Enucleation and evisceration: an analysis of indications, histopathological findings, and surgical trends over 23 years at a tertiary care hospital in western Canada

Abstract

Objective: To report indications for eye removal, histopathological diagnosis, and surgical trends in enucleation versus evisceration over a 23-year period.

Design: Retrospective consecutive case series.

Participants: All patients undergoing enucleation or evisceration at the Royal Alexandra Hospital in Edmonton, Canada, between January 1994 and December 2016.

Methods: Demographic information was recorded and archived hospital charts were accessed and reviewed for clinical diagnosis, histopathological diagnosis, and the type of implant used. Univariate and multivariable logistic regression analysis was performed. The study cohort was divided into 2 time periods by separating the first 10 years of the study period (1994-2004 inclusive) from the rest of the study time period (2005-2016 inclusive).

Results: A total of 786 patients with a mean age (± SD) of 52 ± 23 years were included. The most common clinical diagnosis was blind painful eye (56%) followed by intraocular tumour (23%). Corresponding pathological examination of specimens revealed chronic inflammatory change (46%) and intraocular tumour (25%). Eyes with active infection were more likely to be eviscerated (odds ratio: 4.67; p < 0.001) when compared to other diagnostic groups, and all eyes diagnosed with intraocular tumours were enucleated. While most eyes in the study were enucleated, the proportion of eyes eviscerated increased over the study period (p = 0.010) from 8% between 1994-2004 to 14% between 2005-2016.

Conclusions: While enucleation was performed more commonly overall, the incidence of evisceration increased throughout the study period. There were no instances of occult intraocular tumour in patients who were eviscerated.