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DL Barker, RW Read; Changing Patterns of Evisceration and Enucleation: A 10 Year Retrospective . Invest. Ophthalmol. Vis. Sci. 2002;43(13):345.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To compare evisceration versus enucleation over the past 10 years, determining trends in use, most common indications, and ability to obtain a pathological diagnosis for each procedure. Methods: A retrospective review of all cases accessioned by the Ophthalmic Pathology Laboratory at the Callahan Eye Foundation Hospital at UAB for the years 1990 to 1999, inclusive, was performed. Cases consisting of enucleation or evisceration were selected and the pathology report reviewed. Data extracted included procedure performed, preoperative clinical diagnosis, final pathological diagnosis, and the year the surgery was performed. Use of each procedure was compared on a year-to-year basis, by diagnosis, and by ability to report a specific pathological diagnosis. Results: For the years 1990 to 1999, 980 enucleations and eviscerations were accessioned. The most common clinical indications were blind/painful eye and ruptured globe. A statistically significant increase in the percent of eviscerations performed occurred over the period of study (p=0.043). Evisceration was performed significantly more commonly for eyes with a diagnosis of blind/painful eye and/or phthisis bulbi (p=0.03). No difference was found between use of evisceration compared to enucleation for cases with a diagnosis of endophthalmitis (p=0.43). Evisceration was utilized increasingly over the period of study for eyes with a diagnosis of ruptured globe (p=0.01). All eyes with tumor were enucleated. Eviscerated eyes were significantly less likely to have a specific pathologic diagnosis assigned than were enucleated eyes (p<0.001). Conclusion: This study showed a significant increase in the utilization of evisceration over enucleation at one large eye center over a one decade period, especially for the specific indications of blind/painful eye or ruptured globe. Assignment of a specific histopathological diagnosis was significantly less likely to occur with evisceration compared to enucleation, due to the disruption of intact anatomical relationships. If this trend continues, this will likely have significant impact on material available for the teaching of ophthalmic pathology, requiring increasing dependence on archival slides to provide correlative pathology. While no globe with an intraocular tumor was eviscerated in this series, this risk, as well as the potentially increased risk of sympathetic ophthalmia, must be balanced with the reported improved cosmesis, decreased orbital trauma, and decreased risk of extension of infection into the CSF.
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