Can Evisceration in Endophthalmitis Succeed Without Implants?

TO GO WITH AFP STORY BY DELPHINE THOUVENOT – Surgeons perform a corneal transplant, on April 2, 2012 at the Edouard Herriot hospital in Lyon, southeastern France. AFP PHOTO JEFF PACHOUD (Photo credit should read JEFF PACHOUD/AFP via Getty Images)
Eviscerating without implanting a prosthetic device is an effective alternative for some patients.

This article is part of Ophthalmology Advisor’s conference coverage from the 2021 Fall Scientific Symposium of the American Society of Ophthalmic Plastic and Reconstructive Surgery, held in New Orleans from November 11 to 12, 2021. The team at Ophthalmology Advisor will be reporting on a variety of the research presented by the oculoplastic researchers and other clinicians at the ASOPRS. Check back for more from the ASOPRS 2021 Fall Scientific Symposium.

Eviscerating without implant is an effective alternative method for treatment of patients with acute, overwhelming endophthalmitis, researchers reported in a study they presented at the American Society of Ophthalmic Plastic and Reconstructive Surgery 52nd Annual Fall Scientific Symposium in New Orleans, November 11 to November 12.

The objective of the study was to determine whether the technique of avoiding implants and subsequent infection was appropriate and efficacious.

Sixteen patients (mean age 66.4 years) with acute, overwhelming endophthalmitis and blind eyes underwent evisceration without implant placement in the 5-year case series. The researchers retrospectively evaluated complications and the need for a secondary procedure for fitting prosthesis.

The technique the researchers explored involved the removal of uveal contents with an evisceration spoon and irrigation of the scleral cavity with absolute alcohol to eliminate any remnants of uveal tissue. Scleral relaxing incisions were performed on opposite sides of the eye and xeroform gauze was packed into the scleral cavity. Ophthalmologists applied antibiotic ointment, a conformer and a temporary tarsorrhaphy stitch. The stitch and xeroform gauze were released 48 to 72 hours later, allowing the scleral shell to collapse. At a 1-month follow-up visit, if the socket healed, patients were referred to ocularists for prosthetic fitting.

At mean follow-up time of 1.39 years, 1 patient had experienced pyogenic granuloma, which was treated with topical timolol drops. Two patients required additional procedures before successful prosthetic fitting. One underwent conjunctivoplasty to re-induce scleral collapse, and the other failed to follow up, leading to xeroform gauze removal in a second surgery.

Through the technique, ophthalmologists and patients can avoid implant infection or extrusion and limit the risk of secondary procedure under anesthesia. Secondary procedures that did occur were performed in offices, via conjunctivoplasty, or were avoided entirely, with patient compliance.

“In the blind eye with recalcitrant endophthalmitis, evisceration with the described no-implant technique is a reasonable alternative to evisceration with primary implant placement,” the investigators said.

The researchers excluded 2 patients who were lost to follow up after they were referred to ocularists.

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Dryden S, Simpson E, Ford J, et al. Evisceration without implant placement in patients with endophthalmitis: an alternative technique. Poster presented at: American Society of Ophthalmic Plastic and Reconstructive Surgery 52nd Annual Fall Scientific Symposium; November 11-12, 2021; New Orleans.