Enucleation with reverse replacement of sclera as an alternative to conventional evisceration

To objectively review the results of a technique combining enucleation with evisceration in patients listed for traditional evisceration with preservation of the rectus muscles.

Ten patients who underwent combined enucleation and evisceration with 3 to 36 months of follow-up were identified (average follow-up 14 months). Three eyes were phtihisical, 1 microphthalmic, 1 buphthalmic, 1 a secondary implant following conventional evisceration and 4 non-phtihisical painful eyes. The technique involved enucleation followed by evisceration of the eye contents. Implants, either coral or acrylic, were wrapped in the eviscerated sclera and replaced in the orbit with the posterior pole of the sclera facing anteriorly. The rectus muscles were then resutured onto the sclera. The patients were subsequently recalled and volume replacement, cosmesis and complications were assessed.

Three coral and 7 acrylic implants were placed, 2 of 22 mm, 7 of 20 mm and 1 of 18 mm. No complications were encountered, in particular no implant extrusions. Cosmesis was graded good in 9 out of 10 patients.

Combined enucleation and evisceration allows the selection and placement of an appropriately large-sized implant to achieve good volume replacement with no extrusions in our series. This technique is particularly pertinent as an alternative to standard evisceration in phtihisical eyes.