65103 Enucleation of eye; with implant, muscles not attached to implant

Name of the Procedure:

Enucleation of Eye with Implant, Muscles Not Attached to Implant

• Enucleation (Eye Removal)
• Enucleation with Orbital Implant

Summary

In an enucleation of the eye with an implant, the entire eyeball is surgically removed, and an orbital implant is placed in the eye socket to maintain its structure. The eye muscles are not attached to the new implant.

Purpose

The procedure addresses severe eye conditions where preserving the eye is not possible, such as in ocular cancer, severe trauma, infection, or untreatable painful conditions.

The goals of the procedure are to:

• Remove the diseased or damaged eye.
• Eliminate pain or discomfort.
• Prevent the spread of infection or malignancy.
• Maintain the cosmetic appearance of the eye socket.

Indications

• Intraocular cancers (e.g., retinoblastoma, melanoma)
• Severe ocular trauma or injury
• Non-responsive painful eye conditions (e.g., glaucoma)
• Severe intraocular infections
• Phthisis bulbi (shrunken, non-functional eye)

Preparation

• Fasting for 8-12 hours before the procedure
• Review of medical history and current medications
• Preoperative diagnostic tests such as eye exams, imaging scans, and blood tests
• Adjustment or discontinuation of certain medications (e.g., blood thinners)

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A surgical incision is made around the conjunctiva (the tissue covering the white of the eye).
3. Removal: The eye muscles are detached from the eyeball, and the entire eyeball is carefully removed.
4. Implant Placement: An orbital implant is inserted into the empty socket to retain the shape and support surrounding structures.
5. Closure: The eye muscles are not attached to the implant. The conjunctiva and other tissues are then sutured closed.
6. Dressing: A pressure dressing is applied to the socket to minimize swelling and promote healing.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Enucleation is performed in a hospital or surgical center with appropriate facilities for general anesthesia.

Personnel

• Ophthalmic surgeon
• Anesthesiologist
• Operating room nurses and technicians

Risks and Complications

• Infection
• Bleeding
• Pain or discomfort
• Implant exposure or extrusion
• Socket contracture (shrinkage)
• Anesthesia-related risks

Benefits

• Relief of pain and discomfort
• Prevention of disease spread
• Improved cosmetic appearance with the implant
• Enhanced quality of life

Recovery

• Post-operative pain management with prescribed medications
• Instructions to avoid strenuous activities
• Follow-up appointments to monitor healing
• Fitting of an ocular prosthesis (artificial eye) after 4-6 weeks to improve cosmetic appearance

Alternatives

• Evisceration (removal of the eye’s contents, leaving the scleral shell intact)
  • Less invasive but may not be suitable for certain conditions like cancer.
• Conservative treatments (radiation, chemotherapy)
  • Can be an option for some cancers but may not provide relief for irreparable conditions.

Patient Experience

• The patient will be under general anesthesia during the procedure and will not feel pain.
• Postoperative discomfort is common, manageable with medication.
• Mild swelling and bruising around the eye area are expected.
• Gradual adjustment to the orbital implant and potential fitting with an artificial eye for cosmetic purposes.