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PubMed1999

[Peribulbar anesthesia for peroperative and postoperative pain control in eye enucleation or evisceration: 31 cases].

OBJECTIVES: The aim of this prospective study was to assess peroperative and postoperative analgesia in eye enucleation or evisceration performed under peribulbar anesthesia. PATIENTS AND METHODS: We report 31 patients undergoing an eye enucleation (17 cases) or evisceration (14 cases). The surgical procedure was performed under local anesthesia alone in 22 patients. General anesthesia was associated with local anesthesia in 9 patients. Peribulbar block was achieved with the first insertion of the needle parallel to the inferior orbital floor and the second at level of supraorbital notch. A mixed anesthetic solution of equal quantity of lidocaine 2% with epinephrine (0.25 mg/20 ml) and bupivacaine 0.50% with epinephrine (0.10 mg/20 ml) was injected (total quantity 16.8 +/- 4.3 ml). RESULTS: To assess the peroperative pain we considered the patients with local anesthesia only (22 patients). One of these 22 patients needed one injection (0.50 mg/kg) of propofol for cutting the optic nerve. Surgery was ended without any other drug but that case was considered as a failure. Peroperative analgesia was obtained in 21 of 22 patients (95.4%). To assess analgesia in the postoperative period we included 31 patients. Analgesia was complete from the accomplishment of the peribulbar block to the 4th hour in all patients (efficacy 100%). From the 4th to the 24th hour, pain remained absent in 11 (enucleation 10 cases and evisceration 1 case) of the 31 patients and no drug was used. In 20 patients (enucleation 7 cases and evisceration 13 cases), pain appeared between the 4th and the 10th hour and patients were relieved by paracetamol alone in 14 cases (enucleation 6 cases and evisceration 8 cases) or by its association with nalbuphine in 5 cases (enucleation 1 case and evisceration 4 cases). In one patient (evisceration) the association of the drugs was uneffective. CONCLUSION: Peribulbar anesthesia is safe and generates major postoperative analgesia so we suggest to offer that technique to patients undergoing evisceration or enucleation.

Acetaminophen↗
PubMed1977

Analysis of misdiagnosed retinoblastoma in a series of 726 enucleated eyes.

Of 726 eyes consecutively enucleated at the Mayo Clinic from 1954 through 1974, 41 contained retinoblastoma. In no instance was unsuspected retinoblastoma identified, nor could retinoblastoma be confirmed pathologically in an additional eight eyes in which retinoblastoma was considered in the differential diagnosis. In each of our eight misdiagnosed cases, the eyes were already blind and were cosmetically defective. The frequency of clinical misdiagnosis of retinoblastoma is high in part because it must be considered in every case of leukokoria. Although every effort was made to arrive at an accurate clinical diagnosis, the clinical misdiagnosis of retinoblastoma in a blind eye is of far less serious consequence than the clinical misdiagnosis of a tumor in a seeing eye.

Child, Preschool↗
PubMed1995

Alignment ability of strabismic and eye enucleated subjects on the horizontal and oblique meridians.

For normal sighted observers visual performance is often superior on the principal meridians than on the oblique. There has been no clear consensus on whether disruption of the visual system affects performance on orientation sensitivity tasks. Here we compare the abilities of normally sighted subjects tested monocularly, subjects with one eye enucleated and strabismic subjects using the non-deviating eye, in an orientation task. Subjects were asked to align a dot with a bar that was oriented either horizontally or on the oblique. For all groups, alignments were significantly more accurate and precise for the horizontal bar as compared to the oblique bar. Normally sighted subjects were significantly more precise on alignments in the horizontal and oblique planes than strabismic subjects, using the non-deviating eye. Precision for eye enucleated subjects was similar to that of normally sighted subjects. Precision of alignments did not correlate to the age at diagnosis of strabismus or to depth of amblyopia in strabismus. We conclude that for alignment ability, the disruption of visual development produced by enucleation of eye is not equivalent to that produced by strabismus. This could represent an underlying difference in the visual system between these two groups.

Adolescent↗
PubMed1990

Contrary effect of eye enucleation on VIP-immunoreactive neurons in the suprachiasmatic nucleus and the superior colliculus of the rat.

