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Orbital exenteration--a retrospective study over an 11 year period analyzing all cases from a single unit
A Taylor1, F Roberts, E G Kemp
1Oculoplastic and Ocular Oncology Fellow-Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 OYN, Scotland, UK. taylor_alex_eye@yahoo.co.uk
Purpose:
A retrospective analysis of all cases of orbital exenteration performed at the National Scottish Ocular Oncology Center over an 11 year period.
Methods:
We sought all exenteration cases (1993-2003) from ocular oncology and oculoplastic databases. Fifteen exenterations were performed. One case record was irretrievable. Clinicopathological features and outcome of 14 patients were analyzed. All operations were performed by the same consultant.
Results:
The male to female ratio was 1:1 and the average age at surgery was 66 years. There was a left sided predominance of pathology demonstrated (right to left orbit ratio was 1:1.3. The average follow up period postsurgery was 35 months. The most common underlying diagnosis was malignant melanoma (9/14). Ocular/orbital discomfort was the most frequent presenting symptom (7/14); a mass lesion (10/14) was the most common presenting sign. The average duration of symptoms/signs prior to tertiary institution referral was 10.9 months (range: 0.5-60 months). Exenteration was performed on average 39.7 months (range: 0.13-204) after initial tertiary center presentation. This included patients managed from the outset who failed treatment(s) and then required exenteration. The eyelids were sacrificed in ten cases (10/14). Sockets were lined with eyelid skin (4/10), split skin (thigh) (3/10) or healed secondarily (7/10). Thirteen cases (13/14) had clear histological margins. The average post operative stay was 8.3 days. The most common complication was socket fistula formation (7/14). Ethmoid sinuses were always involved. The average time to fistula development was 4.9 months (sockets lined by skin = 2.2 months compared with sockets left to heal secondarily = 6.9 months). The majority of patients wore occlusive shields long term.
Conclusion:
The most common pathology necessitating exenteration was malignant melanoma. Most patients presented with a mass lesion. Histological tumor free margins were obtained in thirteen of fourteen cases. The most common complication was socket fistula formation.
