Reply re: “Evisceration With Implant Placement Posterior to Posterior Sclera”

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We appreciate and thank Dr. Chugh et al. for their interest in our recently published article on evisceration surgery with implant placement posterior to posterior sclera.1 Our technique described patients undergoing evisceration with normal or near-normal-sized eyeballs.1 It has worked extremely well in this group of patients. The modification of this technique suggested by Chugh et al. in those with severe phthisis (7.4 mm–14.5 mm, average-8.7 mm) is an excellent one and we will look forward to utilizing it in the future. Their success with it has also been excellent as they report.
Chugh et al. might also be interested in another technique we have described for those with even more severe phthisis than their 7.4 mm–14.5 mm patient group, known as the “scleral filet technique.”2 It is for those patients who have undergone evisceration surgery with no implant placement. The scleral shell collapses down on itself to a centrally positioned “scleral remnant.” The patients present with enophthalmos, excellent socket motility, and the visible scleral remnant subconjunctivally. Under appropriate anesthesia, after making a horizontal incision in conjunctiva, we expose the scleral remnant and incise it through its entire thickness in a crisscross fashion from superotemporal to inferonasal and from superonasal to inferotemporal, allowing access to the retrobulbar fat space. Essentially, one is filleting the sclera in such a way that the extraocular muscles are left attached to one of the remnants. If the optic nerve is attached to one of the remnants, it is transected and left to sit within the retrobulbar fat. There is rarely any cavity or uveal tissue present within the scleral remnant and no attempt is made to try and reopen the collapsed scleral shell. If any uveal tissue is found inside the scleral remnant, it can be removed with any excess sclera. An implant (porous or nonporous) is then inserted into the retroscleral fat space and the scleral remnants are reapproximated and closed over the center of the implant with 5-0 polygalctin 910 interrupted sutures. Conjunctiva is closed with a running or interrupted 6-0 plain gut suture and a conformer is put in place. The socket volume is restored and the socket motility is maintained.
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