ENUCLEATION, EVISCERATION, AND EXENTERATION

This review outlines many of the recent advancements in the understand ing and management of the anophthalmic patient. A population-based stu dy demonstrated that the annual incidence of enucleations for all caus es was about 3 to 5 per 100,000. Application of expandable orbital imp lants appears to be promising in the management of microphthalmia or a nophthalmia in infants to maximize orbital growth. Some reports on the use of hydroxyapatite enucleation implants are encouraging, with no m ajor complications observed in one large series. Yet other reports of hydroxyapatite implant exposures, at a very concerning frequency, are also beginning to emerge. Few of the exposures heal spontaneously; how ever, infections or extrusions are very rare, and they are attributabl e to the porous composition of the implant. Conjunctival flaps alone a re suboptimal in the management of exposures. Adjunctive autologous fa scial grafts seem preferable to heterologous sclera in the management of these exposures. Magnetic resonance imaging of the hydroxyapatite i mplant appears to be superior to bone scan in the noninvasive assessme nt of vascularization of these implants. Further advancements are nece ssary to achieve a more optimal enucleation implant.