Pediatric enucleation: analysis of volume replacement

Area of Science:

• Ophthalmic surgery
• Orbital implants
• Pediatric ophthalmology

Background:

• Enucleation is the surgical removal of the eyeball.
• Post-enucleation socket syndrome can lead to cosmetic and functional deficits.
• Volume replacement with orbital implants is critical for optimal outcomes.

Purpose of the Study:

• To assess implant volume replacement in pediatric vs. adult enucleation patients.
• To evaluate long-term sequelae of inadequate volume replacement.
• To establish guidelines for pediatric orbital implant volume replacement.

Main Methods:

• Retrospective observational study of 16 pediatric and 31 adult patients enucleated in childhood.
• Determination of total and implant volume replacement.
• Assessment of secondary surgeries for socket deformities (superior sulcus deformity, enophthalmos, ptosis, ectropion, socket contraction).

Main Results:

• Average implant volume replacement was 68% in pediatric patients (group 1) and 21% in adults enucleated in childhood (group 2).
• 71% of group 2 patients required secondary surgery for volume augmentation and deformity correction.
• Inadequate initial volume replacement correlates with long-term socket complications.

Conclusions:

• Appropriate initial implant sizing in pediatric enucleation can prevent adult socket deformities.
• The study suggests an implant diameter 2 mm less than the eye's axial length for pediatric patients.
• Optimizing primary implant volume replacement is key to avoiding secondary reconstructive surgeries.