RESUMO
Painful-blind eye (PBE) is a challenging and debilitating condition that greatly affects the quality of life of patients. Although PBE can result from a variety of etiologies, currently there is no guideline or consensus on how to approach therapeutically these patients, and most treatments are experience-based. We summarized the evidence from available studies to investigate the current state of PBE treatment strategies. This review revealed that the information available about therapeutic approaches in patients with PBE is insufficient and outdated, therefore, new experimental and larger studies are needed to reach an agreement about this condition.
Assuntos
Evisceração do Olho , Cuidados Paliativos , Humanos , Enucleação Ocular/efeitos adversos , Qualidade de Vida , Dor Ocular/diagnóstico , Dor Ocular/etiologia , Dor Ocular/terapiaRESUMO
PURPOSE: The study aimed to evaluate the clinical and tissue response to a hollow polymethylmethacrylate orbital implant with a multiperforated posterior surface in an animal model after evisceration. METHODS: Sixteen New Zealand rabbits had their right eye eviscerated. All animals received a hollow polymethylmethacrylate implant 12 mm in diameter that is multiperforated in its posterior hemisphere. The animals were divided into four groups, and each one had the eye exenterated at 7, 30, 90, and 180 days post-evisceration. Clinical signs were assessed daily for 14 days post-evisceration and then every 7 days until 180 days. Inflammatory pattern, collagen structure, and degree of neovascularization generated with implant placement were analyzed with hematoxylin-eosin, picrosirius red, and immunohistochemistry staining. RESULTS: There were no signs of infection, conjunctival or scleral thinning, or implant exposure or extrusion in any animal during the study. On day 7, the new tissue migrated into the implant and formed a fibrovascular network through the posterior channels. Inflammatory response reduced over time, and no multinuclea-ted giant cells were found at any time. CONCLUSION: Hollow polymethylmethacrylate orbital implants with a multiperforated posterior surface enable rapid integration with orbital tissues by fibrovascular ingrowth. We believe that this orbital implant model can be used in research on humans.
Assuntos
Implantes Orbitários , Polimetil Metacrilato , Humanos , Coelhos , Animais , Materiais Biocompatíveis , Evisceração do Olho , Implantação de PróteseRESUMO
OBJECTIVE: To provide a descriptive analysis of the indications and the intraoperative and postoperative complications of eye enucleations and eviscerations, and orbital exenterations performed at the only academic institution in Puerto Rico providing supratertiary care. METHODS: A retrospective medical record review of patients who underwent enucleations, eviscerations, and exenterations from January 2015 through June 2020 was conducted. The data were analyzed to generate a descriptive profile of the demographic characteristics of the patients, their clinical indications and surgical complications, and a histopathological diagnosis per type of eye-removal procedure. RESULTS: A total of 118 eyes were removed via enucleation, evisceration, or exenteration over the 66-month study period. The average patient age was 64 (±17.5) years and 63.8% of the patients were male. The most frequently performed eye-removal procedure was enucleation (73.7%), followed by evisceration (18.6%) and exenteration (7.6%). The main clinical indications for enucleations and eviscerations were infectious processes, namely panophthalmitis, endophthalmitis, and/or perforated corneal ulcers, that failed medical management. In our sample, squamous cell carcinoma was the most common diagnosis (both clinically and histopathologically) leading to exenteration. Postoperative complications in our patient cohort were minimal. CONCLUSION: At our institution, enucleations predominate over eviscerations. Retrospective reviews published in recent years indicate that the rate of eviscerations at our institution is comparatively low. The results of this study, the first of its kind at our institution, may encourage a re-evaluation of the indications for evisceration versus enucleation in our patient population.
