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Comparing outcomes of enucleation and evisceration
Tanuj Nakra1, Guy J Ben Simon, Raymond S Douglas
1Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, California 90095-7006, USA. nakra@jsei.ucla.edu
Purpose:
To compare clinical outcomes of enucleation and evisceration by functional and aesthetic measures.
Design:
Retrospective, nonrandomized, comparative analysis.
Participants:
Eighty-four patients who underwent enucleation or evisceration.
Methods:
The medical records of the participants were retrospectively reviewed. Clinical photographs were graded by blinded observers for qualitative measures.
Main Outcome Measures:
Postoperative eyelid and motility measurements, as well as subjective grades of various aesthetic and functional outcomes.
Results:
There is no statistically significant difference in the overall aesthetic outcome of enucleation and evisceration, although several specific comparisons were found to be significant. Implant motility score is higher in eviscerated eyes (5.58+/-2.08) than in enucleated eyes (4.35+/-1.69) (P = 0.05). Adduction of the implant is significantly less than abduction in eviscerated eyes (1.34 vs. 1.44; P = 0.02). Implant motility is greater than prosthesis motility. Both enucleation and evisceration result in enophthalmos and a sulcus defect. Seven of 32 patients (21.9%) who underwent enucleation experienced a complication, whereas only of 7 of 52 patients (13.5%) who underwent evisceration experienced a complication (P = 0.0002). The 2 most common complications were implant exposure and formation of a pyogenic granuloma.
Conclusions:
Although enucleation and evisceration produce aesthetically similar outcomes, eviscerated eyes have better implant motility and experience fewer complications. Both enucleation and evisceration result in enophthalmos, sulcus contour defects, and incomplete transfer of implant motility to the prosthesis.
