Evisceration techniques and implant extrusion rates: A retrospective review of two series and a survey of ASOPRS surgeons.

PURPOSE To compare implant extrusion rates in two retrospective series of patients, treated by different surgeons, and to determine if there are preferred evisceration and implant insertion techniques among oculoplastic surgeons. METHODS A retrospective review of cases of evisceration and implant insertion and a survey of oculoplastic surgeons. RESULTS The implant extrusion rate was zero in the author's series of 53 patients, compared with 27.1% (54 of 192 implants) in series treated by other surgeons. Statistically significant differences were found between the two series in surgical technique, wound care, and duration of antibiotic administration. The author routinely performed posterior sclerotomy, whereas the other surgeons did not. Average implant size was 18.8 mm in the author's series, compared with 13.7 mm in the other series. Antibiotic therapy was administered for 10 to 18 days in the author's series, compared with 28 to 46 days in patients treated by other surgeons. The response rate to the survey was 65% (223 of 343 surveys). Among the surgeons surveyed, immediate and secondary implant techniques were used in nearly equal frequency. Delayed implant technique is used least frequently. Reported implant extrusion rates varied greatly among surgeons, ranging from 0% to 20%. Only 3.9% of surgeons expressed a concern over sympathetic ophthalmia. CONCLUSIONS Injudicious antibiotic use and smaller implants do not decrease the risk of implant extrusion. The survey revealed that immediate and secondary implant techniques are used with equal frequency. The theoretical risk of sympathetic ophthalmia does not appear to be a concern to most surgeons.