Enucleation and evisceration: an analysis of indications, histopathological findings, and surgical trends over 23 years at a tertiary care hospital in western Canada.

OBJECTIVE: To report indications for eye removal, histopathological diagnosis, and surgical trends in enucleation versus evisceration over a 23-year period. DESIGN: Retrospective consecutive case series. PARTICIPANTS: All patients undergoing enucleation or evisceration at the Royal Alexandra Hospital in Edmonton, Canada, between January 1994 and December 2016. METHODS: Demographic information was recorded and archived hospital charts were accessed and reviewed for clinical diagnosis, histopathological diagnosis, and the type of implant used. Univariate and multivariable logistic regression analysis was performed. The study cohort was divided into 2 time periods by separating the first 10 years of the study period (1994-2004 inclusive) from the rest of the study time period (2005-2016 inclusive). RESULTS: A total of 786 patients with a mean age (±â€…SD) of 52 ±â€…23 years were included. The most common clinical diagnosis was blind painful eye (56%) followed by intraocular tumour (23%). Corresponding pathological examination of specimens revealed chronic inflammatory change (46%) and intraocular tumour (25%). Eyes with active infection were more likely to be eviscerated (odds ratio: 4.67; p < 0.001) when compared to other diagnostic groups, and all eyes diagnosed with intraocular tumours were enucleated. While most eyes in the study were enucleated, the proportion of eyes eviscerated increased over the study period (p = 0.010) from 8% between 1994-2004 to 14% between 2005-2016. CONCLUSIONS: While enucleation was performed more commonly overall, the incidence of evisceration increased throughout the study period. There were no instances of occult intraocular tumour in patients who were eviscerated.

Indications for eye removal in southern Nigeria.

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.

Enucleation and evisceration: 20 years of experience.

OBJECTIVE: To determine the indications, relative frequencies, surgical times, and complications for enucleation and evisceration performed at a single academic center. METHODS: Medical records of all patients who underwent an enucleation or evisceration between January 1st, 1990 and December 31st, 2009 at a single academic center were reviewed. Patient demographics and surgical indications, times, and complications were recorded. RESULTS: A total of 85 eyes in 85 patients underwent enucleation (n = 31; 36%) or evisceration (n = 54; 64%) during the study period. Almost all patients were of African descent (96%). The most common underlying cause leading to eye removal was trauma. On average, eviscerations (47.3 ± 10.3 minutes) took significantly less time to perform than enucleations (89.6 ± 10.1 minutes; p < 0.01). Complications included implant exposure, infection, lower lid laxity, fornix insufficiency, and need for subsequent surgery; the occurrence of these complications was found to be similar between the two groups (p = 0.77). No case of sympathetic ophthalmia or inadvertent evisceration of an eye with an occult intraocular malignancy was noted. From the first decade for which data were available (1990- 1999) to the second decade (2000- 2009), the average number of enucleations decreased (p = 0.02) and the average number of eviscerations (p = 0.04) increased. CONCLUSION: Evisceration was found to be a safe and quicker alternative to enucleation in our study. A change in surgical preference from enucleation to evisceration was seen during the 20-year study period.

The eye amputated - consequences of eye amputation with emphasis on clinical aspects, phantom eye syndrome and quality of life.

