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

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


Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India

Correspondence Address:
Neelam Pushker
Room No.474, 4th Floor, Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.15297

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How to cite this article:
Bajaj MS, Pushker N, Balasubramanya R, Wagh VB, Gupta S. Myoconjunctival Enucleation for Enhanced Implant Motility. Result of a Randomised Prospective Study. Indian J Ophthalmol 2005;53:80

How to cite this URL:
Bajaj MS, Pushker N, Balasubramanya R, Wagh VB, Gupta S. Myoconjunctival Enucleation for Enhanced Implant Motility. Result of a Randomised Prospective Study. Indian J Ophthalmol [serial online] 2005 [cited 2015 Apr 28];53:80. Available from: http://www.ijo.in/text.asp?2005/53/1/80/15297

We read with interest the article on myoconjunctival enucleation by Yadava et al.[1] We agree with the authors that the technique would lead to a better motility of the prosthetic eye, even when used with unpegged orbital implants. However, we would like to raise a few pertinent issues.

The authors have used the patient′s own sclera after enucleation to wrap the implant in one group and have used unwrapped implants in the other group. The extraocular muscles have been attached to their natural positions in the former and passed through grooves in the implant in the latter. The two groups are not comparable to evaluate the myoconjunctival technique as better motility is naturally expected in wrapped implants with attachment of muscles to their original sites, as compared to unwrapped implants.

We would also like to know whether the authors have sutured the scleral coat after wrapping it over the silicone implant, and if so, the suturing technique and material used by them. Did they make any scleral windows at the site of reattachment of the extraocular muscles, as doing so would certainly lead to better fibrovascular ingrowth and better integration of the implant into the orbit.

Finally, we would like to say that in patients where there is no evidence of malignancy, it would be far more beneficial to perform an evisceration with an implant, instead of enucleating the eye, removing its contents and putting back the same scleral coat to wrap the implant. Even if the extraocular muscles are sutured meticulously to their original positions, it may never give the same results as an evisceration with implant, since the natural attachment of muscles, being more physiological, would ultimately translate into superior cosmesis and motility.



 
  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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