ASOPRSFall Scientific SymposiumSyllabus
140
4:09pm
Orbital Exenteration: The 10-yearMassachusetts Eye andEar
InfirmaryExperience
Sonali Nagendran
1
, N. Grace Lee
2
, AaronFay
2
, Daniel Lefebvre
2
, FrancisSutula
2
, Suzanne Freitag
2
.
1
Department of Ophthalmology,
FrimleyParkHospital, Frimley, UnitedKingdom,
2
Department of Ophthalmology,Massachusetts Eye and Ear Infirmary, Boston,MA,
UnitedStates
Introduction:
The authors report their experiencewith orbital exenteration surgery at one academic institution over a 10-year period.
Methods:
This is a retrospective review of 25 eyes of 25 patients undergoing orbital exenteration at Massachusetts Eye and Ear
Infirmary between 2003 and 2013.Appropriate institutional review board approval was obtained. Patientswith no follow-up data
or survival datawere excluded from the study. Extracted data from paper and electronicmedical records included demographics,
medical history including diagnosis and previous treatment, surgical details and outcome. Outcomemeasures included surgical
complications, disease status of surgical margins, need for adjuvant treatment, local recurrence,metastases and survival.
Statistical analysiswas performed to create KaplanMeier curves and calculate p-values.
Results:
Twenty three patientswithmalignancy and 2withmucormycosismet inclusion criteria for the study. Surgical procedures
included non-lid sparing total exenteration (44%), lid-sparing total exenteration (32%), non-lid sparing partial exenteration (8%)
and lid-sparing partial exenteration (16%) and 44% underwent additional extra-orbital procedures. Survival rates from the diseases
leading to exenterationwere 72% at 1 year, 48% at 3 years, and 37% at 5 years (Figure 1). Of patientswithmalignancies, 48%
had clearmargins after exenteration.Therewas no statistically significant difference in survival between patientswith clear surgical
margins compared to thosewith tumor-involvedmargins (p=0.12) (Figure 2).Mortalitywas highest from the disease leading to
exenteration in patientswithmelanoma (85.7%) and squamous cell carcinoma (SCC, 42.9%) and lowest in patientswith non-SCC
eyelidmalignancieswithminimal orbital invasion (0%).
Conclusions:
Orbital exenteration is often a palliativemeasure in diseaseswith extremely poor prognoses but this radically
disfiguring surgerymay aid long-term survival in a certain patientswith orbital malignancy.
References:
Ben SimonGJ, Schwarcz RM, Douglas R, Fiaschetti D,McCann JD, Goldberg RA. Orbital exenteration: one size does not
fit all. Am JOphthalmol. 2005;139(1):11-17.
Shields JA, Shields CL, Demirci H, Honavar SG, SinghAD. Experiencewith eyelid-sparing orbital exenteration: the 2000Tullos O.
Coston Lecture. Ophthal Plast Reconstr Surg. 2001;17(5):355-361.
Rahman I,MainoA, CookAE, LeatherbarrowB.Mortality following exenteration formalignant tumours of the orbit. Br JOphthalmol.
2005;89(11):1445-1448.
Hargrove RN,Wesley RE, Klippenstein KA Fleming JC, Haik BG. Indications for orbital exenteration inmucormycosis. Ophthal Plast
Reconstr Surg. 2006;22(4):286-291.
DetailedProgram
—Friday,October 17, 2014
