Scleral Shell Research Articles

Utility of pig head model as an oculoplastic wet lab surgical training tool

ABSTRACT Purpose To assess the utility of pig head model as an oculoplastic surgical training tool. Methods Fresh pig head was availed for surgical workshop for entropion correction, eyelid margin repair, and evisceration with implant for oculoplastic surgery-naïve participants. Skill improvement, surgical understanding, and performance of the participants were evaluated both subjectively and objectively by trained oculoplastic surgeons. Subjective assessment was done by a standardized questionnaire based on Likert scale shared with the participants post training. Objective evaluation was done by the faculty based on a three-point scale and a competency-based surgical assessment rubric. Results There were 18 surgery-naïve participants in the workshop which comprised ophthalmology residents and comprehensive ophthalmologists. About 88.88% of the participants were able to perform the lid margin and sub-tarsal dissection in entropion surgery. While performing lid tear repair, 94.44% were correctly able to identify the grey line and anterior and posterior lamellae. About 83.33% of the participants were able to place an implant in the scleral shell or intraconal space. About 83.33% of the participants noted that texture and tissue maneuvering were similar to the human eye while performing surgical steps. About 94.44% of the participants reported better understanding, development of skill and additional confidence after training. The median score on objective assessment was 3. The performance on real patients resulted in a median score of 4 for entropion correction. Conclusion Porcine orbital dissection is an available, affordable, and useful tool for oculoplastic surgical training. Training on porcine model can improve anatomical understanding, clinical judgement, and surgical efficiency in trainees.

Scleral remodeling in early adulthood: the role of FGF-2

Emmetropization, a natural process of ocular elongation, is closely associated with scleral remodeling. The Fibroblast growth factor-2 (FGF-2) was reported involved in scleral remodeling in myopia models. Herein, we aimed to investigate the role of scleral fibroblast-to-myofibroblast differentiation and FGF-2 in scleral remodeling during maturation. Our findings revealed that the posterior scleral fibroblasts (SFs) from mature guinea pigs exhibit increased stiffness compared to those from young guinea pigs. Moreover, mature SFs displayed decreased cell proliferation but increased levels of α-SMA, matrix metalloproteinase 2 (MMP2), and collagen 1, when compared to young SFs. Additionally, the mRNA expression of scleral Fgf-2, Fgf receptor 1 (Fgfr1), Fgfr2, Fgfr3, and Fgfr4 was increased in mature SFs. Notably, exogenous FGF-2 showed increased cell proliferation and led to decreased expression of α-SMA, MMP2, and collagen 1 in mature SFs. Overall, our findings highlight the influence of maturation on SFs from posterior scleral shells, resulting in increased stiffness and the manifestation of fibroblast-to-myofibroblast differentiation during development. Exogenous FGF-2 increased cell proliferation and reversed the age-related fibroblast-to-myofibroblast differentiation, suggesting a potential role of FGF-2 in regulating scleral remodeling.

Anxiety and Depression after Traumatic Open-Globe Injury.

