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Reconstructive

Evisceration Surgery

Best Evisceration Surgery in India

Evisceration is a surgical process that involves the extraction of ocular contents while the sclera and optic nerve are left intact — in some cases, the cornea might also remain untouched. Evisceration is more preferred because:

  • It has a relatively shorter time of completion.
  • The procedure is less cumbersome.
  • It can be conducted under retrobulbar anesthesia.
  • It gives room for orbital anatomy to be conserved better, enhanced degree of motility, and to this end, better cosmesis.

Evisceration demands a lesser degree of manipulation; a major consequence of this is that there is correspondingly less inflammation and scarring of orbital tissues (fornices and orbital tissues are left intact). This aids in the preservation of the implant. In evisceration, a lower propensity of superior sulcus deformity is encountered. This, therefore, provides an overall improvement on the cosmetic result of patients.

It is due to the fact that evisceration facilitates the whole process of extirpation and drainage of ocular contents to be devoid of orbital invasion that it is usually adopted when it comes to the treatment of endophthalmitis. Having said this, there is a myriad of motives for which an eye may be extracted by surgical resection ranging from cancers affecting the eye (like retinoblastoma or ocular melanoma), end-stage eye disease (such as diabetic retinopathy, glaucoma, or after multiple eye surgeries), to a degenerated blind and/or painful eye, as well as trauma.

However, Evisceration is weighed down by certain downsides, especially in its incapacity to provide for a complete specimen to use in pathologic assessment, in a bid to detect intraocular malignancy or proliferation, and a conjectural risk of sympathetic ophthalmia.

Preoperative Consideration

In order to guarantee the full, normal functionality of anesthesia, and smooth running of the surgery, you will have to map out a schedule with the specialist and stick vehemently to it. In making out an appointment for the surgery session, it is crucial to note that any activities that involve heavy lifting should be avoided, the prospective patient should also distance themselves from strenuous exercises and dirty environments.

Again, it is advisable to meet with an Oculoplastic surgeon to get a better understanding of the whole procedure of getting an ocular prosthesis. This will prime the patient to understand what needs to be done and give a quick preview of how the surgery would be conducted.

Potential risks

In evisceration, it is common to find the following as potential complications to the process:

  • Infection
  • Hemorrhage
  • Implant extrusion

However, as time passes on, long term complications might spring up in form of:

  • Lower eyelid laxity and ectropion
  • Sunken/Deep superior fornix
  • Socket contraction
  • Formation of cysts within and about the conjunctiva
  • Upper eyelid ptosis
  • Implant migration
  • Late extrusion of the implant.

Procedure

As previously stated above, it is exigent that the proper eye for removal is ascertained with surety.

  • A retrobulbar injection and intravenous sedation can be applied in performing a surgical process of evisceration. A retrobulbar injection of 3cc of a 50/50 mixture of 1 percent lidocaine and 0.5 percent bupivacaine with 1:100,000 units of epinephrine is administered by way of an injection to curb leaking and see to it that postoperative control of pain is guaranteed, regardless of whether controlled anesthesia or general anesthesia is utilized. After this is done, the surgeon preps and drapes the patient. A 360° limbal peritomy is performed with blunt-tipped Westcott scissors and small toothed forceps subsequent to the implantation of an eyelid speculum. The four quadrants between the recti muscles are cleared out with the aid of a pair of Steven’s scissors. To do this, we start by gripping the edge of the conjunctiva and Tenon’s capsule, pushing the scissors posteriorly along the sclera to just past the equator, then spreading the tissue by opening the scissors.
  • A tiny full-thickness scleral incision is made at a rough estimate of 1 to 2 mm posterior to the limbus. Following this, the cornea is removed by making a circumferential incision about the axis of the globe using Westcott scissors. The incision is halted just short of completion if the cornea is to be left in its original position, leaving behind a small scleral hinge. With an evisceration spoon or a Freer periosteal elevator, the intraocular contents are set apart from the sclera.
  • Gentle bipolar cautery can be used to stop bleeding from the optic nerve or penetrating arteries. Absolute alcohol and a cotton-tipped applicator are used to carefully remove the pigment. The antibiotic solution is then irrigated liberally throughout the scleral cavity. With the use of a pair of scissors, windows directed anterior to posterior are cut in the sclera in the four quadrants between the recti muscles. It is possible to open the sclera around the optic nerve as well. If a porous implant is set in place, these scleral windows thus facilitate vascular ingrowth.
  • In order to facilitate the placement of the implant into the sclera, scissors are used to make two cuts at the anterior opening of the sclera in an inferior-medial and superior-lateral orientation. In the scleral cavity, a sphere implant that could measure from 14mm up to 18 mm (as the case may be) is implanted.
  • The sclera is covered up with the aid of several interrupted 5-0 braided nylon sutures after the redundant sclera is trimmed. Multiple interrupted 5-0 Vicryl sutures are used to close Tenon’s capsule at the initial stage. Afterward, the conjunctiva is closed as well but with a 7-0 Vicryl running suture in this case. Amidst the eyelids, antibiotic ointment and a conformer are applied, and the socket is pressure patched for 4 to 7 days. For the first several days after surgery, in certain cases, surgeons prescribe prophylactic oral antibiotics. The patient is given instructions to guide in the application of antibiotic ointment to the socket two times each day for 2 to 4 weeks after the removal of the patch.
  • The conformer must be worn religiously to prevent the conjunctival fornices from shortening. The patient is ready to see the Oculoplastic Surgeon for the prosthesis fitting 6 to 8 weeks after surgery. Polycarbonate glasses, like with any monocular patient, should be worn on a regular basis to preserve the remaining eye.

