Complications Following Enucleations and Subsequent Oculoplastic Surgeries.

PURPOSE: To analyze the complications and subsequent type and frequency of oculoplastic surgeries after enucleation in adult patients. METHODS: The authors conducted a retrospective case note review of adult patients who underwent enucleation followed by placement of an alloplastic implant wrapped in donor sclera between 2001 and 2013. The data collected included patient demographics, surgical indication, implant size, postoperative complications, and subsequent oculoplastic surgical procedures. RESULTS: The authors included 186 patients who underwent enucleation during the study period. Malignancy was the leading cause for this operation (79.6%) followed by a blind painful eye (12.4%). Most postoperative complications were managed conservatively with an adjustment of the size of the ocular prosthesis. In most cases, the 20-mm and 22-mm implants were used, and implant size ranged from 16 to 22 mm. There was no correlation between implant size and complication rate. Twenty-six patients required subsequent surgery after enucleation (14%). In total, 9.7% (18 patients of 186) patients underwent eyelid surgery after enucleation, most frequently for blepharoptosis (7%). The interval between enucleation and eyelid surgeries was, on average, 1.9 years. Less frequently, surgery is needed for socket repair for anterior surface breakdown (1.6%), and the interval between enucleation and socket surgery was 0.9 years. CONCLUSIONS: The most frequent complications following enucleation were blepharoptosis and enophthalmos with a deep upper eyelid sulcus. About 15% of patients required subsequent oculoplastic procedures after, on average, 2 years, while surgery in the early postoperative phase was rarely indicated.

A Single- Versus Double-Layered Closure Technique in Anophthalmic Surgery.

PURPOSE: To compare the frequency of orbital implant exposure and extrusion following eye removal with a simplified closure technique, closing Tenon's capsule and conjunctiva in 1 layer versus the classic technique of closure in 2 separate layers. METHODS: The authors conducted a retrospective case note review of patients who underwent evisceration or enucleation treated by 1 surgeon between 2001 and 2013. Between 2001 and 2004, Tenon's capsule and conjunctiva were closed in separate layers; after 2004, a simplified 1-layer closure following eye removal was used. The primary outcome parameters were presence or absence of implant exposure or extrusion. RESULTS: One hundred fifty-seven patients who underwent evisceration and 172 patients who underwent enucleation were included. Following evisceration, 2.5% developed exposure or extrusion of the implant, this was 2.5% in the 1-layer closure technique and 2.7% in the 2-layer closure technique (p = 0.95). Following enucleation, 1.7% developed exposure or extrusion of the implant, this was 1.8% in the 1-layer closure technique and 1.7% in the 2-layer closure technique (p = 0.96). Overall implant exposure and extrusion was 2.1%, this was 2.2% in the 1-layer closure technique and 2.1% in the 2-layer closure technique (p = 0.96). CONCLUSIONS: No difference was found in the frequency of spheric acrylic implant exposure or extrusion in patients who underwent eye removal with single-layer closure of Tenon's capsule and conjunctiva compared with patients treated with separate closure of these layers.