This cross-sectional interview-based study aimed to assess the prevalence and severity of probable anxiety and depression in patients with traumatic open-globe injury and to identify factors associated with anxiety and depression following open-globe injury. Two hundred and twenty-five patients with open-globe injury were identified at the UC Davis Medical Center between 2008 and 2019. Prisoners and patients under 18 at the time of recruitment were excluded from the study. One hundred and twenty-four patients provided consent to participate in the study, which involved a phone interview and chart review. The interview consisted of a section on sociodemographic data and potential associations followed by the Hospital Anxiety and Depression Scale, a standardized 14-question survey that has been validated in previous studies as an excellent predictor of anxiety and depression. A score of 8 for anxiety or depression was considered a positive test, and patients with a positive test in either category were advised to seek further evaluation with their primary care doctors. The prevalence of probable anxiety and depression was calculated, and linear regression was used to identify factors associated with anxiety and depression. The average age was 50.5 ± 19.2, and 75.8% of patients were male. The anxiety score was positive in 37.9% of patients and the depression score was positive in 28.2%. The mean anxiety and depression scores were 6.3 ± 4.7 and 5.5 ± 4.8, respectively. The P value of the linear regressions for anxiety score and depression score were both < 0.001, with R2 = 0.429 and 0.363, respectively. Younger age (P = 0.002) and unemployment at the time of the interview (P = 0.038) were associated with higher anxiety scores. Patients who were bothered by the appearance of their injured eye had higher anxiety scores (P < 0.001) and depression scores (P < 0.001). Patients without a high school diploma had higher depression scores (P < 0.001). Gender, enucleation status, number of people in support network, use of a prosthetic or scleral shell, final logMAR visual acuity, marital status, months since the initial injury, and presence of an intraocular foreign body were not significantly associated with anxiety or depression scores. Traumatic open-globe injury is associated with a high prevalence of probable anxiety and depression. Dissatisfaction with the appearance of the injured eye was associated with higher anxiety and depression scores. Younger age and unemployment were associated with increased anxiety scores, and lack of a high school diploma was associated with higher depression scores.

Ocular Prosthesis: A Next Generation Cosmetic Management by an Eye for an Eye

An ocular prosthesis is an artificial eye that replaces an absent natural eye following an enucleation, evisceration or orbital exenteration. The prosthesis fits over an orbital implant and under the eyelids that covers the structures in the eye socket. It is a non-optical device designed only to improve the cosmesis of an individual with anophthalmic socket or disfigured eye. A normal facial appearance is one of the inherent human traits, if any changed or lost challenges physical, social, mental well-being, self-confidence and psychological influence on the affected people. The loss of an eye is a severe psychological trauma with negative impact on the quality of life of the patient. It is quite challenging to restore the normal look of the patient for bringing him to normality in society. In this view, an ocular prosthetic eye helps to improve the quality of life, satisfaction and appearance of affected eye to any injury or disease of the patient. It is given to uplift the patient’s behavioral, mental status and improve the confidence especially in children. Today, most artificial eyes are made of medical grade plastic acrylate (polymethyl methacrylate material) with an average life of about 2-3years depending upon the way that people use it. It is commonly known as “Device or Scleral Shell or Glass Eye or Fake Eye”. The children require more frequent replacement of the prosthetic eye due to rapid growth changes in the eye. The construction of an ocular prosthesis in the case of congenital and acquired anophthalmia differs in etiology but many concepts of management for a child are the same as for an adult. An early intervention with ocular prosthesis can stimulate orbital growth and prevent facial asymmetry.

Novel use of an autologous scleral button graft to close the anterior defect in evisceration surgery

ABSTRACT Purpose To present an alternative evisceration technique with long-term follow-up data. This technique involves the insertion of an acrylic implant into a modified scleral shell which is closed using an autologous scleral graft. Methods This was a retrospective analysis of eviscerations performed in a district-general hospital in the UK. All patients underwent conventional ocular evisceration after total keratectomy. A full thickness scleral graft is harvested from the posterior sclera, using an internal approach, with an 8 mm dermatological punch. An 18–20 mm acrylic implant is placed into the shell, and the scleral graft is used to close the anterior defect. Demographic characteristics, implant size and type, and cosmetic results from pictures of all patients were recorded. All patients were invited for a review to measure motility, eyelid height, patient recorded satisfaction and complications. Results Of the five patients identified, one had since died. The remaining four attended a review in person. The mean time between surgery and review was 48 months. The mean implant size was 19 mm. There were no cases of implant extrusion or infection. All four had a <1 mm asymmetry in measured eyelid height and ≥5 mm horizontal gaze motility. All patients self-reported “good” cosmesis. An independent assessment identified “mild asymmetry” in two cases and “moderate” in the other two. Conclusion Evisceration with this novel autologous scleral graft technique restores volume in the anterior orbit with good cosmetic results, and with no cases of implant exposure reported in this small case series. This technique should be compared prospectively to established techniques.

