Indications for eye removal over a 13-year period at an ophthalmology referral center in São Paulo, Brazil / Indicações para remoção ocular ao longo de um período de 13 anos no centro de referência oftalmológica em São Paulo, Brazil

ABSTRACT Purpose: To analyze the indications and types of eye removal at Latin America's highest-volume ophthalmic reference center in São Paulo, Brazil. Methods: A retrospective analysis was conducted of surgical pathological reports in the electronic database of the Ophthalmology Department of the Universidade Federal de São Paulo Hospital of patients who underwent eye-removal procedures between January 2000 and December 2012. Results: A total of 412 cases met the inclusion criteria for this study. The most common indications for eye removal were ocular melanoma and retinoblastoma, representing 35.4% and 31.1% of the total cases, respectively. Other frequent indications included endophthalmitis (6.3%), nonspecific inflammation (4.1%), squamous cell carcinoma (3.6%), panophthalmitis (3.4%), and phthisis bulbi (1.2%). The remaining indications accounted for 14.8% of all cases, with each accounting for <1% of the total cases. Enucleation was the most common eye-removal procedure seen in our study. Conclusions: The two most common indications for eye removal were ocular melanoma and retinoblastoma. Alternative treatment options are effective in limiting the need for eye removal but are constrained by our public center's so cioeconomic context.

RESUMO Objetivo: Analisar os tipos e indicações para a remoção dos olhos no maior centro de referência oftalmológica da América Latina em São Paulo, Brasil. Métodos: Revisão retrospectiva de laudos cirúrgico patológico em uma base de dados eletrônica do Departamento de Oftalmologia do Hospital da Universidade Federal de São Paulo. Foram analisados pacientes submetidos ao procedimento de remoção oftálmica no período de janeiro de 2000 a dezembro de 2012. Resultados: Um total de 412 casos estiveram de acordo com os critérios de inclusão desse estudo. A indicação mais comum para remoção oftálmica foi Melanoma ocular e Retinoblastoma, representando, respectivamente, 35,4% e 31,1% do total de casos. Outras indicações frequentes incluíam Endoftalmite 6,3%, Inflamação inespecífica 4,1%, Carcinoma escamocelular 3,6%, Panoftalmite 3,4% e Phthisis Bulbi 1,2%. O restante das indicações totalizaram 14,8% de todos os casos, sendo que cada um correspondem com menos de 1% do total. Enucleação foi o procedimento de remoção oftálmica mais comum observado em nosso estudo. Conclusão: As duas indicações mais frequentes para remoção oftálmica no centro oftalmológico de referência do Brasil foi melanoma e retinoblastoma. Opções terapêuticas alternativas são efetivas para limitar a necessidade da remoção ocular, porém são restritos devido ao contexto socioeconômico de nossa população.

The reasons for evisceration after penetrating keratoplasty between 1995 and 2015 / As causas de evisceração após ceratoplastia penetrante entre 1995 e 2015

ABSTRACT Purpose: The purpose of this study was to determine the indications and frequency of evisceration after penetrating keratoplasty (PK). Methods: The medical records of all patients who underwent evisceration after PK between January 1, 1995 and December 31, 2015 at Ankara Training and Research Hospital were reviewed. Patient demographics and the surgical indications for PK, diagnosis for evisceration, frequency of evisceration, and the length of time between PK and evisceration were recorded. Results: The frequency of evisceration was 0.95% (16 of 1684), and the mean age of the patients who underwent evisceration was 56.31 ± 14.82 years. The most common indication for PK that resulted in evisceration was keratoconus (37.5%), and the most common underlying cause leading to evisceration was endophthalmitis (56.25%). The interval between PK and evisceration ranged from 9 to 78 months. Conclusions: Although keratoplasty is one of the most successful types of surgery among tissue transplantations, our findings show that it is associated with a possible risk of evisceration.

RESUMO Objetivo: O objetivo deste estudo foi determinar as indicações e a frequência de evisceração ocular após cirurgia de ceratoplastia penetrante ou transplante de córnea (PK). Métodos: Foram analisados os registros médicos de todos os pacientes submetidos à evisceração após PK entre 1º de janeiro de 1995 e 31 de dezembro de 2015 no Hospital de Treinamento e Pesquisa de Ankara. Foram registradas a demografia do paciente e as indicações cirúrgicas de PK, diagnóstico de evisceração, frequência de evisceração, tempo entre PK e evisceração. Resultados: A frequência de evisceração foi de 0,95% (16 de 1684) e a média de idade foi de 56,31 ± 14,82 anos. A indicação mais comum para PK que terminou na evis ceração foi o ceratocone (37,5%) e a causa subjacente à evisceração foi a endoftalmite (56,25%). O intervalo entre PK e evisceração variou de 9 a 78 meses. Conclusão: Embora a ceratoplastia seja uma das cirurgias mais bem sucedidas entre os transplantes de tecidos, pode-se deduzir do estudo que não é tão inócua, pois pode evoluir para a evisceração ocular.

