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Trans Am Ophthalmol Soc. 2005;103:568-91.

A comparison of implant extrusion rates and postoperative pain after evisceration with immediate or delayed implants and after enucleation with implants.

Author information

  • Department of Ophthalmology, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA.

Abstract

PURPOSE:

To examine implant extrusion rates after evisceration with immediate or delayed implants in patients with culture-proven endophthalmitis. To compare postevisceration and postenucleation pain.

METHODS:

This prospective, nonrandomized interventional case series included four groups of patients: group 1, 25 endophthalmitis patients undergoing evisceration with immediate implants; group 2, 15 endophthalmitis patients undergoing evisceration with delayed implants; group 3, 31 patients without endophthalmitis undergoing evisceration with immediate implants; and group 4, eight patients undergoing enucleations with implants. Standardized techniques and follow-up schedules were used. Postoperative pain was assessed by weighted frequency of pain medications used during two 48-hour periods. Statistical analysis was performed. Retrospective review of two series of patients undergoing evisceration was performed.

RESULTS:

No cases of implant extrusion occurred during an average follow-up of 37.9 months. Average implant size was 19.0 mm. Conjunctival dehiscence occurred in one patient. Average total pain scores were 20.8 in endophthalmitis patients with immediate implants; 22.1 in endophthalmitis patients with delayed implants; 20.3 in patients without endophthalmitis and with immediate implants; and 23.1 in patients with enucleations and immediate implant insertions. Retrospective review suggested possible causes of implant extrusion.

CONCLUSION:

Both immediate and delayed implant techniques appear safe in patients with endophthalmitis, with the former being simpler, more cost-effective, and perhaps less painful. Prolonged antibiotic therapy and smaller implants may render a false sense of security against implant extrusion; good surgical technique and meticulous postoperative wound care are essential. Postenucleation pain appears more severe than postevisceration pain.

PMID:
17057818
[PubMed - indexed for MEDLINE]
PMCID:
PMC1447574
Free PMC Article
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