The effects of hydroxyapatite implantation with the autogenous sclera cap: A cohort study

We performed a novel hydroxyapatite (HA) prosthesis implantation method in which an HA implant was implanted into the scleral shell with an autogenous scleral cap.Twenty-six patients who had undergone the novel HA prosthesis implantation method and 32 patients who had undergone traditional HA prosthesis implantation were retrospectively reviewed. The postoperative activity of the artificial eye was measured by the Hirschberg test combined with arc perimetry. The visual analog score (VAS) was used to evaluate 2-month postoperative pain and 2-month postoperative discomfort. HA implant vascularization was measured with enhanced magnetic resonance imaging (MRI) 2 and 6 months after the operation. The enhancement volume (VE) and the volume of the HA implant (VHA) were measured. All cases were followed up for 2 years. Measurement data were processed using SAS 6.12.There was a statistically significant difference (P = .016) between the percentages of excellent grade in the two groups. Two months after implantation, the median pain scores of the study and control groups were 2 and 2.5, respectively, and there was a statistically significant difference (W = 585.0, P = .004); there was a statistically significant difference (W = 535.5, P = .000) between the median discomfort scores of the study group (score = 1) and control group (score = 2); the mean VE/VHA values of the study and control groups were 0.3075 and 0.1535, respectively, and there was a statistically significant difference (t = −8.196, P = .000). Six months after implantation, the VE/VHA values of the study and control groups were 0.9686 and 0.5934, respectively, and there was a statistically significant difference (W = 549.0, P = .000). Within 2 years of postoperative follow-up, there were no serious complications in the study group.In the study group, in which the hydroxyapatite implant was implanted into a preserved scleral shell with unaltered muscles and covered with an autogenous scleral cap, postoperative activity and the fibrovascularization of the HA implant were significantly increased, and postoperative pain and discomfort were significantly reduced.

Effect of scleral protein shell amendment on bacterial community succession during the pig manure composting

The impact of scleral protein shell (SPS) amendment on bacterial community succession during pig manure (PM) composting were evaluated in the present work. Five treatments representing different dry weight dosage of SPS [0 % (T1), 2.5 % (T2), 5 % (T3), 7.5 % (T4), 10 % (T5) and 12 % (T6)] were applied with initial mixture of raw materials (Wheat straw along with the PM) and composted for 42 days. Results indicated that the dominant of phyla were Proteobacteria, Actinobacteria, Bacteroidetes and Firmicutes. The relative abundance (RA) of genus un-identified, Ruminofilibacter, Thermovum, Longispora and Pseudomonas were greater among the all treatments but interestingly genus Ruminofilibacter was also higher in control treatment. The network analysis was confirmed that T6 treatment with higher dosage of SPS amendment could enhance the bacterial population and rate of organic matter mineralization. Compared with T1, the T5 has greater potential impact to enhance the bacterial population and significant correlation among the pH and temperature.

Trace elements composition of the scleral shell of the eye in various forms of glaucoma

