Orbital exenteration: The 10-year Massachusetts Eye and Ear Infirmary experience.
The authors report their experience with orbital exenteration surgery at one academic institution over a 10-year period and review the literature. This retrospective cohort study monitored outcomes of all patients who underwent orbital exenteration surgery at Massachusetts Eye and Ear Infirmary between January 2003 and January 2013. Patients with no follow-up data or survival data were excluded from the study. The main outcome measures were surgical complications, disease status of surgical margins, need for adjuvant treatment, local recurrence, metastases and survival. 23 patients with malignancy and 2 with mucormycosis met inclusion criteria for the study. Surgical procedures included non-lid sparing total exenteration (44%), lid-sparing total exenteration (32%), non-lid sparing partial exenteration (8%) and lid-sparing partial exenteration (16%). 44% underwent additional extra-orbital procedures. Survival rates were 72% at 1 year, 48% at 3 years, and 37% at 5 years. Of patients with malignancies, 48% had clear margins after exenteration. There was no statistically significant difference in survival between patients with negative surgical margins compared to positive margins (p = 0.12). Mortality was highest in patients with melanoma (85.7%) and lowest in patients with non-squamous cell lid malignancies (0%). Our study suggests that the type of disease has a much greater impact on the survival of patients undergoing exenteration surgery than the type of exenteration surgery or the disease status of surgical margins. Patients with non-squamous cell lid malignancies and localized orbital disease have the best prognosis for tumor eradication from this radical and highly disfiguring surgery.
a Department of Ophthalmology , Frimley Park Hospital , Surrey , United Kingdom.
Sonali T
ST
Nagendran
b Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA.
N Grace
NG
Lee
b Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA.
Aaron
A
Fay
b Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA.
Daniel R
DR
Lefebvre
b Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA.
Francis C
FC
Sutula
b Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA.
Suzanne K
SK
Freitag
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006782:Hospitals, Special; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009091:Mucormycosis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D009885:Ophthalmology; D017233:Orbit Evisceration / Q000706:statistics & numerical data; D009916:Orbital Diseases / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D020273:Orbital Implants; D009918:Orbital Neoplasms / Q000601:surgery*; D010036:Otolaryngology; D012189:Retrospective Studies; D013524:Surgical Flaps; D015996:Survival Rate
D000935:Antifungal Agents
Mucormycosis; orbital disease; orbital exenteration; tumour