Enucleation

Enucleation refers to the surgical removal of the eye.  Enucleation is suggested when an eye has not responded to any of the treatment options and keeping the eye becomes dangerous to the overall health of the child.  Enucleation is also often suggested for unilateral retinoblastoma where one eye is completely filled with tumor and the other is unaffected and has normal vision.  In these cases, where the child has vision in the unaffected eye, enucleation of the eye filled with tumor offers a cure to the retinoblastoma without loss of useful vision for the child.

 

• The Enucleation Surgery

While your child is asleep under general anaesthetic, the ophthalmologist will surgically remove the eyeball containing the tumor.  There are no cuts or incisions made to the child’s skin and there are no external stitches.  The membrane lining the eyelids (conjunctiva), the muscles that turn the eye and the optic nerve are cut.  A small ball (an implant) is permanently placed into the space where the eyeball was.  The muscles are attached to the implant and the conjunctiva is sewn over the implant.  The stitches will not need to be removed, since they will dissolve by themselves.  A Prosthetic eye (an artificial eye) will later be fit in the space behind the eyelids.  A temporary artificial eye called a conformer is placed under the eyelid to fill the space while the eye heals. The conformer will remain in place until the child’s custom-made prosthesis is fitted for him and painted to match his other eye. While the surgery only lasts approximately 2-3 hours, your child will be required to stay in hospital for 24-48 hours.  One immediate family member will be able to stay with the child in his hospital room for the duration of his stay.

            After the operation, the child will have a large bandage on his eye that will be left in place for two days.  The bandage protects the eye and applies direct pressure that will help reduce the post-operative swelling.  When it is removed, there will be some swelling and maybe some bruising around the eye, however, it will settle down over the next couple of weeks.  When the patch is removed the eyelids are gently cleaned with sterile saline solution (sterile salt solution).  An antibiotic ointment is then placed between the eyelids, and a smaller eye patch is applied.  You will be shown how to do this yourself.  At this point your child is ready to return home.  It will be up to you to change the eye patch and clean the eye daily for the next 10 to 14 days at home until your child returns for his post-operative appointment and receives his first artificial eye.

            Most children have already adjusted to living without vision prior to the removal of the eye(s), and show very little change in their behaviour after returning home.  In many cases the adjustment is more difficult for the parents than for the child as he has been living with a visual impairment long before the retinoblastoma was even diagnosed.

            In the weeks following an enucleation, the physician will examine the enucleated eye carefully under the microscope to confirm that tumor cells have not spread outside the eye.  Sample of the tumor will also be analyzed to determine the genetic mutation that caused your child’s retinoblastoma.  If the optic nerve is found to contain cancer cells, radiation therapy or chemotherapy will be advised.  Usually, the nerve is found to be clear of tumor and the retinoblastoma has been limited to the removed eye. 

 


 


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