Outcomes and complications of evisceration with primary implant: an electronic medical record driven analytics of 1800 cases

Abstract

ABSTRACT Purpose To describe the surgical outcomes and implant complications in 1,800 patients undergoing evisceration with primary implant Methods An Electronic Medical Record-driven analysis of 1,800 patients undergoing evisceration with primary implant between 2013 and 2019. Implant sizing was performed intra-operatively to place the largest implant without tension on the wound closure. Outcome measures included implant complications, prosthesis measurements, and incidence of a good aesthetic outcome. Good outcome was defined as <2 mm enophthalmos and grade 1 or less superior sulcus deformity with a custom ocular prosthesis. Results Eighteen hundred eyes of 1800 patients were included. The mean age at surgery was 36 ± 21 years (median 32 years). Implants used were poly(methyl methacrylate) (PMMA) in 1737 (97%) and porous polyethylene in 63 (3%) patients. Two-petal sclerotomy was performed in 1512 (88%) and four-petal sclerotomy in 165 (10%) patients. The mean diameter of the implant used was 19.35 ± 1.18 mm (median 20, range 10–22 mm). The implant extrusion rate was 3% (56) and implant displacement was seen in none. The mean prosthesis volume and thickness were 2.22 ± 0.67 ml (median 2, range 1–6.5 ml) and 6 ± 1 mm (median 6, range 2–9 mm). The mean difference in prosthesis projection on Hertel’s exophthalmometer was 0.28 ± 1 mm (median 0, range 0–1 mm). Good outcome was observed in 93%. The mean follow-up period was 351 ± 386 days (median 194). Conclusion Evisceration with empirically selected primary orbital implant placement is associated with minimal implant complications and gives a good aesthetic outcome in 93% of the patients.