Purpose:

To evaluate the results of evisceration with posterior sclerotomy and double scleral flap and discuss the risk of sympathetic ophthalmia after evisceration surgery.

Material Methods:

During 1995- 2006 period evisceration with posterior sclerotomy and double scleral flap was performed and spherical implants were inserted in 135 cases. The surgical indication for evisceration was phithisis bulbi secondary to trauma or intraocular surgery in 84 (62.2%), endophthalmitis in 25 (18.5%), painful blind eye in 18 (13.3%), staphiloma 7 (5.2%), and acute traumatic spontaneous evisceration in 1 case (0.7%). 77.8% of the cases have history of at least one intraocular surgery. In this technique, the sclera was dissected into two pieces as superior and inferior flaps via radial scleral incisions, and those flaps were totally severed from the optic nerve posteriorly. Spherical acrylic or porous implants were inserted in each case.

Results:

The mean follow up period was 20.0±19.1 months. Acyrilic implant was used in 63 cases (46.7%), and the remaining 72 cases (53.3%) had hidroxyapatite implants. The diameter of the implant was ≥20 mm in 71.1%, 18 mm in 23%, and 16 mm in 5.9% of the cases. None of the cases experienced implant extrusion during the follow up period. However, implant exposure and implant migration was demonstrated in 5 and 1 cases, respectively. Additionally, 3 cases (2.2%) showed aponeurotic ptosis, 3 cases (2.2%) showed upper sulcus deformity, 1 case (0.7%) showed inferior lid laxity and 1 case (0.7%) showed pyogenic granuloma. None of the cases demonstrated any finding resembling infection or symphatetic ophthalmia.

Conclusion:

The risk of symphatetic ophthalmia after evisceration surgery is very low. Evisceration with posterior sclerotomy and double scleral flap provides optimalisation of the size of the implant after surgery and decrease the complication rates after surgery.

Keywords: Evisceration, double scleral flap