Enucleation Surgery Research Articles

Incidence and Risk Factors of Moderate to Severe Postoperative Pain Following the Placement of Primary and Secondary Orbital Implants: A Prospective Observational Study.

To prospectively explore the incidence and risk factors of moderate to severe pain after primary and secondary orbital implantation following evisceration or enucleation surgery. One hundred eighteen patients under general anesthesia for orbital implantation were enrolled in this study. In 91 patients, primary orbital implantation followed evisceration, and in 27 patients, the implantation was secondary after previous evisceration or enucleation surgery. Medical interventions for all participants were followed by standardized surgical, anesthetic, and analgesic protocols. Postoperative pain (POP) intensity was quantified by an 11-point numerical rating scale within 72 hours after the surgery, numerical rating scale ≥4 was considered moderate to severe POP. Multivariate logistic regression was utilized to identify the risk factors related to the development of POP. Thirty-five patients (29.7%) displayed moderate to severe POP, particularly within 6 to 24 hours after surgery, which peaked at 24 hours. Of these patients, 26 patients who were unable to tolerate the pain received additional doses of analgesics during in-hospital stay. Logistic regression model revealed that preoperative anxiety (odds ratios = 4.890; p = 0.002), congenital microphthalmia (odds ratios = 14.602; p = 0.038), and surgical time longer than 60 minutes (odds ratios = 5.586; p = 0.001) were significantly associated with moderate to severe POP after orbital implantation. Orbital implantation after evisceration or enucleation surgery is likely to cause moderate to severe pain intensity in the early postoperative period. Preoperative anxiety, prolonged surgical time, and congenital microphthalmia were the risk factors.

A preoperative nomogram predicting the pseudocapsule status in localized renal cell carcinoma.

BackgroundTumor enucleation (TE) surgery for localized renal cell carcinoma (RCC) relies on a complete peritumoral pseudocapsule (PC). Study objective was to develop a preoperative model to predict PC status.MethodsThe prediction model was developed in a cohort that consisted of 170 patients with localized RCC, and data was gathered from 2010 to 2015. Multivariable logistic regression analysis and R were used to generate this prediction model. The statistical performance was assessed with respect to the calibration, discrimination, and clinical usefulness.ResultsThe prediction model incorporated the systemic inflammatory markers [neutrophil-lymphocyte ratio (NLR); albumin-globulin ratio (AGR)], CT imaging features (tumor size and necrosis), and clinical risk factors (BMI). The model showed good discrimination, with a C-index of 0.85 (0.78–0.91), and good calibration (P=0.60). The sensitivity and specificity were 62% and 94% respectively. Decision curves and clinical impact curve demonstrated that the current model was clinically useful.ConclusionsWe constructed a model that incorporated both the systematic inflammatory markers and clinical risk factors. It can be conveniently used to preoperatively predict the individualized risk of PC invasion and identify the best candidates to receive TE surgery.

Efficacy and Safety of Retrobulbar Blockade of 0.5% Ropivacaine During Eyeball Enucleation Surgery in Children with Retinoblastoma

Efficacy and Safety of Retrobulbar Blockade of 0.5% Ropivacaine During Eyeball Enucleation Surgery in Children with Retinoblastoma

Prosthetic Rehabilitation of anopthalmic socket: Two case reports

An ocular prosthesis is a simulation of human anatomic eyeball to create an illusion of a normal healthy eye and surrounding structures. So the perfect replication of colour, contour and size of the contralateral eye is essential to provide realism and symmetry for the patient. In addition, precise recording of the anopthalmic socket is also essential for the proper retention and form of prosthesis. This article aims to describe the prosthetic rehabilitation of two patients after enucleation surgery with custom made ocular prosthesis. Keywords: Anopthalmic socket, Enucleation, Eye prosthesis, Ocular defect, Ocular prosthesis

Hepatic hemangioma: What internists need to know.

Hepatic hemangioma (HH) is the most common benign liver tumor and it is usually found incidentally during radiological studies. This tumor arises from a vascular malformation; however, the pathophysiology has not been clearly elucidated. Symptoms usually correlate with the size and location of the tumor. Less commonly the presence of a large HH may cause life-threatening conditions. The diagnosis can be established by the identification of HH hallmarks in several imaging studies. In patients that present with abdominal symptoms other etiologies should be excluded first before attributing HH as the cause. In asymptomatic patient’s treatment is not required and follow up is usually reserved for HH of more than 5 cm. Symptomatic patients can be managed surgically or with other non-surgical modalities such as transcatheter arterial embolization or radiofrequency ablation. Enucleation surgery has shown to have fewer complications as compared to hepatectomy or other surgical techniques. Progression of the tumor is seen in less than 40%. Hormone stimulation may play a role in HH growth; however, there are no contraindications for hormonal therapy in patients with HH due to the lack of concrete evidence. When clinicians encounter this condition, they should discern between observation and surgical or non-surgical management based on the clinical presentation.

