A Single- Versus Double-Layered Closure Technique in Anophthalmic Surgery

Area of Science:

• Ophthalmology
• Surgical Techniques
• Ocular Implants

Background:

• Orbital implant exposure and extrusion are potential complications after eye removal procedures like evisceration and enucleation.
• Standard surgical closure involves separate layers for Tenon's capsule and conjunctiva, while simplified techniques aim to reduce complexity.

Purpose of the Study:

• To compare the incidence of orbital implant exposure and extrusion between a simplified one-layer closure and the traditional two-layer closure of Tenon's capsule and conjunctiva following eye removal.

Main Methods:

• A retrospective review of 329 patients (157 evisceration, 172 enucleation) who underwent eye removal by a single surgeon between 2001 and 2013.
• Patients were divided into two groups: those treated with separate layer closure (2001-2004) and those treated with a simplified one-layer closure (post-2004).
• The primary outcome measured was the occurrence of implant exposure or extrusion.

Main Results:

• Overall, implant exposure or extrusion occurred in 2.1% of patients (2.2% with one-layer closure vs. 2.1% with two-layer closure; P = 0.96).
• Following evisceration, rates were 2.5% for both techniques (P = 0.95).
• Following enucleation, rates were 1.7% for both techniques (P = 0.96).

Conclusions:

• The simplified one-layer closure of Tenon's capsule and conjunctiva is as safe and effective as the classic two-layer closure in preventing orbital implant exposure and extrusion after eye removal.
• This finding supports the use of simplified surgical techniques to potentially improve efficiency without compromising patient outcomes.