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Multicentred international review of orbital exenteration and reconstruction in oculoplastic and orbit practice
  1. Ze Zhang1,
  2. Son Ho2,
  3. Vivian Yin3,
  4. Gonzalo Varas3,
  5. Saul Rajak4,
  6. Peter J Dolman3,
  7. Alan McNab5,
  8. J Godfrey Heathcote6,
  9. Alejandra Valenzuela1
  1. 1 Department of Ophthalmology, Tulane University School of Medicine, New Orleans, Louisiana, USA
  2. 2 Department of Ophthalmology, Orlando VA Medical Center, Orlando, Florida, USA
  3. 3 Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
  4. 4 Royal Adelaide Hospital, South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
  5. 5 Centre for Eye Research Australia and Department of Ophthalmology, Royal VIctorian Eye and Ear Hospital, Melbourne, Victoria, Australia
  6. 6 Departments of Pathology and Ophthalmology, Dalhousie University, Halifax, Nova Scotia, Canada
  1. Correspondence to Dr Ze Zhang, Department of Ophthalmology, Tulane University School of Medicine, New Orleans, Louisiana 70112-2632, USA; ze.zhang1986{at}


Background Orbital exenteration is a disfiguring procedure reserved for life-threatening malignancies. This study examines the clinical course and outcomes of a large series of patients who underwent orbital exenteration for malignant periocular neoplasms.

Methods This is a retrospective review of patients who underwent orbital exenteration from 1 July 2005 to 30 June 2015 at four tertiary referral centres in the USA, Australia and Canada. Demographics, indication for surgery, pathology, surgical technique, reconstruction type and outcomes were reviewed.

Results Orbital exenteration was performed on 102 patients. The mean age at surgery was 67.5 years. The most common malignant tumours encountered were squamous cell carcinoma, melanoma and basal cell carcinoma. Seventy-six patients (75%) underwent reconstruction with a local myocutaneous flap, twelve with partial-thickness skin grafts (PTSG), or split skin graft, two had a free flap, and one had a dermis fat graft. Sixteen patients had combined procedures of two of the above. Complete removal of the tumour was achieved with clear margins in 81 cases. Of all patients, 72% were alive at 48 months or more.

Conclusion The majority of orbital exenterations performed in this series were secondary to periocular malignancies with unsuccessful/insufficient previous treatments. Regional myocutaneous flaps, PTSG, full-thickness skin grafts and dermis fat grafts were all highly effective and durable reconstructive options, and were able to withstand radiation therapy without complications.

  • orbital exenteration
  • periocular malignancies
  • orbital tumors
  • orbital reconstruction
  • histopathology
  • management

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  • Contributors All authors have contributed substantive work to this manuscript.

  • Competing interests None declared.

  • Ethics approval Tulane University School of Medicine Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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