Feline intraocular sarcoma - Case report

Ophthalmic disorders in cats are increasingly common in veterinarians’ professional routine. Eye neoplasms are important diseases that can lead to discomfort, visual loss and death. Feline intraocular sarcoma is a malignant neoplasm that can be diagnosed in cats of any age. In this report, a 6-month-old female cat was treated at the Veterinary Hospital of Federal Rural University of Rio de Janeiro, with the left eyeball in the phthisisbulbi stage resulting from a traumatic event four months previously. Enucleation surgery for the affected eye was performed. The histopathological evaluation of the eyeball revealed early-stage intraocular sarcoma

Corneal perforation and rare primary adenocarcinoma of the lacrimal gland: A case report

Rationale: Primary adenocarcinoma of the lacrimal gland is rare, and its presentation as corneal perforation is even rarer. Corneal perforation is an ocular emergency that warrants urgent ophthalmic surgery, yet complete staging of lacrimal gland tumor pre-operatively is essential for optimal oncological management. Patient’s concerns: A 57-year-old man presented with left eye pain was found to have left eye proptosis and fleshy tissue mass around the eyeball. Uveal tissue was prolapsing over the perforated keratitis cornea, and the eye was full of discharge. Diagnosis: Bedside ultrasound B-scan confirmed vitreous haze, and emergency contrast computed tomography (CT) revealed soft tissue density mass (>40 mm) molding around the left globe and optic nerve without any rim enhancing abscess. Left exogenous endophthalmitis from exposure keratopathy secondary to proptosis caused by the bulky lacrimal tumor located in the confined orbital cone was diagnosed. Interventions: Emergency enucleation surgery of the left eyeball was done for this painful blind eye to control the infection from spreading. Orbital walls were biopsied intra-operatively, and tumor staging was completed by positron emission tomography- CT scan and magnetic resonance imaging. Without evidence of metastasis, left orbital exenteration was followed by adjuvant orbital chemoradiotherapy for the sake of close proximity of resection margin. Outcomes: Left exenterated orbit was fully epithelialized at around 2 months, and there was no recurrence of the disease up to present at the 1 year follow-up. Lessons: Thorough workup on the staging of the disease to minimize the number of operations for oncological patients is always a top priority, yet it may not always be possible as in our case presenting with corneal perforation.

MYOEPITHELIOMA OF THE SOFT PALATE

Myoepithelioma is an uncommon benign salivary gland tumor almost exclusively composed of myoepithelial cells. This is a case of myoepithelioma occurring in the soft palate of a 73-year-old woman, who wears a complete upper denture. On intraoral examination, an ulcerated sessile normochromic swelling measuring approximately 1 cm in diameter was seen, which was present for 3 years. An incisional biopsy was performed, and the microscopic examination revealed a nonencapsulated proliferation of a variety of cells, including spindle, epithelioid, and plasmacytoid. They were arranged in nests and cords and were also dispersed within areas of hyalinized and myxoid stroma. Tumor cells were positive for smooth muscle actin, and S100 protein was in the immunohistochemical reaction, rendering the diagnosis of myoepithelioma. The patient was referred, received treatment by enucleation surgery, and is currently well with no signs of recurrence. Myoepithelioma is an uncommon benign salivary gland tumor almost exclusively composed of myoepithelial cells. This is a case of myoepithelioma occurring in the soft palate of a 73-year-old woman, who wears a complete upper denture. On intraoral examination, an ulcerated sessile normochromic swelling measuring approximately 1 cm in diameter was seen, which was present for 3 years. An incisional biopsy was performed, and the microscopic examination revealed a nonencapsulated proliferation of a variety of cells, including spindle, epithelioid, and plasmacytoid. They were arranged in nests and cords and were also dispersed within areas of hyalinized and myxoid stroma. Tumor cells were positive for smooth muscle actin, and S100 protein was in the immunohistochemical reaction, rendering the diagnosis of myoepithelioma. The patient was referred, received treatment by enucleation surgery, and is currently well with no signs of recurrence.

