ENUCLEATION – The Last Resort For An Eye Case Reasons for enucleation: Enucleation is a procedure that is reluctantly performed in both general prac
ENUCLEATION – The Last Resort For An Eye Case
Reasons for enucleation:
Enucleation is a procedure that is reluctantly performed in both general practice and specialist eye clinics. There are many reasons why enucleation is indicated. These include, buphthalmic, glaucomatous eyes, intraocular neoplasia, severely traumatised globes, uncontrollable enophthalmitis or panophthalmitis, and blind, inflamed eyes in cats. In some eye diseases that will require long term treatment or substantial medical or surgical cost which the owner cannot afford such as chronic keratoconjunctivitis sicca, keratomalacia, corneal perforation with iris prolapse, deep corneal ulceration, desmetocoele, or severe corneal sequestration.
Premedications:
Prior to surgery, all efforts should be made to confirm the need to remove the eye. Ocular cosmesis with an intrascleral prosthesis can be performed in many cases instead of enucleation.
Now that it is confirmed that the eye is to be removed, surgery can be scheduled. Premedication with an injection of a broad spectrum, bacteriocidal antibiotic will mean that there is effective antibiotic prophylaxis at the time of surgery. An injectable NSAID prior to surgery is also indicated to reduce post swelling and discomfort. Infiltration of the retrobulbar tissue with an injectable local anaesthetic appears to add to a painful free post-operative recovery.
Part 1 Surgical Technique:
There are 2 main techniques of enucleation
▪ In the transconjunctival approach the globe is removed by dissection through the conjunctival fornices. This is our preferred technique for eye removal. ▪ The transpalpebral approach may be indicated when there is either infection or neoplasia of the cornea or conjunctiva. This technique involves suturing the eyelids together, and making an incision through the skin to remove the globe, so that the conjunctival sac and the cornea remains closed and not exposed to the orbital socket.
Both surgical procedures carry few complications if proper surgical techniques are adhered. These as with surgery elsewhere in the body would include, gentle tissue handling, aseptic technique, careful haemostasis, approximation of tissues, removal of necrotic tissues. In the eye socket it is important to remove conjunctival surfaces to that the wound can heal avoiding seroma formation.
Next month: Part 2 Complications that can arise from enucleation.
