Most implants inserted were spherical, sized 18–20 mm in diameter. 57% wrapped the implant after enucleation, using salvaged autogenous sclera (20%), donor sclera (28%) and synthetic Vicryl or Mersilene mesh (42%). A minority (7%) placed motility pegs in selected cases, usually as a secondary procedure. 14% of respondents reported implant exposure for each type of procedure and extrusion was reported by 4% after enucleation and 3% after evisceration. Conclusions: This survey highlights contemporary anophthalmic socket practice in the UK. Most surgeons use porous orbital implants with a synthetic wrap after enucleation and only few perform motility pegging.

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.

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.

To determine the trend in frequency and clinical indications of surgical removal of eyes in a tertiary eye centre in Calabar, Nigeria. This is a 10-year retrospective review of patients who underwent surgical removal of eyes in a tertiary centre. The clinical records were reviewed (between Jan 2001 and Dec 2010) for demographic data, type of surgery, and clinical indications. A total of 137 eyes were surgically removed within the study period. Of these 46 were children (<16 years). There were 85 males and 52 females giving a M:F ratio of 1.6:1. Clinical indications for surgical eye removal include infective causes (32.1 %; perforated corneal ulcers, endophthalmitis, panophthalmitis), trauma (21.2 %), tumours (21.2 %), anterior staphyloma (13.1 %), and painful blind eyes (9.5 %). Phthisis bulbi, expulsive haemorrhage and aphakic bullous keratopathy accounted for the remaining 2.8 %. The eyes were removed by evisceration (63.5 %), enucleation (29.9 %) and modified exenteration (6.6 %). The commonest indication for eye removal in children was tumour (retinoblastoma). Eye removal in southern Nigeria is often due to infective causes (panophthalmitis and endophthalmitis), perforated corneal ulcer, mechanical trauma (blunt or open globe injury from gunshots or direct trauma), chemical burns, tumours, persistently painful blind eye and anterior staphyloma. Other indications for eye removal were phthisis bulbi, expulsive haemorrhage and aphakic bullous keratopathy.

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.

Purpose. We describe in our study a modified standard enucleation, using sclera harvested from the enucleated eye to cover the prosthesis in order to insert a large porous implant and to reduce postoperative complication rates in a phthisis globe. Methods. We perform initially a standard enucleation. The porous implant (Bioceramic) is then covered only partially by the patient's sclera. The implant is inserted in the posterior Tenon's space with the scleral covering looking at front. All patients were followed at least for twelve months (average followup 16 months). Results. We performed nineteen primary procedures (19 patients, 19 eyes, x M; x F) and secondary, to fill the orbital cavity in patients already operated by standard evisceration (7 patients, 7 eyes). There were no cases of implant extrusion. The orbital volume was well reintegrated. Conclusion. Our procedure was safe and effective. All patients had a good cosmetic result after final prosthetic fitting and we also achieved good prothesis mobility.

Ocular trauma is common in birds of prey presented to wildlife clinics and rehabilitation centers. Enucleation is the procedure most commonly described for treatment of end-stage ocular disease or chronically painful eyes in birds; however, there are several disadvantages and risks to this procedure. While evisceration has been suggested as an alternative, it has not been described for multiple cases or with long-term follow-up data in birds of prey. This report details an evisceration technique performed in 5 captive birds of prey of 4 different species (1 eastern screech owl [Megascops asio], 1 great horned owl [Bubo virginianus], 2 red-tailed hawks [Buteo jamaicensis], and 1 bald eagle [Haliaeetus leucocephalus]) with long-term follow-up information. In addition, this report describes 14 cases of free-living owls of 3 different species (1 great horned owl, 4 barred owls [Strix varia], and 9 eastern screech owls) on which this technique was performed from 2004 to 2011 and which were subsequently released to the wild. Because of the limited risk of complications and the less-severe disruption of facial symmetry, which may be particularly important in owls that are candidates for release to the wild, evisceration should be considered over enucleation in birds of prey that require surgical intervention for the management of severe sequelae to ocular trauma.

To study the use of four petals evisceration in atrophia bulbi to allow insertion of large orbital implant. An interventional case series. All cases were atrophia bulbi. The axial lengths (AL) of atrophic and contralateral normal eye were measured. It was planned to use implant 3 mm smaller than AL of the contralateral normal eye. Four petals evisceration was used in all cases. Twenty cases were included. The mean age was 27.08 ± 16.07 years. The mean axial length (AL) of atrophic eyes was 16.97 ± 1.42 mm. In 75% of cases, the planned implant was inserted. In all cases, the implant diameter was larger than AL of atrophic eye by a mean of 2.57 ± 0.64 mm. The AL of atrophic eye did not affect the implant size. The mean follow-up period was 22.4 ± 10.1 months. Implant exposure was not recorded in any case. Volume deficiency was recorded in 2 cases (10%). Four petals evisceration facilitated the use of suitable sized implant in atrophia bulbi with minimal complications.