EXTRAFOLICULAR ADENOMATOID TUMOR: A CASE REPORT

Adenomatoid odontogenic tumor (AOT) is a relatively uncommon lesion, described as a benign neoplasm of ectodermal origin. It presents as a slow-growing lesion, and is often asymptomatic. It is uncommon in patients older than 30 years. Women are affected about twice as often as men. The extrafollicular variant is when the tumor is not associated with an included tooth, being in an interradicular position, causing, in most cases, root divergence. A 39-year-old male patient with an increase in volume in the lower premolar region, but otherwise asymptomatic, sought help. A radiolucent area was observed adjacent to the first and second lower premolars, in a triangular shape causing a divergence of these teeth without root resorption. Diagnostic hypotheses were AOT and squamous odontogenic tumor. An incisional biopsy was performed and confirmed the diagnosis of AOT. The lesion was submitted to enucleation surgery. After 1 year of follow-up, no signs of recurrence could be observed. Adenomatoid odontogenic tumor (AOT) is a relatively uncommon lesion, described as a benign neoplasm of ectodermal origin. It presents as a slow-growing lesion, and is often asymptomatic. It is uncommon in patients older than 30 years. Women are affected about twice as often as men. The extrafollicular variant is when the tumor is not associated with an included tooth, being in an interradicular position, causing, in most cases, root divergence. A 39-year-old male patient with an increase in volume in the lower premolar region, but otherwise asymptomatic, sought help. A radiolucent area was observed adjacent to the first and second lower premolars, in a triangular shape causing a divergence of these teeth without root resorption. Diagnostic hypotheses were AOT and squamous odontogenic tumor. An incisional biopsy was performed and confirmed the diagnosis of AOT. The lesion was submitted to enucleation surgery. After 1 year of follow-up, no signs of recurrence could be observed.

An accurate interactive segmentation and volume calculation of orbital soft tissue for orbital reconstruction after enucleation

BackgroundAccurate measurement and reconstruction of orbital soft tissue is important to diagnosis and treatment of orbital diseases. This study applied an interactive graph cut method to orbital soft tissue precise segmentation and calculation in computerized tomography (CT) images, and to estimate its application in orbital reconstruction.MethodsThe interactive graph cut method was introduced to segment extraocular muscle and intraorbital fat in CT images. Intra- and inter-observer variability of tissue volume measured by graph cut segmentation was validated. Accuracy and reliability of the method was accessed by comparing with manual delineation and commercial medical image software. Intraorbital structure of 10 patients after enucleation surgery was reconstructed based on graph cut segmentation and soft tissue volume were compared within two different surgical techniques.ResultsBoth muscle and fat tissue segmentation results of graph cut method showed good consistency with ground truth in phantom data. There were no significant differences in muscle calculations between observers or segmental methods (p > 0.05). Graph cut results of fat tissue had coincidental variable trend with ground truth which could identify 0.1cm3 variation. The mean performance time of graph cut segmentation was significantly shorter than manual delineation and commercial software (p < 0.001). Jaccard similarity and Dice coefficient of graph cut method were 0.767 ± 0.045 and 0.836 ± 0.032 for human normal extraocular muscle segmentation. The measurements of fat tissue were significantly better in graph cut than those in commercial software (p < 0.05). Orbital soft tissue volume was decreased in post-enucleation orbit than that in normal orbit (p < 0.05).ConclusionThe graph cut method was validated to have good accuracy, reliability and efficiency in orbit soft tissue segmentation. It could discern minor volume changes of soft tissue. The interactive segmenting technique would be a valuable tool for dynamic analysis and prediction of therapeutic effect and orbital reconstruction.

Giant chondroid syringomas: Review of surgical challenges and treatment approaches, including excision, enucleation and Mohs micrographic surgery

Giant chondroid syringomas: Review of surgical challenges and treatment approaches, including excision, enucleation and Mohs micrographic surgery

A retrospective analysis of complication rates associated with retrobulbar local anesthesia in dogs undergoing enucleation surgery

Introduction: Enucleation surgery is commonly performed in dogs, and retrobulbar local anesthetic blocks (RB) provide effective perioperative analgesia. There is limited information on complication rates in dogs having received a RB.

Myxoinflammatory Fibroblastic Sarcoma of Eyeball in an Infant: A Rare Presentation.

Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare soft tissue neoplasm most commonly occurring in the distal extremities of adult patients. It is a low-grade neoplasm with high rate of local recurrence but low rate of metastasis. We describe a case of MIFS of eyeball in an infant. An enucleation surgery was performed, and on the basis of histopathological and immunohistochemical evaluation, a diagnosis of MIFS was rendered. Till date more than 400 cases of MIFS have been reported with only a single case report of MIFS in an adult in iris. To the best of our knowledge, ours is the first case of MIFS in the eye in a child. Considering its rarity in children and especially in an infant (this seems to be the youngest patient in the literature), close follow-up is essential as the biology of these lesions cannot be predicted.

Retrobulbar Block and/or General Anesthesia for Orbital Ball Implants After Enucleation Surgery.

Retrobulbar Block and/or General Anesthesia for Orbital Ball Implants After Enucleation Surgery.

Management of Large Radicular Lesions Using Decompression: A Case Series and Review of the Literature

The purpose of this study was to report the clinical efficacy of decompression for 3 cases with large periapical lesions and to review technique details. Three cases with large periapical cystic lesions were treated with decompression after root canal treatment. A traditional decompression technique was used for the first case. After aspiration, mucogingival incision, irrigation, and incisional biopsy, a pediatric endotracheal tube was sutured in place and kept for 3 weeks for lesion debridement. An aspiration/irrigation technique was adopted for the second case. An 18-G needle with a syringe was used to aspirate the cystic lesion. Two needles were then inserted into the lesion; copious saline irrigation was delivered from 1 needle and until clear saline was expressed from the other. For the third case, decompression was accomplished with a surgical catheter that was subsequently replaced with a gutta-percha plug after 1 month. None of the 3 cases underwent complete enucleation and root-end surgery. Healed lesions or lesions in healing were observed after 1 to 2 years. Based on the presented cases and published case reports on decompression, a literature review was provided covering indications, technique details, modification, and prognosis of decompression in endodontics. For large periapical cystic lesions, conservative decompression may be used for certain cases before or in lieu of apical surgery. Decompression enables healing of large, persistent periapical lesions after root canal treatment.

Change of priorities when selecting the method of eye removal: enucleation versus evisceration

To perform comparative analysis of eye removal methods based on the results of own studies over a long period. The study analyses eye removal surgeries performed in Helmholtz Moscow Research Institute of Eye Diseases over the period of 1991 to 2016 and investigates the reasons of selecting enucleation and evisceration methods. Over the period of 1991 to 2001, there were 968 eye removal surgeries performed in the department of traumatology, with reasons listed as trauma aftermath - 884 (91.3%) cases, outcomes of various diseases - 85 (8.7%) cases. From 2002 to 2016, a total of 2529 eye removal surgeries have been performed due to non-oncological reasons, of which 1337 (52.9%) were enucleation surgeries and 1190 (47.1%) - evisceration surgeries. However, over the last 15 years, there has been a clear tendency for changing priorities when selecting the method of eye removal: from 2002 to 2016, the number of eviscerations has increased by 4.2 times (from 16 to 66.6%), while the percentage of enucleations has decreased from 84 to 33.4%. The rise in frequency of eviscerations was noted in post-traumatic pathologies, including post-traumatic uveitis and preatrophy, and buphthalmos. Analysis of clinical and statistical data accumulated over more than 10 years showed positive dynamics in the decrease of eye removal cases and changes in priority when selecting the method towards evisceration, which causes fewer complications, has better functional and esthetic results - especially considering the ongoing development of new evisceration techniques.

Fibroma ossificante central: relato de caso

Introdução: O Fibroma Ossificante Central é um tumor verdadeiro benigno, raro, que necessita da combinação dos exames clínicos, radiográficos e histopatológico para ser diagnosticado. Essa lesão é assintomática, mas pode apresentar um grande volume causando assimetria facial. Pode ter comportamento agressivo e surge da membrana periodontal onde contém células multipotentes capazes de formar cemento, osso lamear e tecido fibroso. Nos maxilares, envolve com mais frequência a mandíbula e pode haver deslocamento dentário. O tratamento é feito por enucleação cirúrgica. Detalhamento do caso: O presente trabalho relata um caso clínico de um Fibroma Ossificante Central na mandíbula, focando nas suas características clínicas, imaginológicas e histopatológicas e no tratamento, assim como revisar a literatura sobre o tema. A paciente procurou atendimento se queixando do aparecimento da lesão após a exodontia de um dente. A lesão teve como diagnóstico Fibroma Ossificante Central, o tratamento foi a cirurgia por enucleação e a reconstrução da mandíbula foi feita com placa e parafusos de titânio. A paciente teve um bom prognóstico e não houve recidiva até o presente momento. Discussão: Na comparação radiográfica, apresenta-se, dependendo do estágio de desenvolvimento, bem delimitada com limites bem definidos. Neste caso, constatou-se uma lesão de limites difusos, o que é contraditório com a literatura.