Assuntos
Oftalmopatias , Evisceração do Olho , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Porto Rico , Estudos RetrospectivosRESUMO
PURPOSE: To analyze the epidemiological profiles of evisceration and enucleation cases in the ophthalmologic emergency department of a Brazilian tertiary hospital. METHODS: Patients treated in the ophthalmologic emergency department of Hospital São Paulo (Universidade Federal de São Paulo) during the period 2013 to 2018 were retrospectively evaluated. Urgent cases of evisceration or enucleation surgery were included, and elective cases were excluded. The following information was extracted from the patients' medical records: demographic data, immediate and associated reasons for the surgical procedure, informed visual acuity, symptom duration until ophthalmologic care, complications, distance from the residence to the tertiary hospital, and time of hospitalization. RESULTS: In total, 61 enucleations and 121 eviscerations were included in this study. The patients had a mean age of 63.27 ± 18.68 years. Of the patients, 99 were male (54.40%), and 83 were female (45.60%). The indications for evisceration or enucleation were corneal perforation with (44.50%) and without (23.63%) signs of infection, endophthalmitis (15.38%), ocular trauma (14.29%), neoplasia (0.55%), burn accident (1.10%), and phthisis bulbi (0.55%). The self-reported visual acuity was no light perception (87.36%) or light perception (1.10%). However, 3.30% of the patients did not cooperate with the examination, and no information on visual acuity was available for the remaining 8.24%. The mean symptom duration before ophthalmologic care was sought was 18.32 days. Two patients had sympathetic ophthalmia after evisceration. CONCLUSIONS: More eviscerations than enucleations were performed throughout the study period. The most common demographic characteristics were age >60 years and male sex. The main indications for urgent evisceration and enucleation procedures were corneal perforation with and without infection, endophthalmitis, and ocular trauma. The findings from this study could guide clinicians in performing preventive measures to avoid destructive eye procedures.
Assuntos
Perfuração da Córnea , Endoftalmite , Traumatismos Oculares , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Evisceração do Olho , Centros de Atenção Terciária , Estudos Retrospectivos , Perfuração da Córnea/cirurgia , Brasil/epidemiologia , Enucleação Ocular , Traumatismos Oculares/epidemiologia , Traumatismos Oculares/cirurgia , Traumatismos Oculares/etiologia , Endoftalmite/epidemiologia , Endoftalmite/cirurgia , Endoftalmite/etiologia , Serviço Hospitalar de EmergênciaRESUMO
Background: There is no hope of preserving vision at the terminal stage of glaucoma, and surgical treatment is indicated in thesecases. Among the various surgical techniques used, eye evisceration with implantation of an intrascleral prosthesis provide thebest cosmetic results. Even though eye evisceration with prosthesis implantation represents an excellent treatment option forterminal glaucoma, reports on the use of this technique in dogs are scarce in the current literature. The aim of this work is to reporta case of a dog with end-stage glaucoma subjected to eye evisceration surgery and implantation of an intrascleral prosthesis.Case: A 7-year-old bitch mixed breed with a history of glaucoma secondary to uveitis with no response to medical therapy wasreferred to the Ophthalmology service of the University Veterinary Hospital of Coimbra (HVUC), Portugal At the ophthalmicexamination, the glaucomatous left eye was buphthalmic, with congested episcleral blood vessels, mydriasis, and posterior luxation of the lens; there was no response to threat or obfuscation, no direct and consensual pupillary reflex, nor pupillary reflexesto chromatic light. The intraocular pressure (IOP) was 55 mmHg, and the Schirmers tear test (STT-1) result was 19 mm/min.Ophthalmoscopy revealed attenuated retinal blood vessels and a pale optic papilla with mild excavation. The right eye wasfunctional, with all parameters assessed on examination and by tests within the normal ranges for the species. An ultrasoundexamination of the left eye confirmed the presence of posterior luxation of the lens and buphthalmia in the absence of intraocularneoplasm. In view of the patients history and results of the clinical examinations, a surgical approach was indicated to treat theglaucomatous eye. The patients tutor requested a surgical procedure that...