Purpose: a comparative study of the elemental composition of scleral biopsy specimens from patients with various clinical forms of glaucoma. Material and methods. 44 patients aged 79.5 ± 2.5 were divided into three groups depending on the form of glaucoma: 16 patients with primary open-angle glaucoma (POAG) (group 1); 13 patients with normal tension glaucoma (NTG) (group 2); 15 patients with pseudoexfoliative glaucoma (PEG) (group 3). For elemental analysis, we used scleral biopsies obtained during planned surgical treatment of glaucoma (non-penetrating sinus trabeculectomy). Scleral fragments of 14 donor eyes with no history of glaucoma served as controls. The concentration of macroelements K, Mg, Ca, and Fe was determined using inductively coupled plasma atomic emission spectrometry (ICP-AES, Agilent ICP-AES 720 ES, USA), while microelement concentration (Zn, Cu, Al, Mn) was measured using inductively coupled plasma mass spectrometry (ICP-MS, Bruker ICP-M S 820, Germany). Results. In all forms of glaucoma, scleral samples showed a varying increase in the content of such elements as Zn, Fe, Mg, AL, Ca, K. The highest content of Zn and Fe was found in the scleral tissue of patients with NTG, the difference with the control (p = 0.0001 andp = 0.0003) and with POAG (p = 0.0002, p = 0.0001) being highly significant. The difference between the content of Zn in scleral biopsies of patients with POAG and PEG was also statistically significant (p = 0.0002), whilst no significant difference in Fe content in the sclera (p = 0.69) was found between POAG and PEG Higher Mg concentrations as compared to the control were found in NTG (p = 0.00014) and POAG (p = 0.00002).Patients with POAG (p = 0.0005) and PEG (p = 0.00022) showed the highest accumulation of Ca in the sclera. No differences were found in Mg content of scleral biopsies between patients with NTG and POAG (p = 1.0), while the level of Ca in POAG (p = 0.02) and PEG (p = 0.00001) was significantly higher than in NTG. A significantly lower content of Cu was found in the sclera samples of patients with NTG (p = 0.022), POAG (p = 0.004) and PEG (p = 0.00004) as compared to the control, as well as a reduced content of Mn in POAG (p = 0.00003) and PEG (p = 0.0012). Contrarywise, NTG patients showed an increased content of Mn (p = 0.000003). No differences were found in the Cu content between the sclera of patients with NTG and POAG (p = 0.47), while Cu level in PEG was significantly lower than in POAG (p = 0.034) and NTG (p = 0.013). Conclusion. The macro- and microelement imbalance of the sclera of the eyes with different forms of glaucoma indicates differences in their pathogenesis. This can be the reason for the different severity of disorders of collagen biosynthesis and the formation of cross-links in the connective tissue structures of the sclera, as well as the varying degree changes in the hydrodynamics of the intraocular fluid, which on the whole can affect the level of intraocular pressure and the pattern of glaucoma development.

Imbalance of macro- and microelements in the scleral shell of the eye in various forms of glaucoma

PURPOSE. To conduct a comparative study of the balance of macro- and microelements in scleral biopsy samples taken from patients with various clinical forms of glaucoma.METHODS. The content of macro- and microelements was analyzed in scleral biopsy samples of 16 patients with primary open-angle glaucoma (POAG), 13 patients with normal tension glaucoma (NTG) and 15 patients with pseudoexfoliative glaucoma (PEG). The mean age of the patients was 79.5±2.5 years. For control, fragments of the sclera of 14 cadaveric eyes without a history of glaucoma were used. Concentration of macroelements — K, Mg, Ca, Fe — was determined by inductively coupled plasma atomic emission spectrometry, the level of microelements — Zn, Cu, Al, Mn — by inductively coupled plasma mass spectrometry.RESULTS. A statistically significant shift in the balance of Cu/Zn compared with controls was found in all forms of glaucoma: NTG (p=0.008), PEG (p=0.006), POAG (p=0.03); while no differences between NTG and POAG in this indicator were detected (p=0.609), with PEG the difference was significant (p=0.0001). The Cu/Fe ratio in the scleral samples of glaucomatous eyes also significantly differed from controls in both NTG (p=0.009) and PEG (p=0.006), as well as in POAG (p=0.006). This parameter in patients with POAG significantly differed from the corresponding parameter in the groups with NTG (p=0.0001) and PEG (p=0.016). A shift in the balance of Mn/Cu compared with controls was detected only in the sclera of patients with NTG (p=0.0064), there were no corresponding differences with controls in PEG (p=0.157) and POAG (p=0.773), but a significant difference was found between NTG and POAG groups (p=0.0001). The balance of Mn/Fe in comparison with the control group was disturbed in all forms of glaucoma: NTG (p=0.0066), PEG (p=0.00034), POAG (p=0.0027). At the same time, in patients with NTG and PEG, the balance of Mn/Fe differed significantly from this indicator in POAG (p=0.078 and p=0.0485, respectively). The most pronounced imbalance of Mg/Ca compared with controls was found in the sclera of patients with PEG (p=0.01) and POAG (p=0.0254).CONCLUSION. In all studied forms of glaucoma, disturbances in the ratios of Cu/Zn, Cu/Fe, Mn/Cu, Mn/Fe and Mg/Ca of varying severity in the sclera were revealed in comparison with the sclera of eyes without glaucoma. Differences in the indicated ratios between NTG, POAG and PEG have also been established, which may define the features in the pathogenesis and clinical course of these forms of glaucomatous lesions.

