Enucleation and Evisceration: 20 Years of Experience

Objective: To determine the indications, relative frequencies, surgical times, and complications for enucleation and evisceration performed at a single academic center. Methods: Medical records of all patients who underwent an enucleation or evisceration between January 1st, 1990 and December 31st, 2009 at a single academic center were reviewed. Patient demographics and surgical indications, times, and complications were recorded. Results: A total of 85 eyes in 85 patients underwent enucleation (n = 31; 36%) or evisceration (n = 54; 64%) during the study period. Almost all patients were of African descent (96%). The most common underlying cause leading to eye removal was trauma. On average, eviscerations (47.3 +/- 10.3 minutes) took significantly less time to perform than enucleations (89.6 +/- 10.1 minutes; p < 0.01). Complications included implant exposure, infection, lower lid laxity, fornix insufficiency, and need for subsequent surgery; the occurrence of these complications was found to be similar between the two groups (p = 0.77). No case of sympathetic ophthalmia or inadvertent evisceration of an eye with an occult intraocular malignancy was noted. From the first decade for which data were available (1990-1999) to the second decade (2000-2009), the average number of enucleations decreased (p = 0.02) and the average number of eviscerations (p = 0.04) increased. Conclusion: Evisceration was found to be a safe and quicker alternative to enucleation in our study. A change in surgical preference from enucleation to evisceration was seen during the 20-year study period.