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Ocular surgeries BY DR GEORGE DEOGRATIAS
1. OCULAR SURGERIES
Prepared by
George deogratias MD5 student.
Archbishop James university college the
constitute of st.augustine university of Tanzania.
(biziriko1991@gmail.com)
+255656592079
3. EVISCERATION
• Removal of the contents of the globe leaves
the sclera ,fat,EOM, and other adjacent
structures of the eye intact and sometimes
the cornea in place.
6. CONT…
Surgical Technique
• A 360-degree conjunctival peritomy is then made at the
• limbus utilizing Wescott scissors undermine the
conjunctiva and Tenon’s capsule
• A full-thickness incision is then made at the limbus so
that
scissors may be introduced to excise the cornea in a
circumferential manner.
• All intraocular contents, including uveal tract, crystalline
lens,
7. CONT…
• vitreous humor, and retina are then removed by using
an
• evisceration spoon, spatula, suction.
• • These contents are sent for histopathologic
examination.
• • Sclera is swabbed with Absolute Alcohol to denature
adherent
• uveal remnants and irrigated properly to remove
alcohol
• • Hemostasis of the nerve and vortex veins may then
• be achieved with cautery and direct pressure.
8. CONT…
• In some cases, a posterior sclerotomy or radial
scleral relaxing incisions to allow for a larger
implant to be placed.
• The best implant size to restore orbital volume
is selected while ensuring appropriate position.
• Implant material is made of different materials
like
9. CONT…
• acrylic, PMMA, silicone, and hydroxyapatite.
• • The implant may be placed directly into the
scleral shell
• • The anterior sclera, Tenon’s capsule, and
conjunctiva is then
• carefully closed in a layered approach before
placement of a conformer.
10. CONT…
• Sclera is sutured with interrupted 6-0 Vicryl
• Conjunctiva with running mattress 6-0 Vicryl
• A temporary tarsorrhaphy may be performed
to help the
• conformer remain in place to maintain the
fornices till
• prosthesis can be placed
11. CONT…
• ADVADVANTAGES OF EVISCERATION OVER
ENUCLEATION
• 1. Shorter operative time
• 2. More cost efficient
• 3. A technically simpler procedure
• 4. A less invasive procedure (important in
cases when GA is
• contraindicated or in bleeding disorders)
12. CONT…
5. Less disruption of orbital tissues
– chance of injury to EOM ,nerves and fat atrophy is
reduced
– Relationships between the muscles, globe, eyelids,
and
fornices remain undisturbed
– Less chance of spread of infection to nervous system
6. Less painful
7. Better cosmetic
8. Good motility of the prosthesis- EOM remain
attached to
the sclera
13. CONT…
9.Lower rate of migration, extrusion, reoperation and socket
complications
10.Preferred by some surgeons in cases of endophthalmitis as
drainage of the ocular contents can be done without invasion
of the orbit.
• The chance of contamination of the orbit with orbital
cellulitis or intracranial extension is therefore theoretically
reduced.NTAGES
15. CONT…
Disadvantages of Evisceration over
Enucleation
• Risk of sympathetic ophthalmia
• Risk of dissemination of intraocular tumors
• Offers a less complete specimen for pathologic
examinations.
16. ENUCLEATION
• A surgical procedure that involves removal of
the entire globe and its contents.
• all other periorbital and orbital structures
including parts of EOM and orbital fat
preserved.
17. CONT…
Indications
• Eye donation
• Intraocular malignancy or high suspicion for
intraocular
malignancy (most commonly uveal melanoma and
retinoblastoma)
• Trauma
• Blind, painful eye
19. CONT…
Advantages
• Enucleation allows for histologic examination of an intact
globe and optic nerve.
• This is important in biopsy of proven or suspected
intraocular malignancy, where it is essential to determine
the margins of the malignancy and invasion of the optic
nerve, if any.
• Enucleation classically has been thought to decrease the
risk of sympathetic ophthalmia as it avoids exposure to
uveal antigens that may occur during an evisceration.
21. EXENTRATION
• A surgical procedure involving removal of the entire
globe and its surrounding structures including muscles,
fat, nerves, and eyelids (extent determined by disease
being treated)
• The goal is to remove all lesions along with appropriate
margins of adjacent tissue while retaining as much
healthy tissue as possible.
• The technique selected depends on the pathologic
process.
22. Varieties of orbital exenteration
Subtotal :
• The eye and adjacent intraorbital tissues are removed such
• that the lesion is locally excised (leaving the periorbita and
• part or all of the eyelids).
• This technique is used for some locally invasive tumors, for
• debulking of disseminated tumors, or for partial treatment in
selected patients.
Total:
• All intraorbital soft tissues, including periorbita, are removed, with
or without the skin of the eyelids.
Extended:
• All intraorbital soft tissues are removed, together with
• adjacent structures(usually bony walls and sinuses).
23. Indications
• Orbital malignancies
Cutaneous tumours with orbital adnexa invasion
including squamous cell carcinoma, basal cell carcinoma,
and sebaceous cell carcinoma.Less common tumors include
conjunctival malignant melanoma, adenoid cystic carcinoma of the
lacrimal gland,
and uveal melanoma with extrascleral extension,Intraocular
melanomas or retinoblastomas
• Painful or life-threatening orbital infections
• Mucormycosis
• Chronic orbital pain
• Orbital deformities
24. COMPLICATIONS
Intraoperative
• Removal of the wrong eye
• Damage to or loss of
extra ocular muscles
• Hemorrhage
• Fracture of thin ethmoid bones during the
surgery, leading to an opening between the
orbit and the nasal cavity.
25. Postoperative
• Infection
• Hemorrhage
• Wound dehiscence
• Extrusion of the conformer
• Contraction of the fornices
• Exposure of the implant.
• Sloughing of the skin graft.
• Sino orbital fistula