In this thesis the term eye amputation (EA) covers the removing of an eye by: evisceration, enucleation and exenteration. Amputation of an eye is most frequently the end-stage in a complicated disease, or the primary treatment in trauma and neoplasm. In 2010 the literature is extensive due to knowledge about types of surgery, implants and surgical technique. However, not much is known about the time past surgery. THE PURPOSE OF THE PHD THESIS WAS: To identify the number of EA, the causative diagnosis and the indication for surgical removal of the eye, the chosen surgical technique and to evaluate a possible change in surgical technique in Denmark from 1996 until 2003 (paper I); To describe the phantom eye syndrome and its prevalence of visual hallucinations, phantom pain and phantom sensations (paper II); To characterise the quality of phantom eye pain, including its intensity and frequency among EA patients. We attempted to identify patients with increased risk of developing pain after EA and investigated if preoperative pain is a risk factor for a later development of phantom pain (paper III); In addition we wanted to investigate the health related quality of life, perceived stress, self rated health, job separation due to illness or disability and socio-economic position of the EA in comparison with the general Danish population (paper IV). THE STUDIES WERE BASED ON: Records on 431 EA patients, clinical ophthalmological examination and an interview study of 173 EA patients and a questionnaire answered by 120 EA patients. CONCLUSIONS: The most frequent indications for EA in Denmark were painful blind eye (37%) and neoplasm (34%). During the study period 1996-2003, the annual number of eye amputations was stable, but an increase in bulbar eviscerations was noticed. Orbital implants were used with an increasing tendency until 2003. The Phantom eye syndrome is frequent among EA patients. Visual hallucinations were described by 42% of the patients. The content were mainly elementary visual hallucinations, with white or colored light as a continuous sharp light or as moving dots. The most frequent triggers were darkness, closing of the eyes, fatigue and psychological stress. Fifty-four percent of the patients had visual hallucinations more than once a week. Ten patients were so visually disturbed that it interfered with their daily life. Approximately 23% of all EA experience phantom pain for several years after the surgery. Phantom pain was reported to be of three different qualities: (i) cutting, penetrating, gnawing or oppressive (n=19); (ii) radiating, zapping or shooting (n=8); (iii) superficial burning or stinging (n=5); or a mixture of these different pain qualities (n=7). The median intensity on a visual analogue scale, ranging from 0 to 100, was 36 [range: 1-89]. One-third of the patients experienced phantom pain every day. Chilliness, windy weather and psychological stress/fatigue were the most commonly reported triggers for pain. Factors associated with phantom pain were: ophthalmic pain before EA, the presence of implant and a patient reported high degree of conjunctival secretion. A common reason for EA is the presence of a painful blind eye. However, one third of these patients continue to have pain after the EA. Phantom sensations were present in 2% of the patients. The impact of an eye amputation is considerable. EA patients have poorer health related quality of life, poorer self-rated health and more perceived stress than does the general population. The largest differences in health related quality of life between the EA patients and the general population were related to role limitations due to emotional problems and mental health. Patients with the indication painful blind eye are having lower scores in all aspects of health related quality of life and perceived stress than patients with the indication neoplasm and trauma. The percentage of eye amputated which is divorced or separated was twice as high as in the general population. Furthermore, 25% retired or changed to part-time jobs due to eye disease and 39.5% stopped participating in leisure activities due to their EAs.

Twenty year review of histopathological findings in enucleated/eviscerated eyes.

BACKGROUND/AIMS: To evaluate the need for routine histopathological analysis of enucleated/eviscerated eyes and changes in indications for eye removal. METHODS: Retrospective review of all enucleation/evisceration histopathology reports over 20 years. Clinical history was correlated with pathological findings. Two 10 year periods (1984-93, 1994-2003) were compared to detect changes in indications for eye removal. RESULTS: In total, 285 histopathology results were traced from 1984 to 2003; 161 and 124 were evisceration and enucleation specimens, respectively. Glaucoma, malignant melanoma, trauma, and retinal detachment were the most frequent diagnoses 1984-1993. Ocular trauma was the most frequent diagnosis 1994-2003, followed by phthisis bulbi and endophthalmitis. Three cases were diagnosed as metastatic carcinoma; all were suspected preoperatively. A fourth case was a diagnostic surprise: adenocarcinoma found in an eye removed for pain and phthisis. Comparison of two 10 year periods showed a decrease in the number of enucleations/eviscerations, perhaps reflecting a decrease in the number of specimens sent. A preference for eviscerations was evident over the 20 years. CONCLUSION: The number of eyes removed and histologically analysed decreased in the period 1994 to 2003, perhaps because of better treatment options, allowing globe preservation. There was a significant shift in the diagnosis in the two time periods, and a preference for evisceration in both. Only one diagnostic surprise was discovered (0.35%). This study does not support the need to send all globes/contents for histopathological examination. However, because of the one unexpected finding, it is recommended where the examination is incomplete or the history of visual loss is unclear.

A study of the indications and changing trends of evisceration in north India.

AIM: To study the demographic pattern and indications for evisceration in north India and to evaluate the changing trends over the last decade. METHODS: In a retrospective hospital-based study, case records of all patients who underwent evisceration at Rajendra Prasad Centre for Ophthalmic Sciences from January 1990 to December 1999 were reviewed. The parameters evaluated were the age and sex distribution, the place of residence (urban/rural) and the indications for evisceration. The aetiology responsible for evisceration was determined on the basis of history, clinical examination and investigations as determined from previous records. RESULTS: One hundred and sixty-four patients had one eye eviscerated during the study period. The mean age of the patients was 51 +/- 13.84 years (range 6 months to 90 years). Panophthalmitis was the most common indication for evisceration (78.6%, n = 129), followed by irreparable globe injury (21.3%, n = 35). There was a significant decrease in the eviscerations performed due to pano-phthalmitis from 104 cases during the period 1990-1994, to 25 cases in the period 1995-1999. CONCLUSION: Panophthalmitis and severe ocular injury are the major indications of evisceration in north India. There has been a significant decrease in the number of eviscerations related to panophthalmitis over the last decade.