Orbit, 2014; 33(6): 477 ! Informa Healthcare USA, Inc. ISSN: 0167-6830 print / 1744-5108 online DOI: 10.3109/01676830.2014.950293
LETTER TO THE EDITOR
Survey of Common Practices Among Oculofacial Surgeons In The Asia-Pacific Region: Evisceration, Enucleation and Management of Anophthalmic Sockets Victor Koh, Nathalie Chiam, and Gangadhara Sundar
Orbit Downloaded from informahealthcare.com by Nyu Medical Center on 05/28/15 For personal use only.
Department of Ophthalmology, National University Health System, Singapore
The indications for evisceration and enucleation are still evolving and controversial.1,2 We conducted an online web-based survey between May 2012 and December 2012 among fellowship-trained oculofacial surgeons in the Asia-Pacific region regarding evisceration, enucleation and management of the anophthalmic socket. We achieved a response rate of 61.7% (73 out of 120 responded) from up to 14 countries. The mean proportions of enucleations and evisceration were 28.7 ± 22.6% and 71.4 ± 22.6% respectively (p50.001). Evisceration was the preferred for panophthalmitis (55.0%), endophthalmitis (80.5%), non-traumatic painful blind eye (80.5%) and painful blind eye after open globe injuries (53.7%). The most common indication for enucleation was intraocular malignancy (78.1%). Silicone/acrylic were the most popular orbital implant materials, followed by porous polyethylene for both adult and pediatric patients. The mean implant sizes for adult and pediatric patients were 20.2 ± 1.78 and 17.2 ± 2.36 mm, respectively. The most popular implant wrapping material was donor sclera (56.1%), but one-third of the respondents also preferred not to use any implant wrap. In contrast, the most popular implant wrap was vicryl mesh in the United Kingdom3 and myoconjunctivalization in the United States.4 In our survey, 95.1% of the respondents do not drill and peg the implant for enhanced motility Consistent with the United Kingdom3 and the United States,4 our survey based in the Asia-Pacific
found that evisceration was favored over enucleation. This could be attributed to surgeons being less concerned with the risk of sympathetic ophthalmia and relatively better post-operative outcomes associated with evisceration.5,6
DECLARATION OF INTEREST The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the letter.
REFERENCES 1. O’Donnell BA, Kersten R, McNab A, et al. Enucleation versus evisceration. Clin Exper Ophthalmol 2005;33:5–9. 2. Migliori ME. Enucleation versus evisceration. Curr Opin Ophthalmol 2002;13:298–302. 3. Shah RD, Singa RM, Aakalu VK, Setabutr P. Evisceration and enucleation: a national survey of practice patterns in the United States. Ophthalm Surg Lasers Imag 2012; 43(5):425–430. 4. Viswanathan P, Sagoo MS, Olver JM. UK national survey of enucleation, evisceration and orbital implant trends. Br J Ophthalmol 2007;91(5):616–619. 5. Liu D. Evisceration techniques and implant extrusion rates: A retrospective review of two series and a survey of ASOPRS surgeons. Ophthal Plast Reconstr Surg 2007; 23(1):16–21. 6. Nakra T, Simon GJ, Douglas RS, et al. Comparing outcomes of enucleation and evisceration. Ophthalmology 2006;113:2270–2275.
Received 20 January 2014; Accepted 28 July 2014; Published online 10 September 2014 Correspondence: Dr. Victor Koh, Level 3, Main Building, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. Tel: +65 6772 6445/ +65 6772 5316. Fax: +65 677 716. E-mail: [email protected]
477
LETTER TO THE EDITOR
Survey of Common Practices Among Oculofacial Surgeons In The Asia-Pacific Region: Evisceration, Enucleation and Management of Anophthalmic Sockets Victor Koh, Nathalie Chiam, and Gangadhara Sundar
Orbit Downloaded from informahealthcare.com by Nyu Medical Center on 05/28/15 For personal use only.
Department of Ophthalmology, National University Health System, Singapore
The indications for evisceration and enucleation are still evolving and controversial.1,2 We conducted an online web-based survey between May 2012 and December 2012 among fellowship-trained oculofacial surgeons in the Asia-Pacific region regarding evisceration, enucleation and management of the anophthalmic socket. We achieved a response rate of 61.7% (73 out of 120 responded) from up to 14 countries. The mean proportions of enucleations and evisceration were 28.7 ± 22.6% and 71.4 ± 22.6% respectively (p50.001). Evisceration was the preferred for panophthalmitis (55.0%), endophthalmitis (80.5%), non-traumatic painful blind eye (80.5%) and painful blind eye after open globe injuries (53.7%). The most common indication for enucleation was intraocular malignancy (78.1%). Silicone/acrylic were the most popular orbital implant materials, followed by porous polyethylene for both adult and pediatric patients. The mean implant sizes for adult and pediatric patients were 20.2 ± 1.78 and 17.2 ± 2.36 mm, respectively. The most popular implant wrapping material was donor sclera (56.1%), but one-third of the respondents also preferred not to use any implant wrap. In contrast, the most popular implant wrap was vicryl mesh in the United Kingdom3 and myoconjunctivalization in the United States.4 In our survey, 95.1% of the respondents do not drill and peg the implant for enhanced motility Consistent with the United Kingdom3 and the United States,4 our survey based in the Asia-Pacific
found that evisceration was favored over enucleation. This could be attributed to surgeons being less concerned with the risk of sympathetic ophthalmia and relatively better post-operative outcomes associated with evisceration.5,6
DECLARATION OF INTEREST The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the letter.
REFERENCES 1. O’Donnell BA, Kersten R, McNab A, et al. Enucleation versus evisceration. Clin Exper Ophthalmol 2005;33:5–9. 2. Migliori ME. Enucleation versus evisceration. Curr Opin Ophthalmol 2002;13:298–302. 3. Shah RD, Singa RM, Aakalu VK, Setabutr P. Evisceration and enucleation: a national survey of practice patterns in the United States. Ophthalm Surg Lasers Imag 2012; 43(5):425–430. 4. Viswanathan P, Sagoo MS, Olver JM. UK national survey of enucleation, evisceration and orbital implant trends. Br J Ophthalmol 2007;91(5):616–619. 5. Liu D. Evisceration techniques and implant extrusion rates: A retrospective review of two series and a survey of ASOPRS surgeons. Ophthal Plast Reconstr Surg 2007; 23(1):16–21. 6. Nakra T, Simon GJ, Douglas RS, et al. Comparing outcomes of enucleation and evisceration. Ophthalmology 2006;113:2270–2275.
Received 20 January 2014; Accepted 28 July 2014; Published online 10 September 2014 Correspondence: Dr. Victor Koh, Level 3, Main Building, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. Tel: +65 6772 6445/ +65 6772 5316. Fax: +65 677 716. E-mail: [email protected]
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