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Eduardo A. Novais, Bruno F. Fernandes, Luiz Frederico R. Pacheco, Sebastian Di Cesare, Cristina Miyamoto, Miguel N. Burnier, Jr.; Unexpected Histopathological Findings in a Large Series of Ocular Evisceration. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1020.
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Evisceration and enucleation are two ophthalmic surgeries used to manage blind painful eyes. There are benefits of performing evisceration over enucleation, but this procedure is contraindicated in cases where intraocular masses are suspected. Inadvertent evisceration of an eye harboring an intraocular tumor may contribute to tumor spread. Histopathological examination of evisceration specimens is crucial to determine the final correct diagnosis of those cases. A histopathological study was performed in a large series to determine the frequency of clinically undiagnosed, unexpected findings in evisceration specimens.
During the study period (1994 to 2011), more than 16,000 human ophthalmic specimens were received at the Henry C. Witelson Ocular Pathology Laboratory and Registry. Of these, 205 were evisceration specimens. Histopathological reports were reviewed and compared with the clinical diagnosis that led to the evisceration. An unexpected finding was defined as the incidence of a histopathological feature not consistent with the clinical diagnosis.
The total number of unexpected findings was 10 (4.88%) including 2 (0.97%) unexpected malignant tumors. Other surprising findings included: 5 (2.44%) cases of granulomatous uveitis within the uveal tract; 1 (0.49%) case of epithelial downgrowth; 1 (0.49%) case of ciliary body adenoma; 1 (0.49%) case of iris nevus; 1 (0.49%) case of malignant necrotic melanoma; and 1 (0.49%) case of spindle-cell melanoma. The other evisceration specimens had histopathological findings consistent with the clinical diagnosis.
Histopathological examination of all evisceration specimens should be mandatory as the standard procedure to confirm the clinical diagnosis and the presence of unexpected cases. The low frequency of unexpected findings in this large series supports evisceration of blind painful eyes as a safe, low cost procedure with a favorable cosmetic outcome.
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