Assuntos
Animais , Cães , Evisceração do Olho/métodos , Evisceração do Olho/veterinária , Olho Artificial/veterinária , Silicones , Glaucoma/veterináriaRESUMO
Background: There is no hope of preserving vision at the terminal stage of glaucoma, and surgical treatment is indicated in thesecases. Among the various surgical techniques used, eye evisceration with implantation of an intrascleral prosthesis provide thebest cosmetic results. Even though eye evisceration with prosthesis implantation represents an excellent treatment option forterminal glaucoma, reports on the use of this technique in dogs are scarce in the current literature. The aim of this work is to reporta case of a dog with end-stage glaucoma subjected to eye evisceration surgery and implantation of an intrascleral prosthesis.Case: A 7-year-old bitch mixed breed with a history of glaucoma secondary to uveitis with no response to medical therapy wasreferred to the Ophthalmology service of the University Veterinary Hospital of Coimbra (HVUC), Portugal At the ophthalmicexamination, the glaucomatous left eye was buphthalmic, with congested episcleral blood vessels, mydriasis, and posterior luxation of the lens; there was no response to threat or obfuscation, no direct and consensual pupillary reflex, nor pupillary reflexesto chromatic light. The intraocular pressure (IOP) was 55 mmHg, and the Schirmers tear test (STT-1) result was 19 mm/min.Ophthalmoscopy revealed attenuated retinal blood vessels and a pale optic papilla with mild excavation. The right eye wasfunctional, with all parameters assessed on examination and by tests within the normal ranges for the species. An ultrasoundexamination of the left eye confirmed the presence of posterior luxation of the lens and buphthalmia in the absence of intraocularneoplasm. In view of the patients history and results of the clinical examinations, a surgical approach was indicated to treat theglaucomatous eye. The patients tutor requested a surgical procedure that...(AU)
Assuntos
Animais , Cães , Olho Artificial/veterinária , Evisceração do Olho/métodos , Evisceração do Olho/veterinária , Silicones , Glaucoma/veterináriaRESUMO
Background: An adult owl was presented with an injury to the right eye that rendered it blind in that eye. The left eye was normal. Removal of the right eye was recommended and a modified eye evisceration was performed. No complications were observed during or after surgery. The objective of this paper is to describe the modified eye evisceration technique that was successfully used in a tropical screech owl (Megascops choliba). Case: An adult owl was presented with an injury to the right eye that rendered it blind in that eye. Two previous surgical treatments have been carried out but have not been successful. Using a portable slit-lamp (Kowa SL-15®), both eyes were examined. The left eye was normal. Upon ophthalmic examination of the right eye, the owl demonstrated blepharospasm and large central corneal ulcer. Removal of the right eye was recommended. The bird received midazolam hydrochloride [Dormire® - 1 mg/kg, IM] and ketamine hydrochloride [Ketamina® - 5 mg/kg IM] as pre-anesthetic medications. Subsequently, the bird was anesthetized with isoflurane (Isoforine®) by facemask for induction, and then maintained with isoflurane vaporized in 100% oxygen through an endotracheal tube. With the aid of a surgical microscope and microsurgery materials, a modified eye evisceration was performed. Post-operatively, the owl received meloxicam [Maxicam® - 0.5 mg/kg, IM] and tramadol hydrochloride [Cronidor® - 15 mg/kg, orally for 4 days]. The day after surgery, the owl was comfortable and its usual appetite was regained. The patient remained hospitalized for 3 weeks and was evaluated daily. The skin sutures were removed 10 days after the surgical procedure and the surgical wound had healed normally. The patient was reintroduced into the wild after 2 months. During the 6 months post-release, the bird was evaluated once a month, and no complications were observed. Discussion: Severe eye trauma and complicated corneal ulcers are common causes of eyeball removal in birds. In birds, there is a high risk of complications during enucleation. The fragility of the orbital bones makes them susceptible to trauma during the surgery. Evisceration involves the removal of the inner contents of the eye while leaving the cornea and the sclera intact. In the current case, evisceration was chosen because the eye was blind, and maintaining a blind eye would be a source of pain and infection. In the modified evisceration technique, the risk of complications is minimal compared to enucleation, mainly because surgical manipulation is minimal. In our case, the total surgery time was 20 min. Another complication reported after enucleation in birds is the possibility of disfiguring the bird because the removal of the globe disturbs the natural head balance. To avoid these complications, the use of an intraocular prosthesis after evisceration in birds has been performed. However, owls have a tubular-shaped globe with scleral ossicles. These factors could hinder or even prevent the accommodation of a cylindrical silicone prosthesis. In the present case, an intraocular prosthesis implant was never considered due to the unavailability of the prosthesis and to avoid the risk of postoperative complications that have been reported from the literature in dogs. In this case, the owl recovered well from anesthesia without complications, and no postoperative hemorrhage was observed. No signs of pain were observed during the postoperative period and the owl had already shown an appetite and fed on the first postoperative day. The previously published reports using the modified evisceration technique also demonstrated an absence of pain signs during the postoperative period.(AU)
