Evisceration Using Scleral Capping Technique for Severe Phthisis Bulbi

ABSTRACT

PURPOSE: To introduce a new technique, involving the creation of a circumferential 360 degrees scleral relaxing incision, using an implant as large as 20 mm in diameter, and report on the surgical results in the treatment of severe phthisis bulbi, which are not indicated for classic evisceration. METHODS: The medical records of 20 patients with 20 phthisis bulbi who had undergone evisceration and placement, using the scleral capping technique, of porous polyethylene orbital implants as large as 20 mm in diameter between September 2002 and February 2006 were reviewed. For each patient, after evisceration, a circumferential 360 degrees equatorial scleral relaxing incision was made posterior to insertion of 4-recti muscles, and a porous polyethylene orbital implant was implanted. Each circumferential scleral relaxing incision wound was loosely sutured in the mattress fashion, using 5-0 braided polyester (Ethibond). RESULTS: The average of preoperative axial length, obtained using A scan and orbital computed tomography scan, was 16.8 mm. Orbital implants of 20 mm in diameter were implanted in all patients. The average of postoperative follow-up interval was 29.1 months. Orbital implant showed good motility to the satisfaction of all of patients. And the scleral capping technique could prevent complications, such as exposure of orbital implant, enophthalmos, and superior sulcus deformity. CONCLUSIONS: Scleral capping technique is safe and useful for evisceration in patients with severe phthisis bulbi. This technique can provide adequate space for the placement of and implant as large as 20 mm in diameter without generating any tension on wound. Consequently, this technique provided cosmesis and prosthesis motiliy, even without the use of a Medor coupling peg, with which patients were satisfied.