An Abscess Causing a Delayed Optic Neuropathy after Decompression for Thyroid Eye Disease

Thyroid orbitopathy is the most common cause of proptosis in adults. It often requires surgical decompression to relieve proptosis, keratopathy, and/or optic neuropathy (1). Complications including diplopia, sinusitis, infraorbital hypesthesia, and cerebrospinal fluid leak have been reported (2–4). Mucocele formation or orbital abscess after decompression surgery are rare (5–9). To our knowledge, there are no reports of an orbital abscess causing a compressive optic neuropathy after decompression. We describe such a patient with both orbital abscess and mucoceles that was treated with intravenous antibiotics, steroids, and surgery

Enucleation and Techniques of Orbital Implant Placement

Enucleation is a surgical procedure that involves removal of the eye and anterior optic nerve, most commonly with retention of the extraocular muscles which are then sewn to the implant. Meticulous surgical technique is essential to prevent long-term complications and ensure optimal long-term function and cosmesis of the anophthalmic socket. When appropriate surgical technique is used, the patient often has a significant improvement in both function and cosmesis after an enucleation, and is quite grateful for the relief of pain they can achieve. It is critical that the surgeon approach this surgery keeping the long term view of the anophthalmic socket in mind. Generally, this involves providing the patient with the largest implant that will fit the socket without undue tension during Tenon’s capsule and conjunctival closure, thereby minimizing socket and eyelid asymmetry and preventing future forniceal and eyelid issues. This chapter reviews basics of enucleation surgery, with a focus on methods to achieve optimal results. Also, the chapter discusses implant placement techniques and provides a brief review of enucleation implants. Additionally, it describes how enucleation implants have evolved and improved over time

Remove, rotate, and reimplant: a novel technique for the management of exposed porous anophthalmic implants in eviscerated patients

PURPOSE: To describe and to evaluate a new and relatively easy technique for porous implant exposure repair. METHODS: Eleven patients with exposed porous orbital implants after evisceration were included in this study. Five patients with large exposures (diameter>7 mm) and six patients with small exposures of orbital implants (diameter<7 mm) that persisted despite posterior vaulting of the prosthesis and usage of antibiotics and steroids for more than 6 weeks, underwent revision surgery with the remove-rotate-reimplant technique (3R technique). Negative microbiological culture taken from the exposed socket surface before surgery was the major inclusion criterion. Five patients with insufficient conjunctival tissue also underwent additional mucosa or hard palate grafting of the defect in addition to the remove-rotate-reimplant procedure. RESULTS: Patients have been followed up for more than 18 months (ranging from 18–30 months). None of them received motility peg insertion after repair. Implant reexposure was detected in one patient during the follow-up period, which was managed by dermis fat grafting with implant removal. CONCLUSION: The remove-rotate-reimplant technique is an effective surgical method for repairing exposed porous anophthalmic implants after evisceration with a 90% success in this study. It avoids the removal of the implant from the sclera, which is a traumatic procedure that may lead to the tearing and loss of scleral tissue covering the implant. Saving the porous implant and scleral cover reduces the surgical time and cost

Orbital Implants and Wrapping Materials

Following globe removal, the surgeon must determine the best orbital implant to place into the anophthalmic socket. A decision on appropriate implant size, whether to place a porous or nonporous implant, and a patient’s total clinical picture must be considered to prevent future complications. Other considerations, including whether to wrap an implant and place a motility peg, must also be made. The modern implant is built on the foundation of anophthalmic socket reconstruction—implant retention, volume replacement, and adequate prosthetic motility. This chapter will review the special considerations the ophthalmic surgeon must weigh when choosing an orbital implant following enucleation and evisceration surgeries