Assuntos
Animais , Evisceração do Olho/métodos , Evisceração do Olho/veterinária , Estrigiformes/cirurgia , Traumatismos Oculares/cirurgia , Traumatismos Oculares/veterináriaRESUMO
El trauma ocular constituye la causa de pérdida ocular más frecuente a nivel mundial y puede presentarse en cualquier etapa de vida, con mayor incidencia en la niñez. El manejo puede ser quirúrgico, quirúrgico-protésico o protésico. A continuación, se presenta un caso clínico que describe la rehabilitación protésica individualizada posterior a una evisceración en una lesión ocular unilateral traumática de hace aproximadamente 56 años, que presenta ptosis del párpado superior, colapso y atrofia muscular debido a la falta de función. Se describe la técnica de confección de los conformadores oculares para corregir la ptosis del párpado superior y lograr la expansión gradual de la cavidad, así como la confección de la prótesis ocular individualizada, con el objetivo de alcanzar los requerimientos funcionales y estéticos esperados. (AU)
Ocular trauma is the most frequent cause of eye loss worldwide. It can occur at any stage of life, with a higher incidence in childhood. Management can be surgical, surgical - prosthetic or prosthetic. We describe individualized prosthetic rehabilitation in a clinical case of upper eyelid ptosis, collapse and muscle atrophy due to lack of function following evisceration in a traumatic unilateral ocular injury approximately 56 years previously. We describe the technique for making ocular shapers to correct ptosis of the upper eyelid and achieve gradual expansion of the cavity, as well as the preparation of an ocular prosthesis to fulfill the expected functional and esthetic requirements. (AU)
Assuntos
Humanos , Feminino , Idoso , Evisceração do Olho , Evisceração do Olho/reabilitação , Olho ArtificialRESUMO
ABSTRACT We present a patient who underwent evisceration surgery after spontaneous rupture of the ocular globe due to long-data uncontrolled glaucoma, with posterior placement of an orbital implant made of a bone cement compound based on polymethylmethacrylate as alternative materials were not available. Such a compound is characterized by excellent biocompatibility and low cost, which makes it an interesting alternative for treatment. The anophthalmic socket was successfully filled, providing proper esthetic results and favorable conditions for the posterior scleral prosthesis implantation. No complications were observed during 10 months of follow-up. We believe that, in the absence of alternative materials, low-cost materials may be used in emergency settings to repair anophthalmic cavities and provide satisfactory functional and esthetic outcomes.
RESUMO Apresentamos um paciente que foi submetido à cirurgia de evisceração após ruptura espontânea do globo ocular devido a glaucoma não controlado de longa data, com posterior colocação de implante orbital feito de cimento ósseo, composto à base de polimetilmetacrilato, diante da indisponibilidade de materiais alternativos. Tal composto se caracteriza pela excelente biocompatibilidade e baixo custo, o que o torna uma alternativa interessante para o tratamento. A cavidade anoftálmica foi preenchida com sucesso, fornecendo resultados estéticos adequados e condições favoráveis para o implante posterior de prótese escleral. Nenhuma complicação foi observada durante os 10 meses de seguimento. Acreditamos que, na ausência de materiais alternativos, materiais de baixo custo podem ser usados em situações emergenciais para preencher cavidades anoftálmicas e prover resultados funcionais e estéticos satisfatórios.
Assuntos
Humanos , Masculino , Idoso , Órbita/cirurgia , Cimentos Ósseos , Implantes Orbitários , Ruptura Espontânea/cirurgia , Ruptura Espontânea/etiologia , Materiais Biocompatíveis , Glaucoma/complicações , Evisceração do Olho , Procedimentos de Cirurgia PlásticaRESUMO
We present a patient who underwent evisceration surgery after spontaneous rupture of the ocular globe due to long-data uncontrolled glaucoma, with posterior placement of an orbital implant made of a bone cement compound based on polymethylmethacrylate as alternative materials were not available. Such a compound is characterized by excellent biocompatibility and low cost, which makes it an interesting alternative for treatment. The anophthalmic socket was successfully filled, providing proper esthetic results and favorable conditions for the posterior scleral prosthesis implantation. No complications were observed during 10 months of follow-up. We believe that, in the absence of alternative materials, low-cost materials may be used in emergency settings to repair anophthalmic cavities and provide satisfactory functional and esthetic outcomes.