65105 Enucleation of eye; with implant, muscles attached to implant

Name of the Procedure:

Enucleation of Eye with Implant and Muscle Attachment
Common Names: Eye enucleation, Orbital implant surgery

Summary

Eye enucleation is a surgical procedure where the entire eyeball is removed from the eye socket (orbit), and an orbital implant is placed to maintain the structure of the socket. The eye muscles are then attached to the implant to allow for some movement and a more natural appearance.

Purpose

Enucleation is performed to address severe eye conditions where preservation of the eye is not possible:

• To remove a malignant tumor such as ocular melanoma.
• To manage severe trauma causing irreparable damage to the eye.
• To alleviate intractable pain from a blind eye or untreatable glaucoma.
• To treat severe infections or inflammatory conditions.

The goal of the procedure is to remove the affected eye while maintaining facial structure and appearance by aligning the eye muscles to the implant, providing a foundation for a prosthetic eye that moves naturally.

Indications

• Ocular tumors (e.g., melanoma, retinoblastoma)
• Severe eye trauma or irreparable injury
• Painful blind eye (due to conditions like glaucoma)
• Severe and untreatable eye infections
• Extensive eye inflammation not responsive to other treatments

Preparation

• Patients may be required to fast for several hours before surgery.
• Adjustments in medications, especially blood thinners, may be necessary as advised by the surgeon.
• Preoperative blood tests and imaging studies may be performed to evaluate the patient's overall health.
• Physical examination and discussion of medical history with the healthcare team.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A careful incision is made around the conjunctiva (the tissue covering the white part of the eye and the inside of the eyelids).
3. Detaching Muscles: The eye muscles are detached from the eyeball but remain intact to be reattached later.
4. Eyeball Removal: The optic nerve is severed, and the eyeball is removed from the socket.
5. Implant Placement: An orbital implant, typically made of porous material, is inserted to occupy the socket and maintain its shape.
6. Muscle Reattachment: The eye muscles are meticulously attached to the implant to allow for movement.
7. Closure: The conjunctival tissue is closed over the implant, and sometimes a temporary conformer is placed.

Duration

The entire procedure typically takes between 1 to 2 hours.

Setting

Enucleation is usually performed in a hospital operating room or a surgical center.

Personnel

• Surgeon (often an ophthalmologist specializing in eye surgery),
• Nurses,
• Anesthesiologist.

Risks and Complications

• Infection
• Bleeding
• Implant exposure or extrusion
• Poor cosmetic outcome or difficulty fitting a prosthetic eye
• Pain and discomfort

Benefits

• Removal of diseased or painful eye, improving quality of life
• Prevention of the spread of malignant tumors
• Preservation of facial structure with natural movement for prosthetic eye attachments
• Pain relief

Recovery

• Pain management with prescribed medications
• Antibiotics to prevent infection
• Follow-up appointments for monitoring and adjusting the orbital implant
• Fitting for a customized prosthetic eye usually occurs several weeks after surgery
• Restrictions on heavy lifting and strenuous activity for a few weeks
• Expected recovery time is typically about 4-6 weeks

Alternatives

• Evisceration: Removal of the contents of the eye but leaving the scleral shell and eye muscles intact.
• Radiation or Chemotherapy: In cases of ocular tumors, to shrink tumors before considering surgery.
• Pain Management and Eye Drops: For less severe conditions, where pain is managed without surgical intervention.

Patient Experience

• Patient will be under general anesthesia and will not feel anything during the procedure.
• Post-surgery, there will be some discomfort and swelling which is managed with medications.
• The patient may experience emotional adjustments upon losing an eye but will be referred to support resources.
• Pain management and regular follow-up visits are crucial for smooth recovery.

Pain management and support systems are important components of the holistic care provided throughout the enucleation process, ensuring the patient's best possible quality of life and cosmetic result.