Ocular enucleation
Ocular enucleation is a surgical intervention which is carried out in very specific cases in which, for serious reasons, it is necessary remove the entire eyeball so that the patient can regain a normal life.
Ocular enucleation
Ocular enucleation is a surgical intervention which is carried out in very specific cases in which, for serious reasons, it is necessary remove the entire eyeball so that the patient can regain a normal life.
What is enucleation?
La enucleation is a surgery through which the entire eyeball is removed and also to replace it with an ocular prosthesis later. The muscles that surround the eye are disinserted to suture them to an implant that is placed during the operation.
Differences between enucleation and ocular evisceration
The difference between enucleation and gutting is that while in enucleation the entire eye is extracted, in evisceration, the iris, cornea, and retina are removed, but the sclera remains (which is the most superficial layer of the eye), and the eye muscles remain intact.
In which cases is enucleation performed?
There are very few cases in which ocular enucleation is recommended. This intervention is indicated above all when there is a intraocular tumor malignant that it cannot be removed through other treatments, and the goal, leaving aesthetic issues aside, is for the patient to survive.
Of the malignant tumors that usually require enucleation, the choroidal melanoma is the most common in adults, and the retinoblastoma In the kids.
Enucleation may also be necessary when, due to a severe eye trauma, they have severely disrupted ocular membranes and content, and it cannot be repaired through gutting.
It can be very difficult for the patient to decide to have the eye enucleated. However, it must be taken into account that this surgery it will significantly improve your quality of life, since as we have seen, it is only carried out in cases that are especially serious.
How does is an enucleation of the eye performed?
Below we explain all the process that is followed before, during and after ocular enucleation:
Previous Exams
A complete ophthalmic exam, and the eyelid and periocular areas are analyzed. A fundus examination is also done, and a series of photographs is taken to compare the patient's condition before and after the intervention.
Surgical process
The operation, which usually takes about an hour, is done in the operating room and on an outpatient basis normally (that is, the patient can go home the same day of the operation), under general anesthesia or local anesthesia with deep sedation.
During operation we extract the eyeball and replace it with an implant which is the same size (glass eye), to maintain the volume of the ophthalmic cavity. This prosthesis is previously made with the exact characteristics of each patient.
The extraocular muscles are sutured to this implant, and a temporary plastic prosthesis (conformer) is placed on it. Sometimes the eyelids are also sutured to facilitate healing and support the former.
Last a bandage is applied over the eye, securing it with tape. This protects the wound, prevents bleeding, and reduces pain, inflammation, and bruising.
Postoperative
Once the intervention is carried out, it is necessary consider following:
- The patient must be brought home by someone else, since having been anesthetized it is dangerous for him to drive.
- They may be taken pain relievers, and in some cases antibiotics or steroids are prescribed.
- You should not swim, exercise, perform any activity that requires effort or any physical activity restricted by the ophthalmologist for a period of two to four weeks. TampYou can hardly bend over or lift heavy objects for at least one month.
- Once the patient is well for it, be able to drive and perform other normal activities, although before doing so, you must agree with your surgeon.
- Act quickly. keeping the bandage over the eye dry. Even if you feel itching or some discomfort, you should keep the time indicated by the surgeon. As usual can be withdrawn daily following eye operation.
- About a week after the surgery, the follow-up exam. If it has not been removed before, the surgeon will remove the bandage to check how the eye is healing.
- When the surgeon is sure that the eye has completely healed, the ophthalmologist can implant the ocular prosthesis. This is usually done six or eight weeks after the intervention.
Maintaining it properly, the prosthesis can last for decades. The ophthalmologist will follow up once or twice a year, to check the status of the orbit and clean and polish the prosthesis.
The patient himself can remove the prosthesis to clean it between appointments, if he feels ready for it and does not feel discomfort when doing it.
Possible risks of ocular exenteration
Between the possible problems that can result from ocular enucleation are mainly the following:
- Infection.
- Cicatrization.
- Fallen eyelid o trouble closing the eye.
- Implant failure (extrusion).
Ocular enucleation, like any other surgery, is not exempt from other risks derived from it, such as anesthesia, which, although possible, are very rare.