The topographic alternation of vasoactive intestinal peptide (VIP) immunoreactivity after long-term bilateral eye enucleation (80 days) was investigated in the suprachiasmatic nucleus (SCN) and the superior colliculus of the adult rat with the peroxidase-antiperoxidase method. In the SCN, the immunostaining of VIP-immunoreactive (IR) cell bodies increased, and the intensity and density of VIP-IR fibers and terminals were markedly enhanced after eye enucleation. On the other hand, after eye enucleation, no VIP-IR cell bodies and fibers were visible in the stratum griseum superficiale of the superior colliculus, although fusiform-shaped VIP-IR neurons were distributed in the layer of unoperated control rats. The present results, therefore, have revealed that the long-term blockage of retinal input induces changes of VIP immunoreactivity in different manners, according to the target brain areas.

Animals↗
PubMed1999

A new device for ocular surgical training on enucleated eyes.

OBJECTIVE: To develop a reliable inexpensive device for teaching ocular surgical procedures and practicing experimental techniques on enucleated eyes. DESIGN: Teaching device trial. PARTICIPANTS: Thirty enucleated porcine eyes. METHODS: A Plexiglas ocular bulb holder was secured with its base support to a polyvinylchloride pillar on a modified polystyrene trial head. MAIN OUTCOME MEASURE: The convenience and reproducibility of both laser and surgical ocular techniques performed with this new device were evaluated. RESULTS: This model allows curvilinear capsulorrhexis and phacoemulsification of porcine lenses through a corneal tunnel incision and insertion of a soft foldable acrylic intraocular lens into the capsular bag. Argon and neodymium:YAG laser iridotomy and retinal argon laser photocoagulation can also be performed with this model. CONCLUSIONS: This inexpensive device is useful for teaching both surgical and laser ocular procedures.

Animals↗
PubMed1997

Unilateral eye enucleation in adult rats causes neuronal loss in the contralateral superior colliculus.

Several studies have reported the morphological changes induced by unilateral enucleation during early neonatal life on the developing visual system. This study has examined cellular changes in the superior colliculi by removal of a single eye in adult rats. Anaesthetised male hooded rats aged 90 d had their right eyes removed. Groups of nonenucleated control and enucleated rats were killed when aged either 150 or 390 d. The brains were removed and both the right and left superior colliculi dissected out. The volume of the stratum griseum superficiale (SGS) within these colliculi was estimated stereologically by light microscopy, as well as the numerical density and total number of neurons within this cell layer. The volume of the cell layer was reduced by about 40% on the side contralateral to the enucleated eye but not on the ipsilateral side at both survival periods examined. The numerical density of neurons within the SGS was unaffected by the enucleation so that the colliculi contralateral to the enucleated eye showed a substantial loss of neurons within this cells layer. This study demonstrates the importance of the retinal ganglion cell input, even in adult animals, for maintaining the viability of neurons in the SGS layer of the superior colliculus.

Animals↗
PubMed2004

Histopathology of eyes enucleated after endoresection of choroidal melanoma.

PURPOSE: To demonstrate the histopathologic features of eyes enucleated after endoresection for choroidal melanoma to assess the complications of this treatment and to determine indications for further treatment after endoresection in the setting of possible tumor recurrence. DESIGN: Retrospective, observational case series. PARTICIPANTS: Sixty-one consecutive patients who had undergone endoresection for uveal melanoma. METHODS: Eyes that had undergone enucleation after endoresection were identified, and their charts and histologic characteristics were reviewed. Pertinent features were described. One patient was excluded because enucleation was performed as a primary treatment when endoresection was abandoned at the time of his initial treatment. MAIN OUTCOME MEASURES: The outcome measures included: reasons for enucleation; tumor recurrence; and location, clinical, and histologic characteristics of each recurrence. RESULTS: Twelve eyes were identified that had undergone enucleation after endoresection. The reasons for enucleation were: (1) local tumor recurrence detected by ophthalmoscopy (2 patients) or echography (1 patient); (2) opaque media preventing adequate ophthalmoscopy (4 patients); (3) blind and painful eye of uncertain cause (1 patient); and (4) a combination of blind eye and limited fundus view (4 patients), which was the result of untreatable retinal detachment (3 patients) and endophthalmitis (1 patient). Eight of 12 patients had recurrent choroidal melanoma. Recurrences were all located adjacent to the resection site, although in 1 patient there was extensive diffuse recurrence throughout the eye. The recurrence was visible clinically in 3 patients and obscured because of opaque media (2 patients), a combination of inadequate echography and retinal detachment (1 patient), retinal detachment (1 patient), and endophthalmitis (1 patient). CONCLUSIONS: Recurrent disease occurred at the site of the primary tumor with no seeding except in 1 patient, whose marginal recurrence was not immediately detected and treated because of opaque media. As with other treatments conserving the eye, enucleation should be performed if adequate ocular examination is not possible, and follow-up should be lifelong.

