Skip to main content
SpringerLink
Log in

Pediatric Enucleation, Evisceration, and Exenteration Techniques

  • Chapter
  • First Online:
Book cover Pediatric Oculoplastic Surgery

  • 1587 Accesses

Abstract

The loss of an eye is certainly a devastating situation. Reconstruction of the socket in the pediatric age group is extremely important, not only for the immediate appearance and psychological benefit of the child and the parents but also for the long-term growth and health of the orbit in younger children. The presence of an eye is necessary for normal orbital growth. With the loss of an eye, as in severe microphthalmia or anophthalmos, orbital growth may arrest. If this occurs, the entire growth of the face is affected and significant deformities can result. A great deal has been written on how to reconstruct and augment the soft tissue of the pediatric socket. This chapter discusses and summarizes techniques that have demonstrated good results in the collective experience of the oculoplastic contributors to this text.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 279.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 379.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ruedeman AD. Plastic eye implant. Am J Ophthalmol. 1946;29:947–52.

    Article  Google Scholar 

  2. Danz W. Motility implants: a review. In: Bosniak SL, Smith BC, editors. Advances in ophthalmic plastic and reconstructive surgery: the anophthalmic socket, vol. 8. New York: Pergamon; 1990. p. 46–52.

    Google Scholar 

  3. Troutman RC. Five year survey on the use of a magnetic implant for improving cosmetic results of enucleation. Arch Ophthalmol. 1954:531–58.

    Google Scholar 

  4. Allen L, Spivey BE, Burns CA. A larger Iowa implant. Am J Ophthalmol. 1969;68:397–400.

    Article  CAS  PubMed  Google Scholar 

  5. Fan JT, Robertson DM. Long-term follow-up of the Allen implant: 1967–1991. Ophthalmology. 1995;102:510–6.

    Article  CAS  PubMed  Google Scholar 

  6. Anderson RL, Thiese SM, Nerad JN, et al. The universal orbital implant: indication and methods. In: Bosniak SL, Smith BC, editors. Advances in ophthalmic plastic and reconstructive surgery: the anophthalmic socket, vol. 8. New York: Pergamon; 1990. p. 88–99.

    Google Scholar 

  7. Choyce DP. Orbital implants: review of the results obtained at the Moorfields branch of the Moorfields, Westminster, and Central Eye Hospitals, London. Br J Ophthalmol. 1952;36:123–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Castrin JA. Experiences with different orbital implants after enucleation. Acta Ophthalmol. 1963;41:435–44.

    Article  Google Scholar 

  9. Gougelmann HP. The evolution of the ocular motility implant. Int Ophthalmol Clin. 1970:689–733.

    Google Scholar 

  10. Nunery WR, Cepela MA, Heinz GW, et al. Extrusion rate of silicone spherical anophthalmic socket implants. Ophthalmic Plast Reconstr Surg. 1993;9:90–5.

    Article  CAS  Google Scholar 

  11. Perry AC. Advances in enucleation. Ophthalmol Clin N Am. 1991;8:75–81.

    Google Scholar 

  12. Perry AC. Integrated orbital implants. In: Bosniak SL, Smith BC, editors. Advances in ophthalmic plastic and reconstructive surgery: the anophthalmic socket, vol. 8. New York: Pergamon; 1990. p. 75–87.

    Google Scholar 

  13. Nunery WR, Heinz GW, Bonnin JM, et al. Exposure rate of hydroxyapatite spheres in the anophthalmic socket: histopathologic correlation and comparison with silicone sphere implants. Ophthal Plastic Reconstr Surg. 1993;9:96–14.

    Article  CAS  Google Scholar 

  14. Lin CW, Liao SL. Long-term complications of different porous orbital implants: a 21-year review. Br J Ophthalmol. 2017;101(5):681–685. pii: bjophthalmol-2016-308932. doi:10.1136/bjophthalmol-2016-308932.

