A profile of destructive surgery in Nepal Eye Hospital

This is a study profile of the patients undergoing destructive surgery in Nepal Eye Hospital over a period of 2 years (2001-2003). The rationale of the study was to know the incidence and causes for destructive surgery (enucleation/evisceration) and the measures to prevent them. Patients admitted in the ward from emergency and outpatients departments for the purpose of enucleation and evisceration were taken into this study. Their visual acuity, slit-lamp examinations, fundus evaluation were done. Most of the patients had no perception of light with painful blind eyes, panophthalmitis, endophthalmitis, staphylomas, crush injuries and malignancies. After a decision made by the surgeons in the round, a full consent was taken for the operation. Evisceration was done for cases with history of ocular infections and the rest were enucleated. Destructive operation was done for (a) saving the other eye, (b) life saving, (c) painful condition and disfigurement. The incidence of destructive surgery in Nepal Eye Hospital was 1.40%. male : female ratio was 1.41:1. The causes for destructive surgery were panophthalmitis (31.71%), painful blind eye (21.95%), endophthalmitis (14.63%), staphyloma (14.63%), retinoblastoma (12.20%) and crush injuries (4.88%). Number of evisceration (73.17%) was higher than enucleation (26.83%) as most of the cases were sequele of corneal ulcer. Enucleation was mostly seen in children and evisceration in adults. Lastly, the incidences of destructive surgery would be minimized by (a) Prompt treatment of corneal ulcers for reducing panophthalmitis (b) pre, intra, and post operative care in intra ocular surgery for reducing endophthalmitis, and (c) genetic counselling (pre marital) for reducing childhood malignancies. Decision for destructive surgery should be a team work rather than a single surgeon's opinion. It should be done under general anaesthesia or retrobulbar block. Precaution must be taken to prevent the appalling tragedy of enucleating the wrong eye by marking above on the eye to be operated or EUA prior to surgery. Last but not the least, there should be fitting of a prosthesis for cosmesis, psychological support and careful follow-up of the healthy eye.