Enucleation of globe with extrascleral extension of melanoma
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 03:59
This video demonstrates an enucleation in a patient with an iris melanoma with extra scleral extension. The area of extra scleral extension has been marked with a marking pen on the conjunctiva. Westcott scissors are then used to perform a peritemy up to the marking nasally. The area is spared of any further dissection in that area and will be addressed later. Stevens scissors are then used to bluntly dissect into the quadrants between the rectus muscles. Care is taken not to be too vigorous around the area of the tumor. A muscle hook is then used to hook the lateral rectus muscle and this muscle is then tagged with a 5–0 Vicryl suture in a locking fashion. The suture is then used to abduct the eye so that the conjunctiva can then be excised in the area of the markings. Again this is a no touch technique in the area of the tumor. Dissection is then carried out along the posterior surface of the conjunctiva and the Tenons to spare any disturbance of the tumor. The medial rectus muscle is then hooked with the muscle hook. The muscle is then tagged with a 5–0 Vicryl suture posterior to the area of the posterior extension of the tumor. This is performed in order not to disturb the area of the tumor. The medial rectus is then transected with Wescott scissors just anterior to the locking suture. The lateral rectus is then disinserted with Westcott scissors. The inferior rectus is then then hooked and tagged with the suture. The same is performed with the superior rectus muscle. A cuff of rectus muscle is left at the insertion. In this case the vertical muscle insertions are tagged with a 4–0 Silk suture in order to provide traction. This is in contrast to the typical enucleation in which the traction sutures are placed through the insertions of the horizontal rectus muscles. The superior oblique tendon is hooked and transected. The inferior oblique muscle is then hooked and transected with the cautery. Metzenbaum scissors are then used to transect the optic nerve. The globe is removed and sent to the pathologist for evaluation. The globe is inspected and the area of the melanoma is noted. It appears to be completely resected.
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