Enucleation of the eyeball

Such surgical treatment as enucleation of the eyeball is quite rare, in exceptional cases, when only the removal of this organ gives the patient a chance to stay alive and lead a relatively normal lifestyle.

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Indications for conduction

Decide on the appointment of such an operation, the treating doctor, or a consultation of doctors, can only in exceptional cases. The indications for an operative intervention are as follows:

• Retinoblastoma or other malignant growth affecting the eye area.
• The consequence of severe trauma to the face, including the eye and, accordingly, the eyeball.
• Atrophy of the eye tissues and nerve endings.
• Prolonged inflammatory process, taking place against the background of complete blindness of the patient.
• Other pathological processes with completely impaired visual function.
• Severe form of glaucoma.
• The threat of the progression of sympathetic ophthalmia.
• Severe penetrating injury or concussion.
• Cosmetic character of the operation with subsequent plastic (installation of an implant - prosthesis).
• Strong pain symptoms in the eye with complete blindness.

Technique of operation

To date, this surgical treatment is carried out in almost all ophthalmological departments and centers. But in order to protect themselves from unpleasant consequences, the patient should choose for treatment an institution with appropriate modern clinical equipment, high professionalism and experience of doctors in conducting such operations.

Today, get acquainted with the ratings of hospitals and reviews about them, and possibly on the Internet, and talking with patients selected for treatment clinic.

After the doctor or a consultation of doctors decided on the inevitability of enucleation of the eye, the patient begins to prepare for surgery. For small patients, this procedure is performed against the background of general anesthesia, while adults receive a local disability.

Local anesthesia is usually done retrobulbarno (the drug is injected directly into the eyeball with a needle and syringe - 2 ml of a 2% solution of novocaine) or drops can be applied to the eye (1% solution of dicaine). After this, the patient is placed on the operating table.

Then the technique of the operation is as follows:

• With the help of the eyelid, the organ to be removed is opened.
• Very carefully, an experienced surgeon will separate the eyeball from its bed. Excision is carried out along the perimeter.
• Then a special surgical hook leads into the orbit.
• Supporting the body, cuts out the straight muscles, oblique remain intact.
• Cut the muscle fibers out.
• Special medical scissors are injected into the surgical wound and brought to the optic nerve, after which both its oblique and muscular fibers are cut off.
• The eyeball is extracted from the orbit.
• Bleeding is stopped with a solution of hydrogen peroxide and pressure puffing.
• Three to four catgut sutures are superimposed on the wound of the conjunctiva.
• A 30% solution of sulfacyl is added to the wound.
• A pressure bandage is applied to the site of the operation.

To create the illusion of a moving eye, a piece of fat excised from the buttock area is inserted into the eye hole. In another case, the patient undergoes plastic surgery, involving the introduction of a carefully selected eye prosthesis. It is attached by means of modern material to the tendons of the muscles remaining in the orbit.

Thanks to innovative techniques and modern materials, distinguishing an artificial eye from the present is quite problematic. This enables a person to lead a familiar social life.

Enucleation of the eyeball after brachytherapy

Brachytherapy - a kind of contact radiotherapy. The essence of the method consists in introducing into the affected organ a source of radiation damaging the damaged cells. The advantage of this measure in getting the opportunity to apply directly to the lesion center is the highest possible radiation dose. In this case, the rest of the body tissues undergo minimal "bombardment" with radiation.

Surgical treatment for complete removal of the eyeball is quite rare, in 6-11% of patients with the indications listed above. And only in one case is the enucleation of the eyeball after brachytherapy. This is a good indicator, as he says that in other cases, the eye, as an organ, managed to be preserved.

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Complications after enucleation of the eyeball

The operation is performed, after which the patient is waiting for the period of postoperative recovery and psychological rehabilitation, which can be overshadowed by postoperative complications.

Like any operation, the event under consideration is quite traumatic. Therefore complications after enucleation of the eyeball are possible:

• The development of the inflammatory process in the injured eye socket.
• Bleeding.
• Swelling of damaged tissues.
• If the requirements of sanitation were violated, it is possible that the eye is infected, which "pulls" even more dangerous consequences.
• If the prosthesis is put, then in some cases its displacement relative to the fixing point can occur. In this case, repeated surgical intervention is necessary to eliminate the defect.
• Allergic reaction to the use of certain medicines.

Postoperative period In order to prevent the development of the inflammatory process and to quickly remove swelling of tissues at the site of the operation, in the postoperative period the patient is obliged to prescribe antibiotics of a wide spectrum of action. It can be intramuscular injections, ointments and topical drops. For example, such as ciprolet, vigamox, dilaterol, ciloxane, levomycetin, tobrex, tsifran, ciprofloxacin, floxal, signicum.

Eye drops of vigamox (vigamox) drip into the area of the affected eye for at least four days. The schedule and dosage of administration are simple: one drop three times a day. At the same time, all sterility rules must be observed so that the source of infection does not enter the wound. For this, after the cap from the package is removed, do not touch the sterile objects with a pipette. The hands that conduct the instillation should be sanitized as well.

Contraindication to the use of this drug can be a high individual sensitivity to the main or auxiliary components of the drug.

With the threat of viral invasion, the patient receives antiseptic medication: okomistin, vitabact, miramistin.

For some time, the patient under treatment also receives pain medication, which allows to reduce the pain syndrome in the area of the affected eye. In most cases, the ophthalmologist appoints one of these drugs to his patient: benoxy, inocaine, alkaine.

Eye drops of an inocaine drip one drop directly into the area of the lesion. The analgesic effect of the drug can be prolonged if a triple drip is carried out at intervals of four to five minutes.

Contraindication to the use of this drug inocaine may be increased sensitivity to the components of the drug.

For the period of complete wound healing, the requirements for the sterility of materials in contact with the site of surgery should be increased.

At this stage, the psychological side is also important. The patient can painfully survive the loss of the eye and may need the help of a professional psychologist, but the psychological and physical support of loved ones can not be replaced by anything.

As already mentioned in this article, surgery, which has in medicine the term - enucleation of the eyeball - is rarely prescribed. But if the question arose about carrying it out, you should protect yourself from unpleasant consequences. For this, the patient should choose the appropriate institution for treatment. It should have a good reputation, it must be equipped with appropriate modern clinical equipment. Not the last role, but, perhaps, even the main one, has experience and qualification of doctors on the conduct of this type of surgical treatment. To solve this issue, you can use the Internet or chat with patients selected for treatment of the clinic. In psychological terms, such a patient, as never before, needs support from relatives and friends during this period.

[12], [13], [14]