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 childs 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 childs 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 childs 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.
