Evisceration with Four Elongated Anterior Scleral Incisions and Circumferential Cogwheel-like Posterior Sclerotomies for Moderate to Severe Phthisis Bulbi

Abstract

Purpose To describe a modified evisceration technique that enables the use of a large orbital implant and reduces postoperative complications in moderate to severe phthisis bulbi. Methods We conducted a retrospective, interventional study on eviscerations with four elongated anterior scleral incisions and circumferential cogwheel-like posterior sclerotomies behind the equator at approximately 330 degrees and placement of a porous polyethylene spherical implant. These procedures were performed between March 2018 and March 2023 by a single surgeon. Patient age, sex, causative diagnosis, axial length, orbital implant size, follow-up duration, and complications were recorded. Results A total of 25 cases underwent the modified evisceration. The mean age was 56.0 years, and the mean implant size was 19.46 mm. During the follow-up period (mean: 36.7 months, range: 12 to 72 months), there were no cases of implant exposure or anophthalmic enophthalmic syndrome. In some cases, mild discharge, ptosis, and conjunctival cysts developed. Conclusions Evisceration with scleral modification is a straightforward and effective technique that enables the placement of appropriately sized (18–22 mm) orbital implant in a severely contracted globe. The surgery yielded excellent results with few complications.