UK National Survey of Enucleation, Evisceration and Orbital Implant Trends

Abstract

Aims: To evaluate current clinical practice in the United Kingdom in the management of the anophthalmic socket; choice of enucleation, evisceration, type of orbital implant, wrap, motility pegging and complications.

Methods: All Consultant Ophthalmologists in the UK were surveyed by postal questionnaire. Questions included their practice sub-specialty and number of enucleations and eviscerations performed in 2003. Specific questions addressed choice of implant, wrap, motility pegging and complications.

Results: 456 / 896 (51%) Consultants responded, of which 162(35%) had a specific interest in oculoplastics, lacrimal, orbits or oncology. Only 243/456 (53%) did enucleations or eviscerations. 92% inserted an orbital implant after primary enucleation, 69% after non-endophthalmitis evisceration, whereas only 43% did so after evisceration for endophthalmitis (50% as a delayed procedure). 55% used porous orbital implants (porous polyethylene, hydroxyapatite, or alumina) as their first choice and 42% used acrylic. Most implants inserted were spherical, sized 18 to 20 mm diameter. 57% wrapped the implant after enucleation, using salvaged autogenous sclera(20%), donor sclera(28%) and synthetic Vicryl or Mersilene mesh(42%). A minority (7%) placed motility pegs in selected cases, usually as a secondary procedure. 14 % of respondents reported implant exposure for each type of procedure and extrusion was reported by 4 % after enucleation and 3 % after evisceration.

Conclusions: This survey highlights contemporary anophthalmic socket practice in the UK. Most surgeons use porous orbital implants with a synthetic wrap following enucleation and only few perform motility pegging.