Severe Self-Inflicted Gunshot Wound of the Face

A 26-year-old male was transported to the hospital with a severe self-inflicted gunshot wound of the middle and lower face (Panel A) due to the suicide attempt. Three-dimensional computed tomography (CT) showed multiple site comminuted fracture of the facial skeleton including maxilla, mandible, right zygomatic, ethmoid, and nasal bones (Panel B). Also, the sockets of multiple avulsed teeth were noted. The patient was transported from the region several days after the injury. Due to the osseous and soft tissue loss, this type of gunshot wounds typically poses a considerable challenge to the oral and maxillofacial and plastic surgeons. Acute management in such cases includes resuscitative and life-saving measures. Timing of each surgical procedure should be chosen according to the patient condition, extent of the injury, and international recommendations.1 Operative principles include: (1) general considerations (all reconstructive options are to be taking into account, moreover, the volume of bone and soft tissue loss, functional and aesthetic purposes should be analyzed and planned very precisely), (2) skeletal fixation, (3) bone grafts, (4) soft tissue coverage, and even (5) a facial transplantation in some cases. In our case, the right eye enucleation (removal of the entire globe with all intraocular contents, while preserving orbital/periorbital structures) was done due to the severely ruptured globe. Typical indications for enucleation are severe eye trauma and blind, intraocular tumors, painful, and cosmetically disfiguring eyes. In case of evisceration the intraocular contents are removed from an intact sclera, extraocular muscle attachments and the orbital adnexa are preserved, with placement of an implant within the scleral shell with a purpose to retain orbital volume. Common indications for enucleation are unresponsive endophthalmitis and for improvement of cosmesis in a blind eye. The most common indication for orbital exenteration (removal of the globe and all orbital contents, including muscles, fat, optic nerve, lacrimal gland, nerves, periorbital bone, upper and lower lid complexes) is malignancy.

Military Marking Round Injury to the Globe

Marking cartridges are an increasingly popular form of nonlethal training munitions used primarily for military live-fire simulations. We report a case of ocular trauma due to such a projectile, resulting in the complete loss of vision and placement of a scleral shell. A 20-year-old man presented with decreased visual acuity in his right eye after being struck at close range by a marking cartridge during military training. Computed tomography imaging revealed a retained metallic foreign body within a deflated right globe, prompting emergent exploration and repair of the right globe. Postoperative course was complicated by pain and pruritis which resolved over a period of months. Nonlethal weapons, such as marking cartridges, are increasingly used for civilian crowd control as well as military and law enforcement training. Despite guidelines mandating the use of personal protective equipment with marking cartridges, eye protection may not be consistently used during simulated combat exercises. To the best of our knowledge, this is the first formal report of ocular injury due to this type of ammunition. Based on this case, we discuss other similar types of nonlethal munition used by military and law enforcement, their risks to the eye and orbit, and what steps may be undertaken to reduce future injury.

Bilateral Destructive Ophthalmomyiasis: A Rare Case Report

Ophthalmomyiasis refers to larval infestation of the eye. A 75 years old male bedridden since three years was brought to casualty by his neighbour after having noticed worms crawling around both his eyes. Examination revealed a poor general condition and bilateral ophthalmomyiasis with blood stained foul discharge. Surgical intervention was undertaken. More than 200 maggots were removed mechanically and it was noted that there was complete destruction of intraocular contents leaving behind the scleral shell in both eyes. Entomological examination revealed larvae to be of Musca domestica and histopathological examination of the surrounding tissue showed no malignancy. Despite intensive treatment patient died after four days of admission.

Complications after Modified Evisceration with Closure of the Anterior Scleral Shell by Donor Scleral Graft.