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)

Condutas para reparação da cavidade anoftálmica no Brasil / Trends on anophthalmic socket repair in Brazil

OBJETIVOS: Avaliar as condutas mais utilizadas no tratamento da cavidade anoftálmica no Brasil, comparando-as com a realidade mundial. MÉTODOS: Estudo exploratório, usando questionário eletrônico enviado pela Internet para oftalmologistas membros da Sociedade Brasileira de Cirurgia Plástica Ocular, Vias Lacrimais e Órbita - SBCPO. As respostas obtidas foram avaliadas por meio de análise de aderência, utilizando o teste do Qui-quadrado. RESULTADOS: Foram recebidos 75 questionários respondidos. Cinquenta e três por cento dos entrevistados tratam cavidade anoftálmica frequentemente e o implante de esfera de polimetilmatacrilato, de 18 mm de diâmetro, é o usado pelos entrevistados na maioria das cirurgias, sendo revestido principalmente com esclera (92%). Apenas sete entrevistados já utilizaram implante acoplado com prótese externa. Oitenta e dois por cento dos entrevistados usam a técnica do enxerto dermoadiposo. O acompanhamento destes pacientes é feito semestralmente pela maior parte dos entrevistados. CONCLUSÃO: O tratamento da cavidade anoftálmica no Brasil geralmente é feito usando a esfera de polimetilmetacrilato, de diâmetro 18 milímetros. Implantes acoplados dificilmente são usados.

PURPOSE: To determine the most common approach to repair the anophthalmic socket in Brazil, and to compare the data with the trends in other countries. METHODS: Exploratory study using electronic questionnaire sent by Internet to ophthalmologists members of the Brazilian Orbit and Oculoplastic Society (SBCPO). The received answers were analyzed by adhesion analysis, using Chi-square test. RESULTS: We received 75 answered questionnaires. Fifty-three per cent of the respondents frequently treat anophthalmic socket and use the 18 mm diameter polymethylmethacrylate sphere in the majority of the surgeries, mainly covered by sclera (92%). Only seven interviewees had used integrated implants with pegging procedure. Eighty-two per cent of the ophthalmologists use the dermolipid graft to reconstruct the anophthalmic socket. They also follow the patients bi-annually. CONCLUSIONS: The treatment of anophthalmic socket in Brazil generally involve polymethylmethacrylate sphere with 18 mm diameter. Pegging procedure is uncommon between us.

Descriptive study on ocular survival, visual outcome and prognostic factors in open globe injuries.

A prospective observational study was done to assess ocular survival, visual outcome and prognostic factors of open globe injury. Eighty eyes of penetrating trauma between 2004 and 2006 were categorized according to the ocular trauma classification system. Primary repair was done and outcomes were assessed at one, three and six months. The final vision was categorized as per World Health Organization classification of visual impairment. Factors at presentation were evaluated for prognostic value towards visual outcome. Sixty-nine eyes with minimum one month follow-up were included for analysis. Statistical analysis was done using Univariate and Multivariate analysis. We found Grade IV visual acuity (<5/200) at presentation (64%) as the most important factor contributing to poor visual outcome. Statistically insignificant factors were time since injury, cataract, and presence of intraocular foreign body. Ocular survival was 97%. We concluded that initial visual acuity, hyphema, zone and length of injury, retinal detachment and vitreous hemorrhage are statistically significant factors affecting outcome in open globe injuries.

