title: Direct fixation of extraocular muscles to a silicone sphere: a cost-sensitive, low-risk enucleation procedure.
abstract: OBJECTIVE
  To describe a simple, cost-sensitive enucleation technique and to evaluate it in the context of intended benefits and long-term outcomes of alternate methods.
  
  
  METHODS
  A retrospective record review of patients who underwent enucleation using the described technique at a single institution by 2 surgeons. Surgery involved direct fixation of extraocular muscles to a solid silicone sphere, using nonabsorbable braided sutures with knots tied beneath the muscle insertions. Outcome measures included implant-related complications.
  
  
  RESULTS
  Seventy-five patients meeting inclusion criteria ranged in age from 3 to 94 years (mean, 54 years; median, 56 years). Surgical indications included a blind painful or disrupted eye in 56 cases; uveal melanoma in 15 cases; retinoblastoma in 2 cases; and endophthalmitis in 2 cases. Follow-up intervals ranged from 3 to 57 months (mean, 27 months; median, 22 months). Complications requiring surgical revision of the implant occurred in 2 of the 75 cases (one luxation; one exposure). There were no instances of chronic socket discharge or implant infection.
  
  
  CONCLUSIONS
  Nonabsorbable-suture attachment of muscles to a solid silicone implant offers an inexpensive enucleation option, with minimal risk of implant migration, exposure, or infection. In light of widespread disaffection with pegging of porous implants, and with no motility advantage of unpegged porous over nonporous implants, consideration should be given to techniques that are equally effective, less costly, and perhaps more reliable.
authors.affiliation: Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, WI, USA. twells@mcw.edu
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Wells
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015353:Eye Enucleation / Q000191:economics* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D020273:Orbital Implants; D017063:Outcome Assessment, Health Care; D019919:Prosthesis Implantation / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D012828:Silicones; D013536:Suture Techniques; D055815:Young Adult
chemical_list: D012828:Silicones