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The article by Eagle et al1 and the editorial in reference to it2 are most important, and obviously will change the surgical management of blind, painful eyes. This article has far wider clinical implications than just indicating the danger in eviscerating eyes with occult neoplasia.
An intraocular malignant melanoma is also life threatening when no evisceration is performed. Thus, it should be stressed that all patients with blind eyes should undergo monitoring for occult neoplasm periodically, not only before surgery. B-scan ultrasound should be used whenever the media is opaque. Moreover, when the results are inconclusive, the possibility of occult intraocular neoplasia may be an indication for enucleation, even when the blind eye is not painful.
The same evaluation should be performed before enucleation as before evisceration. Leaving a malignant tumor in the orbit is as dangerous after enucleation as after evisceration. Enucleated eyes should be carefully inspected after they are removed, and any areas suspected of extraocular tumor extrusion should be examined by frozen sections. If findings are positive, orbital biopsies are indicated, and even exenteration, according to the results.
It is most important to collect data on hidden neoplasm in blind eyes so their prevalence will be known.
Personally, I prefer performing evisceration over enucleation in all cases when the possibility of hidden intraocular tumor is excluded. Evisceration is shorter in duration than enucleation, and the results are good. In patients who could not undergo surgery with general anesthesia, evisceration was performed using retrobulbar anesthesia, though I would not suggest this for enucleation.
Correspondence: Dr Rosner, The Goldschleger Eye Institute, Tel-Aviv University, Sackler Faculty of Medicine, Sheba Medical Center, 52621 Tel-Hashomer, Israel (mrosner@post.tau.ac.il).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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