    Article  PubMed  Google Scholar 

  15. Schellini S, Jorge E, Sousa R, Burroughs J, El-Dib R. Porous and nonporous orbital implants for treating the anophthalmic socket: a meta-analysis of case series studies. Orbit. 2016;35(2):78–86. doi:10.3109/01676830.2016.1139591. Epub 2016 Feb 29

    Article  PubMed  Google Scholar 

  16. Mourits DL, Moll AC, Bosscha MI, Tan HS, Hartong DT. Orbital implants in retinoblastoma patients: 23 years of experience and a review of the literature. Acta Ophthalmol. 2016;94(2):165–74. doi:10.1111/aos.12915. Epub 2015 Nov 25. Review

    Article  CAS  PubMed  Google Scholar 

  17. Drobesk HP, Rothstein SS, Gumaer KI, et al. Histologic observation of soft tissue responses to implants, multifaceted particles and discs of hydroxyapatite. J Oral Maxillofac Surg. 1984;42:143–9.

    Article  Google Scholar 

  18. Roses HM, McFarland MM. The biological behavior of hydroxyapatite implanted into the maxillofacial skeleton. Plast Reconstr Surg. 1990;85:718–23.

    Article  Google Scholar 

  19. Piecuch JF. Extraskeletal implantation of a porous hydroxyapatite ceramic. J Dent Res. 1982;61:1458–60.

    Article  CAS  PubMed  Google Scholar 

  20. Chao SY, Poon CK. Histologic study of tissue response to implanted hydroxyapatite in two patients. J Oral Maxillofac Surg. 1987;45:359–62.

    Article  CAS  PubMed  Google Scholar 

  21. Kazim M, Katowitz JA, Fallon M, Piest KL. Evaluation of a collagen/hydroxyapatite implant for orbital reconstructive surgery. Ophthalmic Plast Reconstr Surg. 1992;8:94–108.

    Article  CAS  Google Scholar 

  22. Ferrone PJ, Dutton JJ. Rate of vascularization of coralline hydroxyapatite ocular implants. Ophthalmology. 1992;99:376–9.

    Article  CAS  PubMed  Google Scholar 

  23. Rubin PA, Popham JK, Bilyk JW, Shore JW. Comparison of fibrovascular ingrowth into hydroxyapatite and porous polyethylene orbital implants. Ophthalmic Plast Reconstr Surg. 1994;10:96–103.

    Article  CAS  Google Scholar 

  24. Tambe K, Pushpoth S, Mudhar HS, Sandramouli S. A histopathologic study of orbital implant vascularization. Orbit. 2009;28(1):50–7.

    Article  PubMed  Google Scholar 

  25. Jordan DR, Bawazer A. Experience with 120 synthetic hydroxyapatite implants (FCl3). Ophthalmic Plast Reconstr Surg. 2001;17(3):184–90.

    Article  CAS  Google Scholar 

  26. Perry AC. Eradication of HIV from HIV impregnated sclera. Presented at the Annual Meeting of the American Society of Ophthalmic Plastic and Reconstructive Surgery, San Francisco, California, 29 October 1994.

    Google Scholar 

  27. Guidelines for preventing transmission of human immunodeficiency virus through transplantation of human tissue and organs. U.S. Department of Health and Human Services, Centers for Disease Control, Atlanta, Georgia, 20 May 1994.

    Google Scholar 

  28. Bedrossian EH. HIV and banked fascia lata. Ophthalmic Plast Reconstr Surg. 1991;7:284–8.

    Article  Google Scholar 

  29. Michel RG, Patterson CN. Evaluation of sclera as a homograft in facial plastic and reconstructive surgery. Facial Plast Surg. 1978;86:206–13.

    Google Scholar 

  30. Bodian M. Repair of ptosis using human sclera. Am J Ophthalmol. 1968;65:352–8.

    Article  CAS  PubMed  Google Scholar 

  31. Heher K, Katowitz J, Low J. Unilateral dermis-fat implantation in the pediatric orbit. Ophthalmic Plast Reconstr Surg. 1998;14(2):81–8.

