59
Enucleation

See Chapter 58.

Intraocular tumors

Blind eyes following severe penetrating injuries

Blind eyes with recalcitrant infections

Blind, painful eyes unresponsive to medical treatment

Preoperative Procedures

See Chapter 3.

1. Treat any infectious processes as necessary.

2. If possible, discontinue aspirin and nonsteroidal anti-inflammatory agents for 10 days prior to surgery. Discontinue warfarin 2–3 days preoperatively, if medically possible.

3. Query patient about bleeding tendencies. A useful screening question is asking if the patient had unusual bleeding after dental extraction. Obtain hematological evaluation if bleeding tendency is suspected.

Instrumentation

Lid speculum

Toothed forceps

Sutures (6–0 Vicryl, 6–0 plain, 5–0 Vicryl)

Needle holder

Cautery

Scissors (Westcott, Stevens)

Muscle hooks

Spherical implant (silicone or methylmethacrylate for Technique One and Medpor SST implant for Technique II; see below)

Sizer set of spheres

Methylmethacrylate conformer

Operative Procedures

1. Determine method to be used for enucleation:

a. Technique I: Silicone or methylmethacrylate sphere

b. Technique II: Medpor sphere

Note: Text will indicate where techniques vary.

2. General anesthesia in most cases.

3. Verify eye to be enucleated.

4. Prep and drape in sterile manner.

5. Place lid speculum.

6. Perform 360 degree limbal peritomy taking care to preserve all conjunctiva (Westcott scissors).

7. Bluntly spread between rectus muscles in all quadrants (Fig. 59.1).

a. Use Westcott or Stevens scissors to bluntly buttonhole through the Tenon capsule down to bare sclera.

b. Aim scissors 45 degrees between rectus muscles.

c. Spread scissors.

8. Isolate medial and lateral rectus muscle with muscle hooks (Fig. 59.2).

9. Use Q-tip or scissors to conservatively strip the Tenon capsule.

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