Abstract
Purpose :
The “Swinging Sclera” technique is a modified approach to evisceration characterized by full-thickness horizontal sclerotomy. The study evaluates long-term outcomes and post-operative motility and stability associated with this modification.
Methods :
A retrospective evaluation was conducted on thirty consecutive patients (16M, 14F; mean age 56.9, range 4.6 to 90.1 years) who underwent ocular evisceration (14R, 16L) performed by a single surgeon (TJM). Postoperative extraocular motility was evaluated in five patients with SiliconCoach Digitizer software. The conjunctiva overlying the implant was marked, and images were captured in various gazes for comparison of the operative and non-operative eye. More extensive demographics and outcomes were assessed in all thirty patients. Standard evisceration procedure was performed and followed by a complete horizontal sclerotomy, extending from the horizontal meridian to 2 mm above the optic nerve. The bisection longitudinally divided insertions of the medial and lateral lecture muscles. Using Steven’s scissors, the posterior Tenon’s capsule was bluntly disrupted, which mobilized the scleral halves to “swing” forward over the implant in the intraconal space. The silicone sphere implant was selected based on approximated prominence of the fellow eye. Anterior sclera, Tenon’s capsule, and conjunctiva were then closed separately.
Results :
Follow-up ranged from 1 week to 3.3 years. Implant sizes were 18mm (n=13), 20mm (n=14), and 22mm (n=2). The mean implant size of the 11 patients who were identified as phthisical prior to surgery was 19.11 mm, compared to 19.26 mm of the non-phthisical group. During this period, there were no reported complications, including infection, implant exposure, extrusion, and migration. Extracted from the five videos, mean operated to non-operated eye horizontal motility ratio was 0.61±0.18, and the vertical motility ratio was 0.76±0.28. The difference between horizontal and vertical motility was not statistically significant (p=0.38).
Conclusions :
The “Swinging Sclera” modified sclerotomy is an efficient technique with no reported complications, even in patients with phthisis bulbi. It maximizes orbital implant size without compromising vertical and horizontal motility or implant stability despite bisection of horizontal rectus muscle insertions.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.