Outcomes of orbital implants after evisceration and enucleation in patients with endophthalmitis

Hui, Jennifer I.

doi:10.1097/icu.0b013e32833b7a56

Cited by 25 publications

(13 citation statements)

References 14 publications

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“…Evisceration recently has become increasingly popular for many reasons [ 19 ]; there is no solid evidence that evisceration is associated with an increased risk of sympathetic ophthalmia [ 20 ] and the surgery requires less manipulation and consequently less inflammation and scarring of orbital tissues and extraocular muscles resulting in better implant motility and cosmetic outcome than enucleation [ 9 , 21 ]. Furthermore, evisceration is simpler, faster, and associated with lower risk of bleeding intraoperatively and fewer postoperative complications, such as ptosis, implant migration, implant extrusion, socket contracture, and the deep superior sulcus syndrome [ 8 , 21 – 23 ]. Similarly, we preferred performing evisceration rather than enucleation unless contraindicated or not feasible; therefore, 62 % of our patients in the current study underwent evisceration rather than enucleation.…”

Section: Discussionmentioning

confidence: 99%

“…In cases of endophthalmitis, evisceration is preferred to enucleation because evisceration is thought to have less risk of postoperative meningitis or encephalitis [ 44 ]. In the current series,12 of the 13 patients with endophthalmitis (92 %) underwent evisceration with silicone sphere orbital implant insertion at the time of primary surgery in an attempt to save the patient a secondary implant insertion, which recently has been reported to be most successful [ 4 , 23 , 44 , 45 ]. We also did not notice an increased risk of infection or implant extrusion in these cases.…”

Section: Discussionmentioning

confidence: 99%

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Enucleation and evisceration at a tertiary care hospital in a developing country

et al. 2015

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BackgroundTo analyze the demographics, indications, and surgical outcomes of anophthalmic surgery (enucleation and evisceration) at Jordan University Hospital during a 5-year period.MethodsWe 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.ResultsAnophthalmic 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.ConclusionsEvisceration 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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Enucleation and evisceration at a tertiary care hospital in a developing country

et al. 2015

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“…This demonstrates that in selected patients, orbital implants at the time of primary eye removal can be successful, despite what is by definition a contaminated wound. This approach can be supported by the fact that primary implants can be used in patients undergoing eye removal with endophthalmitis [31], although this does not take into account the disrupted anatomy associated with battlefield orbital trauma and likely contamination of surrounding tissues. The risk of this approach is highlighted in case 2, as this patient required implant retrieval and further washout due to a high risk of infection.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of ocular evisceration and enucleation in the British Armed Forces from Iraq and Afghanistan

Holmes

McLaughlin

Farooq

et al. 2019

Eye

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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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“…In previous reports, enucleation or evisceration was the only remaining viable treatment option when all options to salvage the eye had been exhausted [1–8]. Because of a relatively high extrusion rate and the potential for sympathetic ophthalmia in the other eye, enucleation had been recommended [2,9,10]. In recent decades, evisceration with either delayed or immediate implant placement has been recommended in patients with endophthalmitis [5–8].…”

Section: Introductionmentioning

confidence: 99%

Prevention of Evisceration or Enucleation in Endogenous Bacterial Panophthalmitis with No Light Perception and Scleral Abscess

Chen

Chao

et al. 2017

PLoS ONE

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Panophthalmitis is the most extensive ocular involvement in endophthalmitis with inflammation in periocular tissues. Severe inflammation of the anterior and posterior segments is frequently accompanied by corneal opacity, scleral abscess, and perforation or rupture. Enucleation or evisceration was the only remaining viable treatment option when all options to salvage the eye had been exhausted. The purpose of this retrospective study is to examine the outcomes of patients with endogenous bacterial panophthalmitis, no light perception and scleral abscess who were treated with multiple intravitreal and periocular injections of antibiotics and dexamethasone. Evaluation included spreading of infection to contiguous or remote sites, following evisceration or enucleation, and sympathetic ophthalmia. Eighteen patients were diagnosed with EBP, with liver abscesses in eight patients, retroperitoneal infection in four, pneumonia in two, infective endocarditis in one, cellulitis in one, drug abuse in one, and mycotic pseudoaneurysm in one. Culture results were positive for Klebsiella pneumoniae in 12 patients, Streptococcus spp. in three, Pseudomonas aeruginosa in one, Escherichia coli in one, and Staphylococcus aureus in one. The average number of periocular injections was 2.2, and the average number of intravitreal injections was 5.8. No eye required evisceration or enucleation and developed the spreading of infection to contiguous or remote sites during the follow-up. No sympathetic ophthalmia was observed in the fellow eye of all patients. Prevention of evisceration or enucleation in patients with EBP, NLP and scleral abscess can be achieved by multiple intravitreal and periocular injections of antibiotics and dexamethasone.

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Outcomes of orbital implants after evisceration and enucleation in patients with endophthalmitis

Abstract: Recent findings indicate enucleation and evisceration are performed for blind eyes with endophthalmitis and both porous and nonporous implants may be placed primarily with acceptable outcomes in these patients.

Cited by 25 publications

References 14 publications

Enucleation and evisceration at a tertiary care hospital in a developing country

Enucleation and evisceration at a tertiary care hospital in a developing country

Outcomes of ocular evisceration and enucleation in the British Armed Forces from Iraq and Afghanistan

Prevention of Evisceration or Enucleation in Endogenous Bacterial Panophthalmitis with No Light Perception and Scleral Abscess

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