Orbital exenteration: a 15-year study of 38 cases.
OBJECTIVE
To determine the clinical indications and outcomes after orbital exenteration when histologic margins were reported as "clear," examining factors affecting local and systemic recurrences and mortality.


METHODS
Retrospective case review of exenterations performed in Sydney Eye Hospital in Sydney, Australia, between 1990 and 2004. Reviewed data indications for exenteration, histopathologic diagnosis, and recurrences on follow-up.


RESULTS
Secondary intraorbital spread of malignant adnexal tumors was the most common indication for exenteration (34 of 38). Among these, the site of the primary neoplasm was the eyelid in 19 cases and the ocular surface in 12 cases. Exenteration was total in 26 cases, subtotal in 8 cases, and extended in 4 cases. In 11 cases, a dermis-fat graft was used for socket reconstruction; 24 cases were allowed to granulate spontaneously. The average healing time was 5 months (range, 4-6 months) for spontaneous granulation, and 6 weeks (range, 4-8 weeks) for dermis-fat grafts. Perineural spread was demonstrated histopathologically in 7 specimens. During follow-up (median, 48 months), there were 9 recurrences (23.7%): 3 local and 6 systemic. Seven patients (18.4%) died of the disease during the follow-up period.


CONCLUSIONS
Dermis-fat grafts for reconstruction of the exenterated socket seem to optimize the aesthetic results. The first year is the most important period for follow-up of local recurrences, but systemic examination is needed for the longer follow-up. This may have implications in terms of reconstruction and adjunctive treatment following exenteration surgery.
Nemet
Arie Y
AY
Department of Ophthalmology, Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia.
Martin
Peter
P
Benger
Ross
R
Kourt
Georgina
G
Sharma
Vidushi
V
Ghabrial
Raf
R
Danks
Jenny
J
D000273:Adipose Tissue / Q000637:transplantation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005134:Eye Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D017233:Orbit Evisceration; D012189:Retrospective Studies; D016896:Treatment Outcome