Novel use of an autologous scleral button graft to close the anterior defect in evisceration surgery

ABSTRACT

Purpose

To present an alternative evisceration technique with long-term follow-up data. This technique involves the insertion of an acrylic implant into a modified scleral shell which is closed using an autologous scleral graft.

Methods

This was a retrospective analysis of eviscerations performed in a district-general hospital in the UK. All patients underwent conventional ocular evisceration after total keratectomy. A full thickness scleral graft is harvested from the posterior sclera, using an internal approach, with an 8 mm dermatological punch. An 18–20 mm acrylic implant is placed into the shell, and the scleral graft is used to close the anterior defect. Demographic characteristics, implant size and type, and cosmetic results from pictures of all patients were recorded. All patients were invited for a review to measure motility, eyelid height, patient recorded satisfaction and complications.

Results

Of the five patients identified, one had since died. The remaining four attended a review in person. The mean time between surgery and review was 48 months. The mean implant size was 19 mm. There were no cases of implant extrusion or infection. All four had a <1 mm asymmetry in measured eyelid height and ≥5 mm horizontal gaze motility. All patients self-reported “good” cosmesis. An independent assessment identified “mild asymmetry” in two cases and “moderate” in the other two.

Conclusion

Evisceration with this novel autologous scleral graft technique restores volume in the anterior orbit with good cosmetic results, and with no cases of implant exposure reported in this small case series. This technique should be compared prospectively to established techniques.

KEYWORDS:

• Evisceration
• oculoplastic
• orbit
• anophthalmic surgery

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Consent participate

Portsmouth PO6 3LYWritten informed consent was obtained from the patient(s) for their anonymized information and photos to be published in this article.

Authors contribution

All authors contributed to the concept, data analysis and report writing.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/01676830.2023.2175876

Additional information

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.