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LETTER TO EDITOR
Year : 2005  |  Volume : 53  |  Issue : 1  |  Page : 79-80
 

Myoconjunctival Enucleation for Enhanced Implant Motility. Result of a Randomised Prospective Study


L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad - 500 034, India

Correspondence Address:
Milind N Naik
L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad - 500 034
India
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DOI: 10.4103/0301-4738.15296

PMID: 15829758

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How to cite this article:
Anand R, Pathak H, Wagh VP, Naik MN. Myoconjunctival Enucleation for Enhanced Implant Motility. Result of a Randomised Prospective Study. Indian J Ophthalmol 2005;53:79-80

How to cite this URL:
Anand R, Pathak H, Wagh VP, Naik MN. Myoconjunctival Enucleation for Enhanced Implant Motility. Result of a Randomised Prospective Study. Indian J Ophthalmol [serial online] 2005 [cited 2014 Oct 2];53:79-80. Available from: http://www.ijo.in/text.asp?2005/53/1/79/15296


Dear Editor,

We read with interest the article titled "Myoconjunctival enucleation for enhanced implant motility. Result of randomised prospective study" published by Yadava et al.[1] The authors have compared the conventional enucleation technique with myoconjunctival technique, and concluded that myoconjunctival enucleation provides enhanced motility and cosmesis. There are several issues of concern. We were concerned about the indications for enucleation mentioned in this article. Staphyloma, endophthalmitis and neovascular glaucoma are better managed with evisceration since it is less invasive and does not disturb the muscle attachments to the sclera.

We were surprised to note that same sized implant (16 mm sphere) was used for all patients to "maintain uniformity", particularly because the authors have discussed various techniques to determine ideal implant size pre-operatively. This would definitely vary the equation of volume replacement within each socket as well as the tension within the sutured recti muscles. Moreover, the authors have not mentioned the exact site of suture placement on the sclera. These two factors, according to us, could significantly confound the results. We failed to understand why the authors performed enucleation if the same patient's sclera was used for wrapping the implant. In such a case, an evisceration is less damaging, provides better implant motility, and has a definite reduced risk of extrusion and superior sulcus deformity. Increased manipulation due to enucleation with resultant increased fat atrophy, and undersized implant could lead to superior sulcus deformity as seen in all patients in author's series. We also failed to understand the reason for using implants with tunnels rather than spherical implants, particularly if the implants were wrapped with sclera and muscles were attached to the sclera. The source of these implants remains unclear.

The authors do mention in their discussion that prosthesis motility is due to shortening and lengthening of the fornices. If the myoconjunctival technique attaches recti directly to the fornices, the increased deepening and shallowing of the fornices would indeed impart better motility. However, it then makes sense to measure this motility with the prosthesis in place. Measuring its motility without the prosthesis does not provide any information about the advantage of the myoconjunctival technique, which primarily acts by deepening fornices, and not by imparting better implant motility. This is a fundamental error in the outcome measure assessment in this study.

The clinical photographs (Figures 4 and 5 in the article) showing motility index measurement prove its vulnerability to measurement errors. A masked observer performing measurement with the scale held parallel to the direction of gaze would have been desirable, given the fact the study was prospective and randomised.

 
   References Top

1.Yadava U, Sachdeva P, Arora V. Myoconjunctival enucleation for enhanced implant motility. Result of a randomised prospective study. Indian J Ophthalmol 2004;52:221-26.  Back to cited text no. 1    



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2005 - Indian Journal of Ophthalmology
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Online since 1st April '05