Evisceration with placement of implant
This is Richard Allen at the University of Iowa. This video demonstrates an evisceration with placement of a solid spherical implant. The patient has a blind painful and has undergone preoperative ultrasound to rule out any intraocular mass. A 360 degree conjunctival peritemy is performed with Westcott scissors. This is followed by a stab incision with a super sharp blade just posterior to the limbus. A 360 degree incision is then made with Westcott scissors just posterior to the limbus. The cornea is removed and an evisceration spoon is placed into the suprachoroidal space and the intraocular contents are removed. These contents often come out piecemeal. After removal of the intraocular contents, the inside of the sclera is visualized. Cotton tipped applicators soaked in absolute ethanol are used to rub the surface of the sclera to denature any residual uvea. The sclera is then irrigated with saline. Relaxing incisions are made anteriorly in the sclera. This is followed by an incision through the posterior sclera with a 15 blade. The incision through the posterior sclera is the extended with utility scissors. Enucleation scissors are then used to transect the optic nerve. The transected optic nerve is visualized on the posterior sclera. A 20 mm PMMA sphere is then placed in the intraconal space posterior to the posterior slcera. The posterior sclera is then closed with interrupted 4-0 vicryl sutures. The anterior sclera is then imbricated and closed with a running mattress suture using the 4-0 Vicryl suture. This results in a double scleral closure over the implant. The conjunctiva is then closed with a running 7-0 vicryl suture. A conformer is placed with antibiotic ointment. I then prefer to place a temporary tarsorrhahpy with 5-0 chromic suture followed by patch of the eye of at least 4 days.