Update on enucleation and evisceration surgery

The best operative results with fewest complications after enucleation surgery can be achieved by following basic principles, some of which are those of conservative tissue excision, using spherical implants placed behind Tenon's capsule into the muscle cone and avoiding surgical techniques that overlap the extraocular muscles (especially the superior rectus) over the front of the implant. The presence of an intraocular tumor demands that an enucleation be done. When the possible development of sympathetic ophthalmia is not present, the surgeon should consider doing an evisceration because of the cosmetic and motility advantages. Mention is made of some developments in enucleation surgery, such as the scleral cap reinforcement, the "baseball" implant technique using donor sclera, the use of liquid nitrogen to freeze intraocular tumors before removal of the eye, the dermis-fat orbital graft, and the use of two spherical orbital implants instead of one.