Complications after Modified Evisceration with Closure of the Anterior Scleral Shell by Donor Scleral Graft.

The Bubble Eye Sign: Understanding the Radiological Imaging of Gas inside the Orbit.

Gas, appears as radiolucent on X-ray, is normally absent in the orbit. However, intraocular surgeries occasionally utilize retained intraocular gas for tamponade effect. Intravitreal gas persists after retinal surgery, being confounded by the scleral shell of the operated eye, outlines the shape of the eyeball, and gives the characteristic bubble appearance on skull X-ray. This is different from orbital emphysema caused by orbital fracture when gas is located outside the globe but confined by the orbit, giving a crescent or concave shape over the superior orbit usually. Falls is common after intraocular retinal surgeries due to change of usual stereopsis, prolonged prone posturing, and other systemic comorbidities. By identifying the “Bubble Eye sign” described, attending physician should alert the presence of intravitreal gas, most commonly iatrogenic. Further ophthalmological history taking and examinations are thus indicated, instead of exposing patients to unnecessary radiation under computed tomography scan for orbital fracture investigation.

Fabrication of ocular prosthesis step by step procedure : Case report

An ocular defect may follow removal of a part or an entire orbit that results in visual impairment as well as esthecially and psychologically handicapped. Loosing eye is trauma not just to the patient but also for the family members. Restoring an ocular defect bring backs esthetics but also the confidence that has been lost. Rehabilitation is also very important as this also preserves the contour of remaining structure. Different materials can be used for ocular defects rehabilitation like silicone or acrylic. This is a case report of a patient with a ‘pthisicial eye’ and mainly focussed on the fabrication of an ocular prosthesis. Keywords: Enucleation, Ocular, Prosthesis, Scleral Shell.

Improving the Motility of a Scleral Shell prosthesis with an Acrylic Orbital Implant: A case report

Evisceration or enucleation of the eye may be performed due to ocular injury, cosmetic deformity, infection or malignancy. After the surgical management, orbital implants can be placed to improve the cosmetic appearance, improve the motility of the scleral shell prosthesis and restore the loss of orbital volume. Various type of orbital implants are available amongst which, the acrylic orbital implant has gained popularity, over the years, due to its limited complications. The following case report represents a 26 year old patient who underwent enucleation and had an existing scleral shell prosthesis. His chief concern was the motility of the prosthesis. The prosthetic rehabilitation was done with the help of an Acrylic Orbital implant and a customized scleral shell prosthesis.

Expediting the prosthodontic management of a patient of phthisis bulbi

Eyes are generally the first feature to be noted on one's face. The loss of an eye can be socially, emotionally, and psychologically a very traumatic experience for the patient. Ocular prosthesis plays an important role in restoring the self-esteem and confidence of the patient. Enucleation results in the entire removal of orbital contents whereas, uniocular phthisis bulbi is a condition, in which the eye is shrunken and cornified. This presents a challenging condition for rehabilitation because of a lack of space for the prosthesis. This article aims to explain the challenges while making a customized scleral shell prosthesis over an existing eyeball to obtain optimum cosmetic and functional results.

Full-field displacement measurement of corneoscleral shells by combining multi-camera speckle interferometry with 3D shape reconstruction

Changes in the biomechanical properties of the connective tissue of the eye occur with age and underlie the development of several ocular diseases, such as glaucoma, myopia, and keratoconus. The biomechanical dynamics of ocular connective tissue are measured by ex vivo inflation testing, in which intraocular pressure (IOP) is varied and optical methods are used to produce maps of corneal and scleral displacement. Current optical methods are limited by acquisition rate, occlusions, poor spatial resolution, and insufficient 3D mapping. We developed an interferometric optical method integrates four-camera electronic speckle pattern interferometry (ESPI) and a novel three-dimensional (3D) shape reconstruction process to measure shape and full-field mechanical deformations of corneal and scleral shells during ex vivo inflation testing. Each camera provides accurate measurements of the laser beam phase related to deformations of the specimen surface; a multi-view stereovision method generates the shape of the specimen and a functional form that links every pixel of a given camera to 3D points on the specimen's visible surface. In this way, dynamic deformations of the specimen are localized, with quantification of the time-dependent 3D displacements of the specimen at nanometric accuracy. The ESPI-3D system is suitable for analyzing scleral deformation and morphological changes caused by time-varying IOP.

