Enucleation of eye; without implant
CPT4 code
Name of the Procedure:
Enucleation of Eye; Without Implant
(Common name: Eye Enucleation)
Summary
Eye enucleation is a surgical procedure that involves the removal of the entire eye but leaves the surrounding muscles and other structures intact. Unlike procedures that include an implant, this version does not replace the removed eye with an artificial implant.
Purpose
Enucleation is performed to address severe eye conditions such as malignant tumors, painful blind eyes, severe eye infections, or extensive trauma. The primary goal is to remove diseased tissue and alleviate pain, offer a cosmetic solution by allowing for future prosthetic use, or prevent the spread of malignancies.
Indications
Specific indications for enucleation include:
- Intraocular cancer (e.g., retinoblastoma, melanoma)
- Painful blind eye due to conditions like glaucoma
- Severe trauma or infection unresponsive to other treatments
- Cosmetic reasons when other reconstructive options are not viable
Preparation
Pre-procedure preparations include:
- Comprehensive eye examination and imaging tests
- Blood tests and overall health assessment
- Fasting for a specified time before surgery
- Temporarily stopping certain medications as advised by the physician
Procedure Description
- General or local anesthesia is administered to ensure comfort.
- A speculum is used to keep the eye open.
- The surgeon cuts the conjunctiva (the white part surrounding the eye).
- Eye muscles are carefully detached from the eyeball while preserving them for future prosthetic attachment.
- The optic nerve is cut to remove the eye.
- The area is cleaned and various layers of tissue are sutured closed.
- Temporary dressing is applied over the socket.
Tools include surgical scissors, scalpel, forceps, and a speculum. Anesthesia can be local or general based on the patient's condition and surgeon's preference.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
Enucleation is usually performed in a hospital or specialized surgical center.
Personnel
The procedure involves a team that includes:
- Ophthalmic surgeon
- Anesthesiologist
- Surgical nurses
- Support staff
Risks and Complications
Risks can include:
- Infection
- Bleeding
- Pain and swelling
- Orbital implant complications if opted later
- Poor cosmetic outcome
- Retained orbital tissue issues
Benefits
- Relief from severe pain
- Removal of diseased or cancerous tissue
- Preparation for future cosmetic prosthetic fitting
Patients may notice pain relief almost immediately, with cosmetic benefits becoming more apparent as healing progresses.
Recovery
- Post-procedure eye patch or dressing may be needed for a few days.
- Prescribed medications to manage pain and prevent infection.
- Avoid strenuous activities for a few weeks.
- Follow-up visits to monitor healing, with possible fitting for an ocular prosthesis after 6-8 weeks.
Alternatives
Other treatment options can include:
- Radiotherapy or chemotherapy for cancer
- Evisceration (removal of eye contents leaving the scleral shell)
- Non-surgical pain management
Each alternative has its own set of benefits and drawbacks, such as varying degrees of effectiveness and cosmetic outcomes.
Patient Experience
Patients may feel some discomfort or pain post-surgery, managed with medication. Emotions can vary, and psychological support may be beneficial. Adjustments to vision and experience with prosthetics will be aided by follow-up and specialist visits.