Painful blind eye: efficacy of enucleation and evisceration in resolving ocular pain.
(1/27)
AIMS: To assess the effectiveness of enucleation or evisceration in relieving pain from painful blind eyes. METHODS: 24 patients with intractable ocular pain underwent enucleation or evisceration with or without an orbital implant. RESULTS: Complete pain relief was achieved in all patients at an average time of 3 months (range 1-15 months). Seven patients required further medical or surgical treatment in addition to removal of the globe. CONCLUSION: Enucleation and evisceration were effective in relieving ocular pain in all patients with a painful blind eye in our study. However, complications of surgery and orbital implants can cause recurrent pain. (+info)
Keratocyte loss in Acanthamoeba keratitis: phagocytosis, necrosis or apoptosis?
(2/27)
PURPOSE: Pathogenesis of Acanthamoeba keratitis involves breakdown of epithelial barrier, stromal invasion by Acanthamoeba, loss of keratocytes, inflammatory response and finally stromal necrosis. The loss of keratocytes, believed to be due to the phagocytic activity of the parasite, occurs disproportionate to and independent of the parasite load, thereby suggesting additional modes of cell loss. To test our hypothesis that the loss of keratocytes in Acanthamoeba keratitis is due to apoptosis, we did both histology and histochemistry on the corneal tissues. METHODS: Routine Haematoxylin and Eosin, Gomori's Methenamine Silver and Periodic acid Schiff stained sections of five corneal tissues from penetrating keratoplasty and eviscerated eyes were reviewed. TUNEL staining was done for morphological detection of apoptosis in three cases, using formalin-fixed, paraffin-processed tissues. RESULTS: Histological changes were epithelial ulceration, loss of keratocytes in all layers, inflammation in anterior two-thirds of the stroma with necrosis, and deeper quiet stroma. Acanthamoeba trophozoites were found in the anterior stroma while the cysts were more in the deeper stroma, with minimal or no inflammatory response. TUNEL staining was positive in keratocytic nuclei in all layers. CONCLUSIONS: This study demonstrates that one of the modes of keratocyte loss in Acanthamoeba keratitis is by apoptosis, possibly in addition to the necrotic process and phagocytic activity of the parasite. The death of inflammatory cells also appears to be mediated by apoptosis. (+info)
Panophthalmitis due to rhizopus in an AIDS patient: a clinicopathological study.
(3/27)
Various opportunistic infections in the eye have been reported earlier in AIDS. We report a case of panophthalmitis in an AIDS patient where the eviscerated tissue on histopathologic and microbiologic examination showed the fungus Rhizopus. (+info)
Effect of basic fibroblast growth factor on fibrovascular ingrowth into porous polyethylene anophthalmic socket implants.
(4/27)
To investigate the effect of basic Fibroblast Growth Factor (bFGF) on fibrovascular ingrowth into porous polyethylene orbital implants (Medpor) and to investigate any differences according to the method of administration. For the treated groups, after evisceration and Medpor implantation, bFGF was administered by soaking Medpor in the bFGF solution, and/or by injecting bFGF into the Medpor 1 week after the operation. Implants were removed 4 weeks after the operation and examined for the degrees of fibrovascular ingrowth by light microscopy. The percentages of the cross-sectional area of the implant occupied by fibrovascular ingrowth and the numbers of proliferated vessels were significantly higher in the bFGF-treated groups (Mann Whitney test, p<0.05). Administration routes had no effect on the degree of fibrovascular ingrowth (Kruskal-Wallis test, p>0.05). bFGF promoted fibrovascular ingrowth into porous polyethylene orbital implants regardless of the route of administration. Therefore, bFGF might be helpful to prevent complications such as implant exposure. (+info)
Synthetic hydroxyapatite-based integrated orbital implants: a human pilot trial.
(5/27)
PURPOSE: Orbital implants are used as fillers following enucleation or evisceration surgeries to replace the lost volume for better cosmesis and motility of the artificial eye. Over the last decade porous hydroxyapatite (HAp) implants derived from the naturally occurring corals, are increasingly used. Recently synthetic HAp-based implants have been introduced. After fibrovasculrisation they have the added advantage of being directly integrated with the artificial shell, thereby increasing the motility to a great extent. The current study, evaluated the efficacy of two different models of synthetic HAp with 75% porosity and pore sizes ranging from 100 to 300 mm. METHODS: Synthetic HAp powders were prepared with a novel wet chemical route. Two models of porous orbital implants with the characteristic designs for both evisceration and enucleation surgery were developed, characterised and implanted to consecutive 25 human subjects, 17 following evisceration, and 8 following enucleation. The postoperative performances of these implants were evaluated in respect to the degree of volume replacement (implant + prosthesis), presence/absence of lagophthalmos and lower eye-lid laxity, status of socket and fornices. Magnetic resonance imaging assessed the stability of the implants within the socket and progressive fibro-vascularisation within the porous scaffold as a function of time. Finally, motility of the implants as well as the prostheses (horizontal movements by Lister Perimeter) and subjective cosmetic results (qualitative) were also evaluated. RESULTS: During the 2.5 years of follow-up study, no significant postoperative complications were noticed. One case, showed an anterior implant exposure of 3-4 mm, and was managed with donor scleral patch graft and one case of conjunctival thinning was corrected by re-suturing the conjunctival dehiscence. Fourteen of the 25 patients had a very good movement of the prostheses (> 20 degrees horizontal movement) and the other 11 patients had a fair motility (10 - 20 degrees). The degree of volume replacement (with prosthesis) was found to be very good in 21 patients and fair in other 4 patients. All patients reported cosmetic satisfaction. CONCLUSION: Synthetic HAp-based integrated orbital implants with this modified design were found clinically safe and cosmetically acceptable. (+info)
Evaluation of the etiology of ocular globe atrophy or loss.
