THE MODIFIED METHOD FOR EVISCERATION IN THE CASE OF BUPHTHALMOS WITH THE USE OF A COMBINATION OF ORBITAL IMPLANTS

Abstract

Aim. The objective of the present study was to evaluate the effectiveness of the modified technique for for evisceration in the case of buphthalmos with the use of a combination of orbital implants. Material and methods. The clinical material collected during 3 years was analyzed. The removal of the eye was performed in 385 patients of whom32 (8.1%) of the total) needed the removal because of of buphthalmos as the consequence of congenital, secondary post-traumatic glaucoma. The age of the patients ranged from 7-75 (mean 39.3 ± 5.7) years. 19 of them were males and 13 females. Nine patients presented with pronounced staphyloma of the sclera. The visual function was absent in all the cases. The modified method for evisceration included radiowave surgery with the use of a Surgitron device operated at a frequency of 3.8 Mg (Ellman, USA) and a combination of orbital implants (both intrascleral and intraconal) in order to obtain an additional volume for the stump. The Karbotextim carbon felt and polytetrafluoroethylene (PTFE) were applied as orbital implants. The surgical intervention is described in many detail. The duration of the follow-up ranged from 6 months to 3 years (mean 21 ± 6.17 months). The groups of comparison were two groups of the patients who had undergone the eye removal for buphthalmos: one of them was comprised of 14 patients treated by means of enucleation with plastic formation of the stump, the other consisted of 21 treated by traditional evisceration. Results. Wound healing in the early postoperative period occurred during normal time, without oedema and reactions to the presence of the additional implant in the orbit. Evaluation of the long-term results of the treatment was made based on the following criteria: retraction of the prosthesis and the upper eyelid into the orbit, asymmetry of the palpebral fissure, motility of the stump and the prosthesis. The best functional and cosmetic results (in comparison with enucleation and standard evisceration) were obtained in the patients treated with the use of the modified evisceration procedure and the application of the additional orbital implant. Conclusion. The modified method for evisceration in the case of buphthalmos with the use of a combination of orbital implants allows to compensate not only the volume of the eviscerated eye but also the volume of the atrophic orbital tissue. Moreover, it yields an additional stump volume of 0.5-0.7 cub. cm and permits to spare the fascial links between the orbital tissues and thereby prevent the development of stump and prosthesis hypophthalmos in the late postoperative period. The modified evisceration technique is more effective than both enucleation and standard evisceration in the patients with buphthalmos.