Enucleation and Evisceration: A 10-Year Analysis of Postoperative Complications and Sympathetic Ophthalmia Risk at a Major Australian Tertiary Hospital, With a Review of the Current Literature

TL;DR

This study compares enucleation and evisceration surgeries over 10 years, finding that enucleation leads to more postoperative complications but no cases of sympathetic ophthalmia.

Contribution

A 10-year analysis of postoperative complications and SO risk in enucleation vs. evisceration surgeries at an Australian hospital.

Findings

Enucleation surgeries had more postoperative complications (35.7%) than evisceration (15.6%).

Implant complications were more common in enucleation (21.7%) than evisceration (3.1%).

No cases of sympathetic ophthalmia were reported in either group.

Abstract

Purpose: This study aims to compare postoperative outcomes between enucleation and evisceration surgery over a 10-year period at an Australian tertiary public hospital.

Methods: Retrospective chart review of patients who underwent primary enucleation or evisceration surgery at the Princess Alexandra Hospital between 1st March 2014 and 1st March 2024. After inclusion and exclusion criteria were applied, 73 eyes remained in the study (45 evisceration; 28 enucleation).

Results: Larger-sized implants were used in the enucleation cohort compared to the evisceration cohort (p=0.011). Enucleation surgeries (35.7%) had more postoperative complications than the evisceration group (15.6%) (p=0.004). The enucleation cohort had a higher prevalence of implant complications (exposure or extrusion) (21.7%) compared to the evisceration cohort (3.1%) (p=0.029). The prevalence of implant complications between evisceration and enucleation was not statistically significant for birth sex, race, surgery indication, implant material, or implant size. There was no reported sympathetic ophthalmia (SO) in either cohort.

Conclusions: There was no reported SO among the two groups. Patients who underwent enucleation surgery were, however, significantly more at risk of experiencing a postoperative complication and implant exposure or extrusion. There is poor follow-up compliance in patients who have undergone anophthalmic surgery in the Australian public hospital system. Improving patient education and surgical guidelines may help achieve better postoperative outcomes and follow-up durations after anophthalmic surgery.

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