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Mon Jan 22, 2007 4:01 pm


There seems to be some confusion on some posts over the actual enucleation procedure and “implant”. A brief and generic description of the surgery might help clarify.

The actual surgery to remove an eye is straight-forward. The surgeon first cuts around the conjuntiva, the clear tough membrane on the outside of the eye. The muscles of the eye are then identified and severed. A clamp is used to hold the muscles and keep them from retracting. Once the six muscles are cut the actual globe is removed from the socket. The artery and vein supplying the blood, as well as the optic nerve are then severed and the globe is freed from the socket.

Here is where the confusion seems to be. At that point a sphere – usually about 18mm in diameter - is placed in the socket. This is the actual “implant” and can be made of polymer or the newer coral (hydroxyappatite) material. Often if the polymer implant is used it is encased in donor scleral tissue. Then the eye muscles are then sewn over and to the implant and the conjuntival tissue is closed. The implant is always placed in the socket immediately after the eye is removed. After the closure the socket is washed, antibiotic and steroids used and a conformer (this might be what is being confused for an implant) is placed under the lids. The conformer is a thin concave thing like a huge contact lens. Some are made of a rubber like substance and have two holes in the front so ointment can be placed in the socket during healing, while others are clear acrylic. The conformer is worn while the socket heals in order to keep the shape of the socket. It is best to leave the conformer in all the time but they tend to easily pop out and can be reinserted without too much trouble once the technique is mastered.

It takes six to eight weeks on average before the socket is healed and ready for the prosthesis fitting. During the first week the ointments (antibiotic and steroids) are used twice a day but after that it just needs to be kept clean and dry. It can be uncomfortable to slightly painful as it heals, especially when you move your good eye.

Now for me this surgery was uncomfortable but not painful. There was swelling and bruising of the eyelids that went away after the first week. The video everyone has seen is of the molding for the actual prosthesis. For me it was cold but absolutely not painful and only took a few minutes. The substance used is the same as dentist use to take impressions of teeth. Nothing during the fitting for the prosthesis was painful or even uncomfortable other than having to sit still for a long time.

Hope this helps clarify the confusion over the implant. I’ll be happy to answer any other questions for those facing this surgery.



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Mon Feb 05, 2007 10:14 pm

 
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Hi Alisia~ I have a question for you, Im faceing an Enucleation in the near future just waiting for this infection to go away..when they remove your eye do you still have tears? or does this surgery damage the tear duct? As far as pain you mentioned you realy didnt have it too bad, I bet my high pressure (range 70-90) that get extremly painful is the worse as far as pain, I figure if I make it through a bad day I'll get through this just fine. Kendra :rollsmilie3:



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Mon Feb 05, 2007 10:39 pm

 

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Last edited by Marmalade on Tue Feb 06, 2007 9:01 pm, edited 1 time in total.


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Tue Feb 06, 2007 2:34 pm


Hi Kendra,
Sorry for the delay in replying but I have not been on the board in awhile. The answer is yes, your tears remain and the surgery does not affect the glands or ducts. The major gland for producing tears is actually behind the bone in your socket but your lids also produce tears. Now a serious infection can harm the glands but that is rare. As for the enucleation itself – the pain varies from mildly uncomfortable to downright agony depending on the person, but for me (an I think most folks) it was not bad at all - rather like a trip to the dentist. In fact, I had been in so much pain prior to surgery it was a tremendous relief. You shouldn’t need anything stronger than Advil after the first day or two. For me the nausea from the anesthesia was worse than any mild pain but after a day the effects had worn off. I had my surgery on a Friday, came home that night and by Saturday noon was up and around feeling good. Sunday was best as the chronic pain from the eye was gone and that was such a glorious relief. Monday I had a follow-up with the surgeon and was told to take it easy (no bending, lifting or stress) but I could do most everything including returning to school on Tuesday. Over the week that followed there were occasional sharp pains when I moved my good eye but I soon figured out to move my head and keep the eye straight. For that first week I had to put the medicine in through the conformer (mine was the thick white one with two holes in the front) three times a day. After that it was just leave it alone and wait for the socket to heal. My first fitting for the prosthesis was six weeks after the surgery and it took four visits over a week. Nothing at the occularist was uncomfortable and it was fascinating watching her work (she let me see the molding process in her lab) and especially as she hand painted the iris and used thin silk thread to make the blood vessels. I’d say don’t worry too much because if your increased IOP is causing you pain now, the surgery will most likely be a relief. Best of luck and let us know how it turns out and what your impressions of the pain level are.



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Tue Feb 06, 2007 3:18 pm

 
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Thanks Alisia~ wow thats a mouth full! Yes I will keep you all posted, this also will help others either faceing or even thinking of such an opperation. OK Another question I forgot to ask you....when you get the mold made, is it all done the same visit? or do you need to get that made and go back for the finalle process...I know this is a big process from start to finish, Meaning the first visit to getting the surgery, right down to the last getting a prosthesis made. this doesnt happen over night. and some Dr.'s want to try other metheds to "save" the eye even tho theres a lot of pain and it has no vision. :laola:



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Tue Feb 06, 2007 3:59 pm

 

Hi Kendra,
I was just reading your questions about prosthetics. Just thought I'd let you know that a prosthetic can be made and finished in one day. I went to Carolina Eye Prosthetics in Burlington, NC, and the whole process only took about 6 hours. I went home with my eye. And they do high quality work--Duke University Eye Center (where I had my surgery) sends all their patients there. I think you are in Arkansas, which would be a little trip, but if you want any more information, let me know.
I wish you well at the doctor visit. I can only repeat what has already been said, the surgery itself is surprisingly easy and I had very little pain. I was back at work in 2 1/2 weeks (I'm a hairdresser.)
Karin



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Tue Feb 06, 2007 4:31 pm

 
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Thanks Karin! the more people I've heard from here say what you are as well...fear is not a factor here, nor will I allow it too be, so I'm already one step ahead of this. fear is not knowing...so I ask as you all can see (no pun intended lol) but I do tend to ask a lot of question,but thats OK. Yes Im in Arkansas now... where did you say you went...I'm closer to MO. OK & Tenn, I'm in NW Arkansas the Ozark Mountains



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