    Article  CAS  Google Scholar 

  32. Katowitz JA. Orbital expansion with dermis-fat grafts in the pediatric age group. Presented at the Annual Meeting of the American Academy of Ophthalmology, Anaheim, California, 14 October 1991.

    Google Scholar 

  33. Crawford JS, Doucet TW. Uses of fascia in ophthalmology and the benefits of autogenous sources. J Pediatr Ophthalmol Strabismus. 1982;19:21–5.

    CAS  PubMed  Google Scholar 

  34. Jordon DR, Anderson RL. Obtaining fascia lata. Arch Ophthalmol. 1987;105:1139–40.

    Article  Google Scholar 

  35. Jordan DR, Klapper SR. Chapter 14: controversies in enucleation technique and implant selection: whether to wrap, attach muscles, and peg? In: Guthoff R, Katowitz J, editors. Essentials of ophthalmology, Orbit, vol. 3. Berlin: Springer; 2008. p. 195–201.

    Google Scholar 

  36. Shah SU, Shields CL, Lally SE, Shields JA. Hydroxyapatite orbital implant in children following enucleation: analysis of 531 sockets. Ophthal Plast Reconstr Surg. 2015;31(2):108–14.

    Article  PubMed  Google Scholar 

  37. Small RG. Exenteration of the orbit: indications and techniques. In: Smith BC, Della Rocca RC, Nesi FA, Lisman RD, editors. Ophthalmic plastic and reconstructive surgery. St. Louis: Mosby; 1987. p. 1151–64.

    Google Scholar 

  38. Kherani F and Katowitz J Pediatric eyelid and conjunctival sparing orbital exenteration. Canadian Academy of Ophthalmology Annual Meeting, 2005.

    Google Scholar 

  39. Looi A, Kazim M, Cortes M, Rootman J. Orbital reconstruction and eyelid- and conjunctiva-sparing orbital exenteration. Ophthal Plast Reconstr Surg. 2006;22:1–6. Heher KL, Katowitz JA, Low JE. Unilateral dermis-fat graft implantation in the pediatric orbit. Ophthal Plast Reconstr Surg. 1998;14(2): 81–8.

    Article  PubMed  Google Scholar 

  40. Handler LF, Heher KL, Katowitz JA. Chapter 30 Management of the microphthalmic orbit. In: Katowitz JA, editor. Pediatric oculoplastic surgery. Berlin: Springer; 2002. p. 576–8.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Calgary, Calgary, Canada

    Femida Kherani

  2. Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada

    Femida Kherani

  3. Division of Oculo-Facial Plastic and Reconstructive Surgery, Department of Ophthalmology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Sonul Mehta

  4. The Children’s Hospital of Philadelphia and The Edwin and Fannie Gray Hall Center for Human Appearance, University of Pennsylvania, Philadelphia, PA, USA

    James A. Katowitz MD, FACS

Authors
  1. Femida Kherani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sonul Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James A. Katowitz MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sonul Mehta .

Editor information

Editors and Affiliations

  1. Professor Emeritus of Ophthalmology and Director of Oculoplastic and Orbital Surgery, The Children’s Hospital of Philadelphia and The Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania, USA

    James A. Katowitz

  2. Associate Professor of Clinical Ophthalmology and Director of the Oculoplastic and Orbital Surgery Fellowship Program, The Children’s Hospital of Philadelphia and The Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA

    William R. Katowitz

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Kherani, F., Mehta, S., Katowitz, J.A. (2018). Pediatric Enucleation, Evisceration, and Exenteration Techniques. In: Katowitz, J., Katowitz, W. (eds) Pediatric Oculoplastic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-60814-3_41

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-60814-3_41

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60812-9

  • Online ISBN: 978-3-319-60814-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation