The swinging sclera technique for evisceration.

Area of Science:

• Ophthalmology
• Ophthalmic Surgery

Background:

• Evisceration is a surgical procedure to remove the eye's contents while preserving the sclera.
• Standard evisceration techniques may limit orbital implant size, potentially affecting cosmetic outcomes.
• Phthisis bulbi, a condition of a shrunken, non-functional eye, presents unique challenges in evisceration.

Purpose of the Study:

• To introduce a modified evisceration technique utilizing a full-thickness horizontal sclerotomy.
• To evaluate the impact of this technique on post-operative ocular motility.
• To assess the long-term outcomes and implant stability of the modified evisceration procedure.

Main Methods:

• A retrospective chart review was conducted on patients undergoing evisceration by a single surgeon.
• The modified technique involved a complete horizontal sclerotomy at the 3 and 9 o'clock positions, allowing scleral halves to overlap the implant.
• Post-operative motility was assessed in a subgroup of five patients using photographic analysis in extreme gazes.

Main Results:

• Thirty patients (16 male, 14 female; mean age 56.9 years) were included in the study.
• Eleven patients had phthisis bulbi; mean implant size was 19.24 mm.
• Mean horizontal and vertical motility ratios of operated to non-operated eyes were 0.61 and 0.76, respectively, with no significant difference (p=0.38).

Conclusions:

• The modified evisceration technique with horizontal sclerotomy effectively accommodates larger implants, even in cases of phthisis bulbi.
• Dividing the medial and lateral rectus insertions did not compromise ocular motility or implant stability.
• This technique offers an effective solution for achieving favorable cosmetic and functional outcomes in evisceration surgery.