(6/27)
This survey investigated the etiology of atrophy or loss of the ocular globe in patients assisted at the Maxillofacial Prosthetics Clinic of two Schools of Dentistry in Sao Paulo State, Brazil. A total of 238 patients were examined and their clinical files were reviewed. The etiology of eyeball atrophy/loss was assessed with respect to gender, age group, affected side and type ophthalmologic surgery performed. The greatest incidence of ocular globe loss was due to traumatic etiology (57.14%), followed by pathogenic (36.13%) and congenital (5.04%) etiologies. Comparing the genders, a predominance of male patients was observed (61.76%; p<0.01). The age group most frequently affected was between 21 and 40 years (42.01%; p<0.01). For all types of etiologies investigated in this study, enucleation was the most commonly used surgical procedure for removal of the ocular globe (66.38%; p<0.01). Loss of the left eye was predominantly seen (55.04%), even though no statistically significant difference was found between sides (p>0.01). (+info)
Twenty year review of histopathological findings in enucleated/eviscerated eyes.
(7/27)
BACKGROUND/AIMS: To evaluate the need for routine histopathological analysis of enucleated/eviscerated eyes and changes in indications for eye removal. METHODS: Retrospective review of all enucleation/evisceration histopathology reports over 20 years. Clinical history was correlated with pathological findings. Two 10 year periods (1984-93, 1994-2003) were compared to detect changes in indications for eye removal. RESULTS: In total, 285 histopathology results were traced from 1984 to 2003; 161 and 124 were evisceration and enucleation specimens, respectively. Glaucoma, malignant melanoma, trauma, and retinal detachment were the most frequent diagnoses 1984-1993. Ocular trauma was the most frequent diagnosis 1994-2003, followed by phthisis bulbi and endophthalmitis. Three cases were diagnosed as metastatic carcinoma; all were suspected preoperatively. A fourth case was a diagnostic surprise: adenocarcinoma found in an eye removed for pain and phthisis. Comparison of two 10 year periods showed a decrease in the number of enucleations/eviscerations, perhaps reflecting a decrease in the number of specimens sent. A preference for eviscerations was evident over the 20 years. CONCLUSION: The number of eyes removed and histologically analysed decreased in the period 1994 to 2003, perhaps because of better treatment options, allowing globe preservation. There was a significant shift in the diagnosis in the two time periods, and a preference for evisceration in both. Only one diagnostic surprise was discovered (0.35%). This study does not support the need to send all globes/contents for histopathological examination. However, because of the one unexpected finding, it is recommended where the examination is incomplete or the history of visual loss is unclear. (+info)
A comparison of implant extrusion rates and postoperative pain after evisceration with immediate or delayed implants and after enucleation with implants.
(8/27)
PURPOSE: To examine implant extrusion rates after evisceration with immediate or delayed implants in patients with culture-proven endophthalmitis. To compare postevisceration and postenucleation pain. METHODS: This prospective, nonrandomized interventional case series included four groups of patients: group 1, 25 endophthalmitis patients undergoing evisceration with immediate implants; group 2, 15 endophthalmitis patients undergoing evisceration with delayed implants; group 3, 31 patients without endophthalmitis undergoing evisceration with immediate implants; and group 4, eight patients undergoing enucleations with implants. Standardized techniques and follow-up schedules were used. Postoperative pain was assessed by weighted frequency of pain medications used during two 48-hour periods. Statistical analysis was performed. Retrospective review of two series of patients undergoing evisceration was performed. RESULTS: No cases of implant extrusion occurred during an average follow-up of 37.9 months. Average implant size was 19.0 mm. Conjunctival dehiscence occurred in one patient. Average total pain scores were 20.8 in endophthalmitis patients with immediate implants; 22.1 in endophthalmitis patients with delayed implants; 20.3 in patients without endophthalmitis and with immediate implants; and 23.1 in patients with enucleations and immediate implant insertions. Retrospective review suggested possible causes of implant extrusion. CONCLUSION: Both immediate and delayed implant techniques appear safe in patients with endophthalmitis, with the former being simpler, more cost-effective, and perhaps less painful. Prolonged antibiotic therapy and smaller implants may render a false sense of security against implant extrusion; good surgical technique and meticulous postoperative wound care are essential. Postenucleation pain appears more severe than postevisceration pain. (+info)