Enucleation with "on-the-table" evisceration

Purpose: To evaluate the surgical technique of enucleation followed by an ' 'on-the-table evisceration'' and placement of a hydroxyapatite orbital impl ant wrapped by the patient's own sclera for the treatment of blind phthisic painful eyes. Patients and methods: In this single-center retrospective study, 50 consecu tive patients undergoing an operation using the same surgical technique, be tween April 1993 and November 1999, were studied. Patients underwent enucle ation, then the eyeball was eviscerated ''on the table''. The patient's own cleaned sclera was used to wrap a hydroxyapatite orbital implant, the post erior pole of the sclera was placed at the anterior pole of the implant. Co njunctival breakdown, sphere size, conjunctival discharge, the first signs of sympathetic ophthalmia motility, and cosmetic results were analysed. Results. After an average follow-up of 13.3 months few complications were e ncountered: 4 cases (8%) of inclusion cyst and 3 cases (6%) of discharge. T he implant placed had a diameter of 18mm, 20mm, 22mm in, respectively, 48%, 48%, and 4% of the eyes. The prosthesis motility was good, medium, and poor in, respectively, 33 (78 .6%) cases, 8 (19%) cases, and 1 (2.4%) case. The prosthesis tolerance was good, medium, and poor in respectively 86%, 10%, and 4% of the cases. Conclusion: The surgical technique of enucleation followed by an ''on-the-t able'' evisceration and autologous sclera wrapping a hydroxyapatite implant is an easy procedure. It allows, on phthisic eyeballs, the placement of a large orbital implant f or good cosmesis results, without major complications.