Korean J Ophthalmol.  2019 Aug;33(4):366-370. 10.3341/kjo.2018.0052.

Orbital Exenteration: A 23-year Report

• Kasaee A
• Eshraghi B
• Nekoozadeh S
• Ameli K
• Sadeghi M
• Jamshidian-Tehrani M

• KMID: 2454778
• DOI: http://doi.org/10.3341/kjo.2018.0052

Abstract

PURPOSE
Orbital exenteration is a psychologically and anatomically disfiguring procedure which indicated in some patients with malignant or progressive diseases of orbital and periorbital area. In this study, we reviewed 176 patients that underwent orbital exenteration.
METHODS
This was a retrospective study of medical records from all patients who underwent orbital exenteration from March 1991 to March 2014 in oculoplastic department at an eye care center. Demographic data, diagnosis, site of primary involvement and technique of surgery were determined in patients.
RESULTS
One hundred seventy-six cases of orbital exenteration were included that had documented histopathology. The age of patients ranged from 1 to 91 years (mean age ± standard deviation, 55.43 ± 27 years). Ninety-seven (55.11%) males and 79 (44.88%) females were included. Fifteen different tumors were identified. The most common indication was patients with basal cell carcinoma 49 (28%) followed by 41 (23.5%) squamous cell carcinomas, 35 (20%) retinoblastoma, and 13 (7%) adenoid cystic carcinomas. In total, adnexal malignancies were the most common tumors, secondarily involving the orbit. Eyelids 89 (50.5%) and the globe 43 (24%) were the most frequent site of involvement. Three types of exenteration were performed, based on available data of 129 operation sheets, 46 (35.7%) subtotal, 62 (48.1%) total, and 21 (16.3%) cases of extensive exenterations. In total 97 cases were evaluated pathologically for perineural involvement, of which perineural invasion was noted in 9 (7%) reports.
CONCLUSIONS
Frequency of exenteration in our center has increased in past 3 years and the majority of cases were eyelid basal cell carcinoma. Patient education considering periocular lesions can help in earlier diagnosis of malignant lesions and therefore reducing the number of exenteration.

Keyword

Basal cell carcinoma; Orbital exenterartion; Perineural

MeSH Terms

Carcinoma, Adenoid Cystic
Carcinoma, Basal Cell
Carcinoma, Squamous Cell
Diagnosis
Eyelids
Female
Humans
Male
Medical Records
Orbit*
Patient Education as Topic
Retinoblastoma
Retrospective Studies

Reference

1. Rose GE, Wright JE. Exenteration for benign orbital disease. Br J Ophthalmol. 1994; 78:14–18.

2. Bartisch G. Ophthalmodoulcia. Dresden. 1583; 3:208.

3. Golovine SS. Orbito-sinus exenteration. Ann Ocul. 1909; 141:413–431.

4. Shields JA, Shields CL, Suvarnamani C, et al. Orbital exenteration with eyelid sparing: indications, technique, and results. Ophthalmic Surg. 1991; 22:292–297.

5. Frezzotti R, Nuti A. Repair after orbital exenteration. Personal technique. Acta Neurochir (Wien). 1982; 60:119–124.

6. Shore JW, Burks R, Leone CR Jr, McCord CD Jr. Dermis-fat graft for orbital reconstruction after subtotal exenteration. Am J Ophthalmol. 1986; 102:228–236.

7. Bartley GB, Garrity JA, Waller RR, et al. Orbital exenteration at the Mayo Clinic. 1967–1986. Ophthalmology. 1989; 96:468–473.

8. Nagendran ST, Lee NG, Fay A, et al. Orbital exenteration: the 10-year Massachusetts Eye and Ear Infirmary experience. Orbit. 2016; 35:199–206.

9. Rahman I, Cook AE, Leatherbarrow B. Orbital exenteration: a 13 year Manchester experience. Br J Ophthalmol. 2005; 89:1335–1340.

10. Mohr C, Esser J. Orbital exenteration: surgical and reconstructive strategies. Graefes Arch Clin Exp Ophthalmol. 1997; 235:288–295.

11. Levin PS, Dutton JJ. A 20-year series of orbital exenteration. Am J Ophthalmol. 1991; 112:496–501.

12. Naquin HA. Exenteration of the orbit. AMA Arch Ophthalmol. 1954; 51:850–862.

13. Rathbun JE, Beard C, Quickert MH. Evaluation of 48 cases of orbital exenteration. Am J Ophthalmol. 1971; 72:191–199.

14. Kennedy RE. Indications and surgical techniques for orbital exenteration. Adv Ophthalmic Plast Reconstr Surg. 1992; 9:163–173.

15. Maheshwari R. Review of orbital exenteration from an eye care centre in Western India. Orbit. 2010; 29:35–38.

16. Pushker N, Kashyap S, Balasubramanya R, et al. Pattern of orbital exenteration in a tertiary eye care centre in India. Clin Exp Ophthalmol. 2004; 32:51–54.

17. Sihota R, Tandon K, Betharia SM, Arora R. Malignant eyelid tumors in an Indian population. Arch Ophthalmol. 1996; 114:108–109.

18. Shields JA, Shields CL, Demirci H, et al. Experience with eyelid-sparing orbital exenteration: the 2000 Tullos O. Coston Lecture. Ophthalmic Plast Reconstr Surg. 2001; 17:355–361.

19. Ben L, Aemero M, Gushchin AG, et al. Clinico-pathological patterns of patients who underwent orbital exenteration in a tertiary eye hospital of Nepal. Ethiop J Health Sci. 2016; 26:543–548.

20. Kaur A, Khattri M, Jaiswal V. Pattern of orbital exenteration at a tertiary eye care centre in North India. Nepal J Ophthalmol. 2012; 4:64–67.

21. Goh AY, Layton CJ. Evolving systemic targeted therapy strategies in uveal melanoma and implications for ophthalmic management: a review. Clin Exp Ophthalmol. 2016; 44:509–519.

22. El-Sawy T, Sabichi AL, Myers JN, et al. Epidermal growth factor receptor inhibitors for treatment of orbital squamous cell carcinoma. Arch Ophthalmol. 2012; 130:1608–1611.

23. Gill HS, Moscato EE, Chang AL, et al. Vismodegib for periocular and orbital basal cell carcinoma. JAMA Ophthalmol. 2013; 131:1591–1594.

24. Pathak C, Pawah S, Singh G, et al. Prosthetic rehabilitation of completely blind subject with bilateral customised ocular prosthesis: a case report. J Clin Diagn Res. 2017; 11:ZD06–ZD08.

25. Hatamleh MM, Haylock C, Hollows P, et al. Prosthetic eye rehabilitation and management of completely blind patients. Int J Prosthodont. 2012; 25:631–635.