From international ophthalmology to space ophthalmology: the threats to vision on the way to Moon and Mars colonization.

To report the ophthalmological risks of space travel. The literature about the effect of microgravity and cosmic radiation on the human eye has been reviewed, focusing on the so-called "spaceflight related neuro-ocular syndrome (SANS)", and possible remedies. The eye is the major candidate to suffer from the adverse space conditions, so much so that SANS is the main concern of the National Aeronautics and Space Administration (NASA). SANS, that affects astronauts engaged in long-duration spaceflights, is characterized by optic nerve head swelling, flattening of the posterior region of the scleral shell, choroidal folds, retinal cotton wool spots, and hyperopic shift. Even if it seems related to an increased volume of the cerebrospinal fluid in the brain and the optic nerve sheaths, its pathogenesis is still unclear. In addition, cataract is related to the effect of galactic cosmic rays on the lens. Centrifuges, pressurizing chambers, and mechanical counter-pressure suits have been advanced to counteract the upward fluid shift responsible for the SANS syndrome. Shields with a high content of hydrogen, magnetic shielding systems, and wearable radiation shielding devices are under study to mitigate the exposure to galactic cosmic rays. Since 1961, the year of the first manned mission outside the Earth, history has shown that the human being may venture in space. Yet, visual impairment is the top health risk for long-duration spaceflight. Effective remediation is mandatory in anticipation of long space missions and Moon and Mars colonization.

Evisceration Versus Enucleation Following Ocular Trauma, a Retrospective Analysis at a Level One Trauma Center.

Penetrating and perforating ocular trauma is often devastating and may lead to complete visual loss in the traumatized eye and subsequent compromise of the fellow eye. Enucleation is commonly utilized for management of a non-salvageable eye following penetrating and perforating ocular injuries. Recently, the use of evisceration for non-salvageable traumatized eyes has increased. As a technically easier alternative, evisceration offers several advantages to the ocular trauma surgeon to include faster surgical times, better cosmesis and motility, and improved patient outcomes. Debate still persists concerning whether or not evisceration is a viable option in the surgical management of a non-salvageable eye following ocular trauma given the theoretical increased risk of sympathetic ophthalmia and technical difficulty in construction of the scleral shell with extensive and complex corneoscleral lacerations. A retrospective analysis at a level 1 trauma center was performed to evaluate the practicality of evisceration in ocular trauma. Eyes that underwent evisceration or enucleation following ocular trauma at San Antonio Military Medical Center, a level 1 trauma center, between 01 January 2014 and 30 December 2016 were examined. Factors evaluated include mechanism of injury, defect complexity, ocular trauma score, and time from injury to surgical intervention. Surgical outcomes were assessed. In total, 29 eyes were examined, 15 having undergone evisceration and 14 enucleation. The average size of the scleral defect before evisceration was 20mm in length, and 23mm before enucleation. The mechanism of injury and characterization of the defects among the two groups were relatively similar and described. Overall comparison of the two study groups in terms of surgical outcomes and complications was also relatively similar, as demonstrated. No cases of postoperative persistent pain, sympathetic ophthalmia, infection, or hematoma were identified for either group. The postoperative outcomes demonstrated for the evisceration group are comparable to enucleation, which is consistent with the recent literature. Defect size and complexity did not affect surgical construction of the scleral shell during evisceration. If consistently proven to be a safe and viable alternative to enucleation, evisceration can offer shorter surgical times and better cosmesis for patients. More research into the long-term complication rates and more cases of evisceration for use following ocular trauma should be assessed. Still, this analysis demonstrates that evisceration is a viable surgical alternative and perhaps superior to enucleation for the management of a non-salvageable eye following extensive ocular trauma in many cases.