Adult↗
PubMed1989

A long term study of axonal transport in the central visual system following eye enucleation in the adult cat.

The effect of the enucleation of one eye on anterograde and retrograde labelling in geniculo-cortical, cortico-geniculate and commissural projections was investigated in adult cats by means of horseradish peroxidase (HRP) and tritiated aminoacids. It was found that in addition to the immediate decrease of retrograde labelling with HRP in the cortical projections from the deafferented A-laminae of the dorsal part of the lateral geniculate nucleus (Singer et al. 1977) there is a further reduction which lasts up to 75 days after enucleation. At 146 and 363 days after enucleation a slight increase in the number of labelled neurones was noted in the deafferented lamina. Qualitative assessment did not reveal any changes of anterograde labelling with tritiated amino acids in geniculo-cortical, cortico-geniculate and commissural axones. In addition, the retrograde labelling with HRP in cortico-geniculate and commissural projections seemed to be unaffected by eye enucleation.

Amino Acids↗
PubMed1989

Effect of pinealectomy, eye enucleation, and melatonin treatment on ovarian activity and vitellogenin levels in the catfish exposed to short photoperiod or long photoperiod.

To investigate the relative importance of pineal, and eyes, and melatonin treatment on ovarian activity, catfish. Heteropneustes fossilis subjected to pinealectomy, eye enucleation, or both were exposed to short (LD 9:15) or long (LD 14:10) photoperiod during the different stages of the annual reproductive cycle. During the preparatory period, pinealectomy accelerated ovarian recrudescence under long photoperiod, but no effects of pinealectomy were observed under short photoperiod. Pineal has no influence on ovarian activity during the prespawning and spawning periods of the reproductive cycle. In the late postspawning period, ovarian recrudescence is accelerated after pinealectomy in catfish maintained under short photoperiod (LD 9:15 at 25 degrees C). But under long photoperiod (LD 14:10 at 25 degrees C), pinealectomy delayed ovarian recrudescence. An investigation into the role of the eyes revealed that eye enucleation nullifies the inhibitory effects of LD 9:15 and represses the stimulatory effects of LD 14:10. Combined surgery inhibited ovarian development under both the regimes. It is significant that pinealectomy and/or blinding neither counteracted nor delayed the postspawning ovarian regression. The findings suggest that the role of the pineal in catfish reproduction is variable and depends upon the photoperiod to which they are exposed as well as on the time of the year and the stage of the reproductive cycle. It is concluded that extraretinal and extrapineal photoreceptors also are involved in influencing seasonal reproduction. Further, no effects of melatonin treatment on ovarian activity or on vitellogenin levels during the preparatory or prespawning periods were observed, indicating that the pineal effects on gonadal activity in catfish may not be mediated through the secretion of melatonin.

Animals↗
PubMed2005

[An eleven-year experience of eye enucleation caused by severe ocular injuries].

