Indications for destructive eye surgery at Sekuru Kaguvi Eye Hospital, Zimbabwe

Abstract

Background: Destructive Eye Surgery (DES) is a management option that is offered as a final resort where keeping the globe risks jeopardizing life or the general health of an individual. The three destructive eye operations are: evisceration, enucleation and exenteration in order of increasing aggressive nature of the operation.
Objective: To find out the common indications for destructive eye surgeries (DES) at Sekuru Kaguvi Hospital (SKH).
Methods: Patients who presented to Sekuru Kaguvi Hospital in the period January to March 2017 who ended up having some form of DES were enrolled into the study. Data was collected on participant demography, occupation, the affected eye, diagnosis and the subsequent DES done.
Results: A total of 37 eyes of 37 patients had DES done during the period January to March 2017. Generally more males had DES done on them compared to females (73%). Percentages of the DES done were: eviscerations 51.4%, enucleations 29.7% and exenterations 18.9%. The main indication for DES was trauma in 32.4%, followed by retinoblastoma in 21.6%, panophthalmitis in 21.6%, ocular surface squamous neoplasia in 18.9%, staphyloma and painful blind eye in 5.4%. The commonest indication for the eviscerations was
a ruptured globe in 57.9%, the remainder being panophthalmitis. There was a total of 11 ruptured globes requiring an evisceration and 10 (90.9%) were males. Globe ruptures attributed to assault were 71.2%. The mean age for eviscerations was 39.21 years. Of the total enucleations done, 72.7% were children under 5 years (average age 2 years), the commonest indications being retinoblastoma in this group (87.5%). A total of 7 exenterations were performed, the commonest indication being ocular surface squamous neoplasia in 85.7%. Males were at a higher chance of being exenterated than females (5:2). Most of the removed eyes had no vision (no light perception in 73%, light perception in 18.9%, hand movement in 5.4% and 3/60 in 2.7%).
Conclusion: The main indication for DES was trauma followed by panophthalmitis and retinoblastoma. The commonest indication for exenteration was OSSN which can be treated earlier before warranting eye removal. There is thus need to address these preventable conditions and risks that can lead to eye removal.