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Laura Phan, Michael K. Yoon, Thomas Hwang, Timothy McCulley; The "Swinging Sclera" Modification Of Evisceration: Assessment Of Motility And Long Term Follow-up. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1029.
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To assess a modification to standard evisceration, "the swinging sclera technique," specifically evaluating the long-term outcome and effect of a full thickness horizontal sclerotomy on post-operative motility.
Twenty-one consecutive patients (14M, 7F; mean age 46 (range 18 to 95 years)) who underwent ocular evisceration (11 right, 10 left) were retrospectively evaluated. For the first 5 patients, videos of postoperative extraocular motility were available and assessed using SiliconCoach Digitizer software. Still photographs in extreme up, down, right and left gaze were available for eight patients. Measurements were taken from the photos with a central mark placed on the conjunctiva as reference point. Movements between the operated and non-operated eyes in horizontal and vertical excursion were compared. The surgical procedure was performed as follows. The initial steps of the evisceration were performed in the standard fashion. Prior to implant placement, a complete horizontal sclerotomy was extending from the horizontal meridian to 2 mm above the optic nerve, yielding superior and inferior halves. Steven’s scissors were used to bluntly disrupt posterior Tenon’s, mobilizing the sclera and allowing for deep placement of larger implants within the intraconal space. The implant which best approximated the prominence of the fellow eye was chosen. In all cases a silicone sphere was used. Anterior sclera, Tenon’s capsule and conjunctiva were then closed in a standard layered fashion.
Follow-up ranged from 8 to 60 months. Implant size ranged from 16 to 22 mm (mean 19.4 mm). No significant complications were encountered during this period. Base on the five videos, the mean operated to non-operated eye horizontal motility ratio was 0.61+/- 0.18, and the mean operated to non-operated vertical motility ratio was 0.76 +/- 0.28. From the still photos, the mean operated to non-operated eye horizontal motility ratio was 0.66+/- 0.15, and the mean operated to non-operated vertical motility ratio was 0.67 +/- 0.16. There was no statistical difference in horizontal and vertical motility from the video or still photo assessment.
Evisceration with a complete horizontal full-thickness sclerotomy is an effective technique that allows for larger orbital implant. Despite splitting the insertion of the horizontal recti muscles, horizontal motility was not adversely affected.
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