Evisceration Decision as a Primary Surgical Intervention: Why and When?

Abstract

Purpose: To evaluate indications of patients to whom evisceration was performed as a primary surgical intervention in a tertiary eye center. Methods: Patients who underwent evisceration as a primary surgical intervention between years 2016-2021 were retrospectively analyzed. The patients were classified into 2 groups in terms of corneal perforation presence and these groups were divided into 4 subgroups according to presence of trauma and infection: Traumatic infectious or non-infectious and nontraumatic infectious or non-infectious causes. Results: A total of 20 eyes of 20 patients who underwent evisceration as a primary surgical intervention were recorded. The mean age was 70.45±3.99 (36-90) with a female/male ratio of 9/11. Light perception was absent in most of the eyes (14 patients). Standard surgical procedure was performed under general anesthesia and orbital implants were placed in 6 of 20 patients, who had no infectious situation. Primary evisceration was performed predominantly to patients with corneal perforation (15/20). Subgroups of these cases included penetrating injuries (2/20), microbial keratitis with corneal perforation (7/20), and non-infectious corneal perforation (6/20). In 5 of 20 cases without corneal perforation owing to uncontrolled infectious pathologies [endophthalmitis (2/20), microbial keratitis (3/20)] primary evisceration was performed. Post-operatively, standard medical treatment was ordered, and no surgical complications were observed. Conclusion: Ophthalmic surgeons tend to postpone evisceration surgery due to its brutal nature. Clinicians may perform the procedure as a primary surgical intervention in selected cases. In conclusion, surgeons should think wisely and consider the benefit and damage balance when deciding to perform evisceration surgery as a primary intervention.