Dr.SAI DIVYA JAJAPURAM,Dr.Bejjanki Kavya Madhuri,Dr.Swathi Kaliki
Objectives:
1) To determine the indications of enucleation in adult population (age > 20 years) in Asian Indian patients
2) To analyse the changing trends in the causative factors leading to enucleation between 1996 – 2018
Methods:
A single-center retrospective study of 478 adults (defined as >20years) who underwent enucleation between January 1996 to March 2018 were analysed.Clinical data along with histopathological correlation was reviewed and data was analyzed based on Age at presentation (middle age >20 to 60 years; older adults > 60 years) and decade at presentation and etiological trends noted over the decades.
Results:
Demographics: Of the 478 patients, there were 304 male and 174 females. The mean age at enucleation of the patients was 42 years (38yrs in the middle aged and 70 years in old aged groups).Number of middle aged adults who underwent enucleation were 418(87%) while 60(13%) were in the older age group. Primary enucleation was defined as when enucleation is done as the primary treatment modality and secondary enucleation when other conservative or surgical measures of globe salvage failed. Number of Primary enucleations done are 462 (97%) while 16 enucleations were secondary (3%). Clinicopathological correlation was present in 96% (458) cases.
Etiological factors: The most common cause of enucleation was Intraocular malignancies (43%, n=206) followed by Phthisis/atrophic bulbi at (37%, n=175). Acute trauma lead to enucleation in 69 adults(14%). Among the 418 middle aged adults, Atrophic/Phthisis bulbi was the most common cause of enucleation(39%, n=163) closely followed by uveal melanoma(33%, n=141).Acute trauma is a significant cause of ocular morbidity in middle aged (16%, n=68). Choroidal metastasis was found in 9 patients while OSSN lead to enucleation in 12 patients in middle aged group. The common causes ofenucleation in order of frequency in the older age group was Uveal melanoma (41%, n=25), Phthisis/painful blind eye (20%, n=12) and OSSN (17%, n=10) respectively. Choroidal metastasis was found in 3 patients.
Trends: In the 3rd decade of age the most common cause was Phthisis and between 4th – 7th decades, the most common cause was Uveal Melanoma and in the 8thdecade, intraocular malignancies was the most common cause while in the 9th decade, Malignancies along with Sequelae like Phthisis or painful blind eye contributed equally. There was a decreasing trend in the number of enucleations over the age wise distribution with maximum number of enucleations between 3rd – 5thdecade.There was a gradual increase in the number of enucleations over the years. Of the 478 enucleations, 40% of enucleationswere during 2006-2010 and 22% between 2005-2010 and 2011-2015. Over the years 1996 through 2018, there was a decreasing trend for enucleations for Phthisis/Atrophic Bulbi(65% to 5%) and acute trauma(11% to 2%) and an increasing trend for intraocular malignancies(19% to 84%). This trend corresponds to improved quality of care and preference for eviscerations for trauma and its sequelae and increased referral pattern to the institute for malignancies over the years.
Conclusions:
In Asian Indian adult population, malignant tumors remain the most common indication for enucleation in older patients, while desire for better cosmesis with customized ocular prosthesis is the main indication for enucleation in middle-age adults. A significant number of patients requiredenucleation for advanced intraocular tumors, especially uveal melanoma and OSSN. Efforts towards early referral, early diagnosis, and appropriate treatment might reverse this trend of enucleation in the future. Improved quality of care for non-tumor pathologies has decreased the morbidity related to enucleation.
Leave a Comment