In this multicentre cohort study, the authors investigated a total of 2071 patients who underwent evisceration with primary implant placement over a six-year period at four tertiary eyecare centres in India. Out of 1,345,480 new ophthalmic presentations during the study period, the prevalence rate of end-stage eye diseases requiring evisceration was found to be 0.15%. Evisceration with implant constituted 0.84% of all surgeries performed in the tertiary-care network and 7.4% of surgeries performed in the oculoplastic service with average follow-up duration of 351 ± 386 days (median 194). Among the patients who underwent evisceration, 64% were male. Approximately 55% of the patients came from a lower socio-economic group. The mean age at the time of surgery was 39 years (range from three months to 96 years). Children constituted 15% of the cases. The clinical indications for evisceration are as follows: trauma (41%), infection (34%), intractable glaucoma (10%), post-ocular surgery (7%), congenital causes (5%) and other causes. The most common surgical indications for evisceration were a painful blind eye (37%), phthisis bulbi (27%), staphyloma (10%), open globe injury (9%), perforated corneal ulcer (8%), disfigured blind eye (5%), microphthalmos with poor visual potential (2%) and end-stage endophthalmitis (2%). Comparing the results with global data, the authors note that indications for evisceration vary based on the economic status of the country. In developed economies, trauma, painful blind eye due to infection and intractable glaucoma are common causes. A decrease in the number of eviscerations due to ocular infection related evisceration, also resulting in trauma becoming the cause in developing nations like India. However, infection remains the most common clinical setting for evisceration in Africa. This study also identified younger age at evisceration compared to developed countries. The mean age at surgery in this study was 39 years, while studies from developed countries reported mean ages ranging from 51 to 63 years. The authors highlight that trauma and infection were the main reasons for evisceration in this study, emphasising the importance of preventive strategies and early treatment of ocular injuries and infections. They recommend further studies from different regions to gain a comprehensive understanding of the global trends in this oculoplastic surgical procedure.
Evisceration in India: demographic and clinical trends from a large multicentre cohort study
Reviewed by Su Young
Demography, clinical settings and outcomes in evisceration with implant: an electronic medical records driven analytics of 2071 cases.
