Indian Journal of Ophthalmology

ARTICLE
Year
: 1969  |  Volume : 17  |  Issue : 4  |  Page : 151--153

Sub-total enucleation and ocular prosthesis


LK Trivedi, DB Massey, R Rohatgi 
 Kanpur Eye Hospital, Kanpur, India

Correspondence Address:
L K Trivedi
Kanpur Eye Hospital, Kanpur
India




How to cite this article:
Trivedi L K, Massey D B, Rohatgi R. Sub-total enucleation and ocular prosthesis.Indian J Ophthalmol 1969;17:151-153


How to cite this URL:
Trivedi L K, Massey D B, Rohatgi R. Sub-total enucleation and ocular prosthesis. Indian J Ophthalmol [serial online] 1969 [cited 2021 Jun 14 ];17:151-153
Available from: https://www.ijo.in/text.asp?1969/17/4/151/38533


Full Text

The first ocular prosthesis was fit­ted by Ambroise Pare in 1579 who used enamelled gold and silver. A blown glass shell was made in 1740. Since then several kinds of prostheses and implants have been tried, such as evisceration with buried implants ori­ginated by Mules (1885). Adam Frost (1886) was the first to use glass ball inserted into the Tenon's capsule and Ruedmann (1945) originated semi­buried integrated prosthesis.

An ideal prosthesis is one which can anatomically and physiologically si­mulate the fellow eye. In brief we can enumerate the aims as follows:

1. Good stump with prominent floor

2. Deep and adequate fornices

3. Proper movement 4. No discharge

5. No ptosis and lagophthalmos

6. No deep sulcus of upper lid, with preservation of normal contour of lid.

The types of prosthesis being used at present are tabulated as follows

 Material and Method



Having tried and followed the re­sults of two out of three types of im­plants mentioned above, and finding them to be unsatisfactory in one or the other aspect, the technique of sub­total enucleation was performed by us as follows :

The eyes selected for this operation were those which were large and dis­figured due to anterior and ciliary staphyloma, a condition commonly met with in India. The aim was to shorten the globe, retain the muscles with normal insertions and retain the vitreous so that the shape of the eye­ball was maintained. As motion is transmitted to the prosthesis through the movement of the stump and con­junctival cul-de-sac, the conjunctiva was saved as much as possible during sub-total enucleation, because if the conjunctival cul-de-sac is small, mo­tion is correspondingly limited. Motion is transmitted to the cul-de-sac by fascial and rectus muscle attachments and Tenon's capsule. Therefore, care was taken to damage them as little as possible during the operative proce­dure.

 Technique Of Operation



Local or general anesthesia is given according to the age of the patient. Perilimbal conjunctival incision is made, conjunctiva and Tenon's cap­sule is undermined, the staphyloma­tous portion only is excised, avoiding vitreous loss. Cataractous lens is re­moved. Sclera is stitched with inter­rupted catgut suture vertically and conjunctiva and Tenon's capsule are stitched horizontally. A conformer is then inserted. The prosthesis is fitted after 8 to 10 days. Regular move­ments are established between four to six weeks.

 Discussion



The aim of prosthesis is to give na­tural shape and movements to the af­fected eye to match the fellow eye as much as possible. The matching is not very difficult to attain, but the problem lies in achieving normal movement of the prosthesis. In order to overcome this, many types of im­plants have been invented and tried through the ages.

A perfect prosthesis fulfilling all the criteria has not been achieved so far. The whole eye-ball transplanted from a cadaver would be an ideal prosthesis if it is not rejected and its shape and movements are normally retained. As such an ideal cannot be attained at present, prosthesis is the only solu­tion. Movements to the prosthesis is imparted by the stump. We feel that an ideal stump would be the eye­ball itself, complete with its muscular and fascial attachments, lying in the normal position. The stump made by sub-total enucleation is ideal because it retains the shape due to its contained vitreous. The movements are ade­quate because of the undisturbed mus­cular and fascial attachments. The cul-de-sac is also adequate to retain the prosthesis. The prosthesis is fitted dir­ectly over the stump leaving no dead space in between, thus movements are properly transmitted to the prosthe­sis.

An artificial material is not intro­duced, hence there is no foreign body reaction, granulation tissue formation or discharge. Migration and extrusion of the implant also does not occur.

The position of the stump is most important, as it is placed most ante­riorly it requires a very light cosmetic shell type of prosthesis which is pro­perly in contact. Movements are ex­pected to be better under these condi­tions.

In our series of 60 cases of sub-total enucleation and fitting of prosthesis, and comparing with the other buried and intra scleral implants, we found that our method gives much better cosmetic results including movements. The problem of artificial implants is minimized.

The disadvantage of this type of stump is that it can only be tried in staphylomatous eyes. Such cases, however, are commonly met with in India and hence this method can be tried frequently.

 Summary



A new method of making a stump for the fitting of prosthesis has been described. It is limited to staphylo­matous eyes which can be shortened and approximated to the fellow eye by sub-total enucleation. Sixty cases have been treated with good cosmetic results, the stress being proper move­ments.[2]

References

1MULES, P. H.: Glass-ball implants. Trans. Ophth. Soc. U.K. 5, 200, (1885).
2RUEDMANN. A. D.: Trans. Amer. Ophth. Soc. 43, 304. 1945.