The swinging sclera technique for evisceration

To present a modified evisceration technique with a full-thickness horizontal sclerotomy and assess post-operative motility and long-term outcomes.

This is a retrospective chart review of patients who underwent evisceration with a single surgeon (TJM). The standard initial steps of evisceration were performed. Before implant placement, a complete radial sclerotomy was extended posteriorly at the 3 and 9 o'clock positions, 2 mm above the optic nerve, longitudinally dividing the medial and lateral rectus insertions. The scleral halves were mobilized, allowing them to "swing" forward and overlap over the spherical implant. In a subgroup of five patients, postoperative motility was assessed by marking the conjunctiva overlying the implant and taking photos in extreme gazes. Operative and non-operative eye measurements were compared in SiliconCoach Digitizer Software.

Thirty patients were identified (16 male, 14 female; mean age 56.9, range 4.6-90.1 years). Eleven patients were noted to have phthisis bulbi. Implant sizes were 18 mm (n = 13), 20 mm (n = 14), and 22 mm (n = 2) with a mean of 19.24 mm. Mean horizontal and vertical motility ratios of operated to non-operated eye were 0.61 ± 0.18 and 0.76 ± 0.28, respectively, with no statistically significant differences (p = 0.38).

Evisceration with complete horizontal full thickness sclerotomy is an effective technique that prevents the sclera from limiting implant size, even in patients with phthisis bulbi. Longitudinal division of the recti insertions also did not affect function or implant stability.