Postoperative Care

After the whole process of evisceration is completed successfully, the oculoplastic surgeon will provide you with several prescriptions [such as steroid and topical antibiotics] which will help in catalyzing your rehabilitation. Asides from that, it is necessary for you to revisit the clinic in around five days to get the bandage covering the operated eye(s) taken off and the ocular prosthesis fitted over the orbital implant. It is very key to realize that once the eye pad is removed, tears with traces of blood are not a rarity as they might seem to you.

Other suggestions for your healing are now highlighted below:

  • To prevent the implants from getting moved out of position, avoid rubbing your fingers on your eyelids.
  • For the first couple of weeks after surgery completion, stay away from being immersed in deep water, whether during a bath and/or a swimming pool. In the next two weeks that follow after surgery, you should endeavor not to allow water to come into touch with the operated eye as much as possible. You can use a clean cloth and warm water to gently clean the region beneath your eyelid’s border.
  • For the next two weeks after surgery, avoid heavy lifting. These exercises would not merely prolong the normal time stipulated for your recovery, but they will also put a lot of strain on the operated eye, producing pain.

On average, recuperation time for evisceration is 4-6 weeks, but it is very probable that you have the go-ahead to resume normal activity – work or school – within 2 weeks of the procedure. Be that as it may, you should be aware that the surgeon will set up a follow-up schedule for you at various intervals to assess your healing and check for tumor recurrence. Nevertheless, keep in touch with the clinic if you notice any strange changes or reactions while you’re healing. And avoid vigorous physical exercises/activities.

Evisceration Procedure at Esthetic Clinics in India

Even as vision loss cannot be evaded, it is especially critical that you seriously ponder, and meticulously draw out the ideal evisceration surgical strategy to thwart any impending issues. The Esthetic Clinics nearby is on a mission to see to it that the evisceration procedure in India is conducted in the smoothest possible manner. Our plastic surgeons, cosmetic surgeons, and other medical professionals work together as a team to see to it that you get the best evisceration surgical/medical routine performed on you. In a dedication premised upon the ideals of excellence and professionalism. Over the years, our fine standards, and quality assurance have placed us in a separate league.

We have at our disposal a celebrity oculoplastic and cosmetic surgeon in Dr. Debraj Shome, who has rolled out several publications and won a handful of noteworthy accolades to his name. With state-of-the-art facilities and equipment, The Esthetic Clinics is one of the world’s top medical centers today, and we are always ready to handle your situation with the urgency it deserves.

Evisceration Surgery in India: How Much Does It Cost?

The implant attachment technique chosen, as well as the size of the implant required, will impact the cost of evisceration surgery. Other factors influencing the cost of evisceration surgery are the severity of your disease and the surgeon’s charge

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About Doctor

Dr. Debraj Shome

Dr. Debraj Shome is Director and Co founder of The Esthetic Clinics. He has been rated amongst the top surgeons in India by multiple agencies. The Esthetic Clinics patients include many international and national celebrities who prefer to opt for facial cosmetic surgery and facial plastic surgery in Mumbai because The Esthetic Clinics has its headquarters there.



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