Analysis of high-risk histopathologic features of 482 primarily enucleated retinoblastomas

Objective: To evaluate the high-risk histopathologic features of retinoblastoma eyes enucleated as primary treatment. Methods: Retrospective case series study. An analysis was carried out on the high-risk histopathologic features of 482 primarily enucleated retinoblastoma eyes in Beijing Tongren Eye Center during December 2011 and December 2016. The high-risk histopathologic features included post lamina cribrosa invasion, massive choroidal invasion, anterior segment invasion and extraocular invasion. According to the neovascularization of iris (NVI) in the tissue specimen, the patients were divided into the NVI positive group and negative group. The rates of high-risk histopathologic features in the NVI positive group and negative group were analyzed using the chi-square test. Results: Among 482 children with retinoblastoma, 280 (58.1%) were males and 202 (41.9%) were females. The median age at enucleation surgery was 24 months (range, 1-84 months). Of the 482 primarily enucleated eyes, 184 (38.2%) were classified as high-risk histopathologic features, including 148 (30.7%) with post lamina cribrosa invasion, 15 (3.1%) with optic nerve transection invasion, 66 (13.7%) with massive choroidal invasion, 35 (7.3%) with anterior segment invasion, and 5 (1.0%) with extraocular invasion. NVI was detected in 257 (53.3%) cases and there was a significant relation between high-risk histopathologic features and NVI. The rate of high-risk histopathologic features was significantly higher in the NVI positive group (123 cases, 47.9%) than the NVI negative group (61 cases, 27.1%) (χ(2)=21.883, P=0.001). The rate of post lamina cribrosa invasion was significantly higher in the NVI positive group (110 cases, 42.8%) than the NVI negative group (38 cases, 16.9%) (χ(2)=37.860, P=0.001). Conclusions: In this large sample of patients, about 1/3 of retinoblastoma eyes has high-risk histopathologic features. The NVI positive retinoblastoma is more likely to have high-risk histopathologic features or post lamina cribrosa invasion than the NVI negative retinoblastoma. (Chin J Ophthalmol, 2018, 54: 782-786).

Sonographically indeterminate scrotal masses: how MRI helps in characterization.

Magnetic resonance imaging (MRI) of the scrotum represents a useful supplemental imaging technique in the characterization of scrotal masses, particularly recommended in cases of nondiagnostic ultrasonographic findings. An accurate characterization of the benign nature of scrotal masses, including both intratesticular and paratesticular ones may improve patient management and decrease the number of unnecessary radical surgical procedures. Alternative treatment strategies, including follow-up, lesion biopsy, tumor enucleation, or organ sparing surgery may be recommended. The aim of this pictorial review is to present how MRI helps in the characterization of sonographically indeterminate scrotal masses and to emphasize the key MRI features of benign scrotal masses.

Robotic enucleation for pediatric insulinoma with MEN1 syndrome: a case report and literature review

BackgroundA patient with a rare pediatric insulinoma and MEN1 syndrome was treated by robotic enucleation surgery.Case presentationWe present a case of a 9-year-old girl presenting with repeated loss of consciousness, concomitant with a pale face, palpitations, and convulsions, which had persisted for 2 years and had been aggravated during the previous 2 months. She was previously misdiagnosed with epilepsy in another hospital. We further examined her while she was hospitalized. By combining her medical history and imaging examination and lab test results, a diagnosis of insulinoma was confirmed. Sanger-directed sequencing on a peripheral blood sample revealed an MEN1 gene mutation, indicating pediatric insulinoma with MEN1 syndrome. The patient underwent minimally invasive insulinoma enucleation surgery under the Da Vinci robot-assisted system with intraoperative ultrasound (IOUS) connected. The surgery was successfully completed within 65 min, and the girl recovered well postoperatively and no longer experienced symptoms of hypoglycemia.ConclusionThis is the first report of a case of pediatric insulinoma treated using robotic enucleation. This experience demonstrates the feasibility and safety of combining robotic surgery with the enucleation procedure as an excellent strategy for pediatric insulinoma.