An evaluation of acrylic spherical implant in cases of evisceration

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Original Article

Author Details : Ram Kumar, Akash Srivastava, Deepti Yadav

Volume : 3, Issue : 1, Year : 2017

Article Page : 67-72

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Abstract

Purpose: To evaluate the acceptance of implant and cosmetic results achieved following evisceration operation with use of non integrated spherical acrylic implant.
Method: The patient included in the study were taken from the out patient department of upgraded department of ophthalmology B.R.D Medical College; Gorakhpur, from December 2015 to November 2016. Since the study involved mutilating surgery of eye only those patients were selected in whom either there was specific indication for sacrificing the eye or there was no chance of any visual recovery. In all, 40 patient formed the study group of whom, 32 cases were panopnthalmitis; 4 were of endophthalmitis and 4 were of anterior staphyloma. Detailed history taken and examination done under (a) General examination (b) Systemic examination and (c) Detailed ocular examination. Procedure and its probable ultimate outcome along with complications was explained to patients and only those patients who willingly accepted for surgery were included in the study. Cases of Necrotizing scleritis and perforating injury of sclera are excluded from the study. Post surgery the patient was evaluated 3^rd day, then after discharge on 1^st week, 4^th week and 6^th months. During all follow up’s; examination was done with emphasis on following parameters: (a) any complaints by patient i.e. pain, discharge , discomfort etc., (b) wound healing, (c)examination of prosthesis bed. (d) shape & formation of socket (e) fitness of eye prosthesis. (f) movement of prosthetic eye.
Result: Of the total study group, 80% of patient were of panophthalmitis (maximum), while those of endophthalmitis and anterior staphyloma comprising 10% each. Out of 40 patients, 24 (60%) underwent evisceration with acrylic spherical implant placement and in the rest 16 (40%) no implant was put. Of the 24 patient in whom evisceration was done with acrylic spherical implant placement, all complained of discomfort, discharge and pain on 3^rd post op day. On routine follow up at 1^st week, pain present in just 6(25%) cases, discomfort in 18(75%), and discharge in 21((87.5%) cases, at 4^th week post op, only 2 (8.3%) cases complained of discomfort, with no discharge or pain. Of the 16 patient who underwent evisceration without implant placement, symptoms of discharge, discomfort and pain were present in all 100% on 3^rd post op day. Discharge was seen only in 6(37.5%) cases with discomfort in 10(62.5%) and pain present only in 4(25%) cases each at 1^st week follow up. At 6^th month discharge was present in 20.8% cases in implant groups and 25% in without implant. Other prominent complication was conjunctival dehiscence seen in 4(16.6%) cases at 2^nd week in implant group. Exposure of the implant occurred in 3(12.5%) at 2^nd week follow up.
Conclusion: Socket complication like superior sulcus deformity and anophthalmic-enophthalmos following evisceration were bare minimum in patient with implant placement. Cosmetic result in terms of amplitude and range of movements of artificial eye in cases of evisceration with implant placement is much better in all four gazes as compared to those without implant placement. To achieve near natural cosmetic appearance in terms of “eye movement(prosthetic eye)” spherical implant placement is modality of choice.

Keywords: Acrylic sphere, Evisceration, Prosthetic eye, Superior sulcus deformity

How to cite : Kumar R, Srivastava A, Yadav D, An evaluation of acrylic spherical implant in cases of evisceration. IP Int J Ocul Oncol Oculoplasty 2017;3(1):67-72

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