UNLABELLED: The objective of this study was to evaluate indications for primary and delayed enucleation caused by severe eye injuries. MATERIAL AND METHODS: One hundred nine enucleations performed in the Clinic of Eye Diseases of Kaunas University of Medicine Hospital during 1993-2003 years because of severe ocular injuries were analyzed retrospectively. Fifty seven of the eyes were enucleated primarily and 52 enucleations were delayed for later period. RESULTS: The most common indications for primary enucleation were: loss of internal eyeball tissues in 40 (74.1%) cases; wide tissue defect--5 (9.3%) cases; long wound--4 (7.4%) cases; endophthalmitis and panophthalmitis--5 (9.3%) cases. The most frequent indications for delayed enucleation were: endophthalmitis and panophthalmitis in 28 (59.6%) cases; atrophia and phthisis bulbi--13 (7.7%) cases; secondary glaucoma--6 (12.8%) cases. CONCLUSIONS: Amount of enucleations performed in the Clinic of Eye Diseases of Kaunas University of Medicine Hospital because of severe ocular injuries was without a significant change during ten-year period. Enucleations were performed more frequently in male patients of employable age. The most common causes for enucleation were open globe injury and penetrating wound. Loss of internal eyeball tissues, wide tissue defect, long wound, endophthalmitis and panophthalmitis were the most common indications for primary enucleation. The most frequent indications for delayed enucleation were: endophthalmitis and panophthalmitis, atrophia and phthisis bulbi, secondary glaucoma.

Adolescent↗
PubMed1985

Increased dependence of superior colliculus metabolic activity on visual cortex after eye enucleation.

Metabolic activity, as previously shown by the 2-deoxy-D-[14C]glucose technique, is depressed in the superior colliculus after eye enucleation and recovers substantially by 30 days. To determine whether or not this recovery involves an increase in visual cortex control over superior colliculus metabolic activity, rats that had undergone either monocular or binocular enucleation 30 days earlier received visual cortex ablations. In the monocularly enucleated group, a bilateral visual cortex lesion produced greater depression in the recovered superior colliculus than in the opposite control colliculus, and increased the metabolic differences between the two colliculi compared with those of rats recovered from monocular enucleation but cortically intact. In the binocularly enucleated group a unilateral cortex lesion produced greater ipsilateral depression than did the same ablation in the otherwise intact rat. These findings led to the conclusion that the recovery in the superior colliculus that follows eye enucleation involved an increase in cortical control over metabolic activity.

Animals↗
PubMed1994

Effects of eye enucleation on NADPH-diaphorase positive neurons in the superficial layers of the rat superior colliculus.

Dihydronicotinamide adenine-dinucleotide phosphate diaphorase (NADPH-d) positive neurons in the superficial layers of superior colliculus (SC) were studied in the adult rat after eye enucleation at postnatal day 5 (P5). Bilaterally, NADPH-d histochemistry revealed either weakly or intensely labeled neurons. In the SC contralateral to the enucleation, the volume of superficial layers decreased significantly, whereas the total number of NADPH-d positive neurons was only slightly reduced, thus resulting in an increased cell density. Bilaterally, the number of NADPH-d positive neurons was around 20% of Nissl-stained neurons. While the number of neurons which were weakly positive for NADPH-d was unchanged contralateral to the enucleation (thus resulting in a significant increase in their percentage on the overall NADPH-d population), the number of intensely labeled neurons decreased by 30%. Intensely labeled neurons were classified with respect to cell size and dendritic distribution. Some (126) were reconstructed and analyzed on the computer, in order to quantitate morphological differences in dendritic distribution in the denervated and control SC. The percent of neurons which could be assigned to some classes (marginal, stellate, narrow field vertical and wide field vertical) was reduced contralateral to the enucleation. In addition, vertically-oriented neurons (narrow field vertical, wide field vertical and pyriform) showed a significant decrease in soma size, dendritic length and number of branch points. And finally, the overall orientation of dendrites on narrow and wide field vertical neurons was more dispersed, when compared to the control colliculus. Thus, P5 eye enucleation affects the adult morphology of NADPH-d positive neurons in the superficial layers of the rat SC, resulting in increased cell density, changed relative number of cells in each morphological type, and altered soma size, dendritic length and orientation in specific neurons.

Aging↗
PubMedDate not supplied

Enucleated eye model for intraocular retinal prosthesis implantation.

An enucleated porcine eye model was developed to assess intraocular retinal prosthesis implantation surgery. The surgical technique consists of corneal and crystalline lens removal, keratoprosthesis replacement, and vitrectomy. To test the eye model, the scleral incision was increased to 5 mm and a 10-mm wide retinal prosthesis folded and inserted. One retinal tack was used to fix the prosthesis to the retina. A retinal prosthesis array was inserted without significant damage to the array and conformed to the curvature of the eye. Fundus photography and optical coherence tomography were performed at the end of surgery.

Animals↗