Extrusão dos implantes em portadores de cavidade anoftálmica / Anophthalmic cavity and implant extrusion

OBJETIVO: Avaliar as características dos portadores de cavidades anoftálmicas que desenvolveram extrusão do implante. MÉTODOS: Estudo retrospectivo, observacional, tendo sido avaliados 37 portadores de cavidade anoftálmica que tiveram extrusão do implante de cavidade, na Faculdade de Medicina de Botucatu-UNESP. RESULTADOS: As extrusões ocorreram em cavidades enucleadas ou evisceradas, a maioria delas submetidas a cirurgia em decorrência de phthisis bulbi ou trauma, em geral de 1 a 2 anos após a cirurgia inicial. A deiscência precedeu a extrusão em todos os casos, tendo a extrusão ocorrido com todos os tipos de implantes empregados. CONCLUSÃO: Após a colocação de implantes de cavidade podem ocorrer complicações. A deiscência e extrusão das esferas são possibilidades que podem requerer nova intervenção cirúrgica, para a qual o paciente e o oftalmologista devem estar preparados.

PURPOSE: To evaluate the characteristics of patients with anophthalmic cavity who developed sphere extrusion. METHODS: A retrospective observational study was done evaluating 37 patients with anophthalmic cavity and sphere extrusion at the "Faculdade de Medicina de Botucatu-UNESP". RESULTS: Extrusion was observed in enucleated and eviscerated cavities. The majority of the patients had the eye removed because of phthisis bulbi or trauma and the extrusion happened 1 or 2 years after the surgery. Extrusion was preceded by conjunctival dehiscence and exposure of the sphere and occurred with all used implants. CONCLUSION: Complications after orbital implant placement are a possibility. Dehiscence and sphere extrusion may happen and another surgery would be necessary. The patient and the ophthalmologist have to be prepared for this.

A profile of destructive surgery in Nepal Eye Hospital.

This is a study profile of the patients undergoing destructive surgery in Nepal Eye Hospital over a period of 2 years (2001-2003). The rationale of the study was to know the incidence and causes for destructive surgery (enucleation/evisceration) and the measures to prevent them. Patients admitted in the ward from emergency and outpatients departments for the purpose of enucleation and evisceration were taken into this study. Their visual acuity, slit-lamp examinations, fundus evaluation were done. Most of the patients had no perception of light with painful blind eyes, panophthalmitis, endophthalmitis, staphylomas, crush injuries and malignancies. After a decision made by the surgeons in the round, a full consent was taken for the operation. Evisceration was done for cases with history of ocular infections and the rest were enucleated. Destructive operation was done for (a) saving the other eye, (b) life saving, (c) painful condition and disfigurement. The incidence of destructive surgery in Nepal Eye Hospital was 1.40%. male : female ratio was 1.41:1. The causes for destructive surgery were panophthalmitis (31.71%), painful blind eye (21.95%), endophthalmitis (14.63%), staphyloma (14.63%), retinoblastoma (12.20%) and crush injuries (4.88%). Number of evisceration (73.17%) was higher than enucleation (26.83%) as most of the cases were sequele of corneal ulcer. Enucleation was mostly seen in children and evisceration in adults. Lastly, the incidences of destructive surgery would be minimized by (a) Prompt treatment of corneal ulcers for reducing panophthalmitis (b) pre, intra, and post operative care in intra ocular surgery for reducing endophthalmitis, and (c) genetic counselling (pre marital) for reducing childhood malignancies. Decision for destructive surgery should be a team work rather than a single surgeon's opinion. It should be done under general anaesthesia or retrobulbar block. Precaution must be taken to prevent the appalling tragedy of enucleating the wrong eye by marking above on the eye to be operated or EUA prior to surgery. Last but not the least, there should be fitting of a prosthesis for cosmesis, psychological support and careful follow-up of the healthy eye.

Enucleaçäo e evisceraçäo no Instituto e Fundaçäo Hilton Rocha durante 8 anos (1987-1994) / Statistical evalution of enucleation and evisceration cases in Instituto e Fundaçäo Hilton Rocha between 1987-1994

Os autores fazem levantamento estatístico de um período de 8 anos (1987-1994) no Instituto e Fundaçäo Hilton Rocha e analisaram 501 olhos de 496 pacientes. Foram observados os seguintes aspectos: local e época das cirurgias, idade, sexo, cor profissäo, procedência, principais causas de evisceraçäo e enucleaçäo, exame anátomo-patológico, olho operado, relaçäo entre idade e tratamento prévio com tipo de cirurgia realizada. As causas mais frequentes de evisceraçäo foram: atrofia bulbar (42,4 por cento) endofitalmite/panoftalmite (18,2 por cento), glaucoma absoluto (11,4 por cento) e de enucleaçäo: retinoblastoma (27,3 por cento), atrofia bulbar (24,4 por cento), melanoma da coróide (18,9 por cento).