View 2019 Abstracts

Enucleation and evisceration are therapeutic surgical approaches used in the management of intraocular tumours, severe ocular trauma and painful blind eyes. There are a number of different approaches towards the surgery as well as post-operative care. In this study we set out to assess anophthalmic surgery performed in the North East of England, in order to understand current practice, identify trends and allow for service provision planning based on the findings.

This is a multi-centered evaluation of all anophthalmic surgery recorded in the North East region, which included 2 tertiary trauma centres- Royal Victoria Infirmary in Newcastle; James Cook University Hospital in Middlesbrough as well as Sunderland Eye Infirmary between 01/01/2012 and 31/12/2016. The type of surgery, presence of tarsorrhaphy, implant size, type of anaesthesia, antibiotics used, type of implant, complications and further procedures were analysed.

63 eyes of 62 patients, underwent anophthalmic surgery during the study period, with 54 enucleations and 9 eviscerations performed. While the majority of procedures were performed under general anaesthesia in 61 cases, local anaesthesia alone was used in 2 cases. Tarsorraphy was included in the primary anophthalmic surgery in 70% of cases. The choice of implant included: Silicone 36%, Acrylic 34%, Medpore 11%, Bioceramic 11%. The most commonly chosen size of implant was 20mm, which was used in 42% of the cases. The complications were rare and included: socket cyst n=4, subconjunctival haemorrhage n=2, slow wound closure n=1, socket infection n=4, implant exposure n= 4, conjunctival prolapse n=2, post-operative swelling n=1 and orbital haematoma n=1. Subsequent procedures required were also rare. Implant exchange was performed in n=2 cases, excision of socket cyst in n=3, temporary tarsorrhaphy in n=2, lid tightening in n=1, examination under anaesthesia n=2, dermis graft n=1. Postoperative systemic antibiotics were prescribed in 70% of cases, with oral co-amoxiclav most commonly used.

Our evaluative study demonstrates that anophthalmic surgery is rare, but generally safe procedure, with evisceration being most commonly performed. The complication rate was very low and the subsequent surgery to correct any of the issues was rare. Interestingly, the rate of immediate post-operative infection was no higher in the patients who did not receive post-operative antibiotics. However, a prospective study would be required to confirm this.