enucleation

Discussion in 'Ophthalmology: Eye Physicians & Surgeons' started by rubensan, May 3, 2007.

  1. rubensan

    rubensan Senior Member
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    aside from closing sclera and tenons in an interrupted fashion and placing a tarrsorhaphy, any other advice for preventing extrusion of the implant?
     
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  3. JR

    JR Guest

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    Here is a portion of an excellent article by R. Davies, M.D. from www.ophthalmic.hyperguides.com (Bascom Palmer run site):

     
  4. rubensan

    rubensan Senior Member
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    i'm sorry....i meant evisceration :eek:
     
  5. ryangeraets

    ryangeraets Junior Member
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    Just a resident here, but this is what I've picked up:

    I think extrusion is probably not the risk you are really worried about, but rather exposure or migration of the implant, as if it's a biointegrated implant it's not going to pop out of the sclera. But regarding exposure, this is my experience:
    We don't leave the cornea attached, it's competely removed and sent to pathology with the intraocular contents, so you do have a fairly appreciable gap in front. We make radial relaxing incisions anteriorly to get the implant in, but also cut out a ring around the optic nerve and place relaxing incisions posteriorly as well. This allows the implant to sit a bit more posteriorly within the scleral sleve and also allows you to pull the sclera completely over the implant anteriorly. The leaflets of sclera are not put end to end, but placed on top of one another so they overlap a bit (redundancy to prevent exposure). This can occasionally be difficult as eyes coming to evisceration are often pre-phthisical or phthisical and are generally smaller than the implant you are going to want to put in.
    In the end, your first post had two of the most important points, meticulous closure of the overlying sclera, Tenon's, and conj.
    GOod luck!
     
  6. JR

    JR Guest

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    Here you go:

     
  7. rubensan

    rubensan Senior Member
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    thanks dude!
     

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