title: Worldwide enucleation techniques and materials for treatment of retinoblastoma: an international survey.
abstract: OBJECTIVE
  To investigate the current practice of enucleation with or without orbital implant for retinoblastoma in countries across the world.
  
  
  METHODS
  A digital survey identifying operation techniques and material used for orbital implants after enucleation in patients with retinoblastoma.
  
  
  RESULTS
  We received a response of 58 surgeons in 32 different countries. A primary artificial implant is routinely inserted by 42 (72.4%) surgeons. Ten (17.2%) surgeons leave the socket empty, three (5.2%) decide per case. Other surgeons insert a dermis fat graft as a standard primary implant (n=1), or fill the socket in a standard secondary procedure (n=2; one uses dermis fat grafts and one artificial implants). The choice for porous implants was more frequent than for non-porous implants: 27 (58.7%) and 15 (32.6%), respectively. Both porous and non-porous implant types are used by 4 (8.7%) surgeons. Twenty-five surgeons (54.3%) insert bare implants, 11 (23.9%) use separate wrappings, eight (17.4%) use implants with prefab wrapping and two insert implants with and without wrapping depending on type of implant. Attachment of the muscles to the wrapping or implant (at various locations) is done by 31 (53.4%) surgeons. Eleven (19.0%) use a myoconjunctival technique, nine (15.5%) suture the muscles to each other and seven (12.1%) do not reattach the muscles. Measures to improve volume are implant exchange at an older age (n=4), the use of Restylane SQ (n=1) and osmotic expanders (n=1). Pegging is done by two surgeons.
  
  
  CONCLUSIONS
  No (worldwide) consensus exists about the use of material and techniques for enucleation for the treatment of retinoblastoma. Considerations for the use of different techniques are discussed.
authors.affiliation: Department of Ophthalmology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Daphne L
authors.initials: DL
authors.lastname: Mourits
authors.affiliation: Department of Ophthalmology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Dyonne T
authors.initials: DT
authors.lastname: Hartong
authors.affiliation: Department of Ophthalmology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Machteld I
authors.initials: MI
authors.lastname: Bosscha
authors.affiliation: Department of Ophthalmology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Roel J H M
authors.initials: RJ
authors.lastname: Kloos
authors.affiliation: Department of Ophthalmology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Annette C
authors.initials: AC
authors.lastname: Moll
mesh_terms: D003657:Decision Making; D015353:Eye Enucleation / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D038622:Internationality; D012175:Retinoblastoma / Q000601:surgery*; D011795:Surveys and Questionnaires