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Introduction
The use of either enucleation or evisceration for the management of severe ocular trauma, intraocular malignancy, blind painful eye, endophthalmitis, and cosmesis has been compared for more than a century.1 Historically, enucleation has been preferred by many surgeons, perhaps due to the perceived risk of sympathetic ophthalmia after evisceration, but the latter has gained renewed interest with expanding indications that may offer fewer complications.2 We administered an Internet-based survey to members of the American Society of Ophthalmic Plastic and Reconstructive Surgeons (ASOPRS) to determine the current attitudes regarding enucleation and evisceration management and compared them to historical trends. The complete survey is available as supplemental material in the PDF version of this article.
Patients and Methods
E-mails were sent to 552 ASOPRS members inviting them to complete a 36-question Internet-based survey that compiled their answers anonymously. The questions focused on determining training background, preference for evisceration versus enucleation, imaging modalities, implant materials, wound-closure techniques, postoperative complications observed, and indications for which procedures were performed.
Many questions contained an option for participants to type in a response if their answer choice was not listed. Respondents were not required to answer every question and some questions allowed participants to select one or more answer. The data were entered into a database and statistical analysis was performed using OpenEpi software (Atlanta, GA).
Results
A total of 113 surveys were completed, representing a 20.4% response rate. Based on the average number of procedures performed over the past year and number of years post-fellowship, this survey represents more than 11,000 eviscerations and 14,000 enucleations. Table 1 indicates the number of years since surgeons completed fellowship training, stratified further into whether they perform evisceration and/or enucleation. Overall, 94.6% of respondents perform evisceration and 97.8% perform enucleation; the indications for which these were performed are displayed in Table 2.
Participants were asked to choose their top imaging modality to evaluate eyes with opaque media prior to enucleation or evisceration. The most common choice was B-mode ultrasonography, regardless of whether enucleation or evisceration was performed (Table 3). Participants were also asked to choose up to two favored implant materials used in evisceration or enucleation. Regarding implant materials, Medpor (Stryker Craniomaxillofacial, Portage, MI) and acrylic appeared to be slightly favored...