Services / Ophthalmological surgeries / Ophthalmic reconstructive surgery

Ophthalmic reconstructive surgery

Ophthalmic reconstructive surgery is the restoration of the appearance of the eye after removal of the eyeball.

Enucleation and evisceration are the most dramatic and definitive procedures performed on the eye, involving removal of the eyeball. They are performed when a patient’s life is at risk (e.g. cancer), or when they experience extreme soreness of the blind eye (e.g. after an eye trauma).

Enucleation is the removal the entire globe along with a part of the optic nerve. The surgeon leaves the eyelids, orbital fatty tissue, blood vessels, as well as the nerves and muscles responsible for eye motility. Typically, after enucleation, the muscles, all orbital tissues and the conjunctiva are sutured with Tenon’s pouch. For a better cosmetic effect, a prosthesis of the size similar to the removed eye is inserted in place of the eye. The oculomotor muscles are sutured to the prosthesis so that the implant can move.
Evisceration is a surgical technique which involves removing all intraocular contents while preserving the remaining scleral shell. Theses days more and more often an orbital implant is placed straight after evisceration. The surgical procedure ends with the placement of a conformer over the implant, which serves a liner under the eyelid that allows the eye to retain its shape.

PRACTICAL INFORMATION

Before an orbital reconstruction it is necessary to undergo a pre-assessment at the Retina Ophthalmological Outpatient Clinic and Hospital. During the visit we will take your medical history, perform full ophthalmological exam and the necessary diagnostic tests.

Kalkulator MediRaty

Indications for enucleation or evisceration of the eyeball

unresectable tumours,
blind, painful eyeball, not amenable to pharmacological and surgical treatment (e.g. after trauma, after surgery, in the course of glaucoma).
cosmetic (if lacking a sense of light),
optic nerve aplasia and hypoplasia,
prevention of sympathetic ophthalmia,
intraocular inflammation in eyes without sense of light, not amenable to standard treatment,
severe trauma to the eye, the extent of which prevents reconstruction of the eyeball.

Potential post-operative complications associated with enucleation or evisceration

purulent discharge associated with tissue infection,
post-operative wound dehiscence,
cysts and inflammatory nodules in the orbit
fusion of tissues in the folds of the conjunctival sac,
post-enucleation socket syndrome (characterized by drooping of the upper eyelid, deepening of the upper eyelid sulcus and/or collapse of the orbit). This causes facial asymmetry and problems with fitting the prosthesis.

Therefore, it is recommended to place an orbital implant straight after the removal of the eyeball. Their presence in the orbit prevents the development of post-enucleation socket syndrome.

What is an orbital implant

An orbital implant is an eyeball implant that fills the space left after the removal of the eyeball.

The placement of such an implant prevents drooping of the upper eyelid, deepening of the upper eyelid sulcus and collapse of the orbit. Many implants allow for the suturing of the oculomotor muscles, giving it a chance for partial mobility. The placement of an orbital implant allows to fill the space after the removal of the eyeball, so that a better cosmetic effect can be achieved, thus improving the patient’s comfort.

The implant prepares the patient for the insertion of an epi-prosthesis.

Once the conjunctiva covering the implant has healed, an epi-prosthesis, or an ‘artificial eye’, is applied.

The epi-prosthesis is modeled after the other eye, with the same iris color and similar scleral vasculature. The epi-prosthesis is held in place by the eyelids and adheres to the previously placed orbital implant.

Types of orbital implants

There are different types of ocular implants:

ocular implants that integrate with orbital tissues – they are porous, allowing blood vessels and connective tissue to grow into them. Such implants are made of materials that resemble natural bone-building materials – hydroxyapatite or polyethylene.
ocular implants that do not integrate with orbital tissues – they are made of silicone, which is a solid and biologically inert material used in medicine. Preventing vessels from growing into the interior, they do not integrate with the orbit.
mixed hydroxyapatite-silicone implants (e.g. the Guthoff implant) – the front is made of hydroxyapatite and the back is made of silicone. In Guthoff implants silicone ensures adequate mobility of the implant in the orbit, as it does not allow vessels or connective tissue to overgrow and block movement.

Ocular implants are always tailored to the patient’s needs. The selection of an implant is preceded by a consultation, during which the doctor will assess the condition of the orbit and measure diagnostic parameters to select the right eyeball implant.

Possible complications associated with secondary orbital implant surgery

exposure, migration and expulsion of the implant,
rarely – infection and hemorrhage that is difficult to control.

Pre-operative recommendations

on the day of the surgery, you should report to the Clinic wearing comfortable clothes (e,g. a tracksuit); you will be given a disposable patient bodysuit
on the day of the surgery do not put on facial or eye makeup,
prescribed chronic-use medications should be taken at the usual time, except the ones listed below,
3-7 days before the surgery patients should discontinue blood thinners, such as: Acard, Aspiryna, Aspro C, Asprocol, Polopiryna, Rhonal, Ring N, Solucytel, Thomapyrin, Pradaxa, Xarelto, Plavix, Warfin, Acenokumarol.

Prior to the scheduled surgery you will be provided with additional detailed information

How long is an orbital reconstruction surgery?

Orbital reconstruction surgery is performed under combined anesthesia (local anesthesia with sedation). This means that the anesthesiologist administers intravenous sedatives and painkillers, while the ophthalmologist anesthetizes the eye topically.

The entire procedure is completely painless and it takes up to 2 hours. The patient is discharged after they have rested for about an hour.

Immediately after the surgery the patient may experience significant discomfort within the area of the removed eye. Swelling, redness, and inflammation may occur. Hematomas, soreness of the affected tissues, vomiting, nausea and severe orbital pain are also frequently observed.

Important after an orbital reconstruction surgery

After the surgery the patient usually remains at the Retina Ophthalmology Hospital for about an hour. If necessary, they will be given painkillers and antiemetics. A pressure dressing is applied to prevent postoperative bleeding.
After the procedure the patient should not use public transport, and should be escorted home by an adult companion.
For 24 hours after anesthesia the patient cannot drive, operate dangerous equipment or drink alcohol.
After the surgery the face should not be immersed in water and the eye should be kept dry, as this can lead to infection. For 3 weeks caution should be exercised when bathing, until the wound becomes watertight.
For 2-3 weeks after the surgery patients should abstain from doing work that requires a lot of physical effort (e,g., moving heavy furniture or lifting over 15 kilograms).
The dressing remains on the patient’s eye until the first follow-up visit, which takes place the day after the procedure. Then next follow-up visits are scheduled.
A conformer, which is a type of liner that allows the eye to retain its shape, remains on the eye for about two weeks, allowing the eye to retain its shape.
Ophthalmic drops should be used according to the regime specified in the treatment information sheet.

After the surgery the patient receives a set of detailed information and instructions from our staff.