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Speaker: Consider intraocular tumors before enucleation, evisceration
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PHILADELPHIA — Imaging studies should be completed before enucleation or evisceration surgeries to rule out unsuspected tumors, a speaker said at the Wills Eye Conference.
“Blind, painful eyes or eyes with unilateral glaucoma may contain unsuspected malignant tumors,” Ralph C. Eagle Jr., MD, said. “Failure to diagnose can have adverse consequences for the patient and the surgeon.”
Ralph C. Eagle Jr.
Eagle reported seeing six eyes eviscerated that had uveal melanomas that had not previously been detected, as well as additional cases of eviscerated eyes with melanomas.
“Whether ocular evisceration puts a patient at greater risk for metastatic disease is unclear because it is now thought that most tumors have already metastasized before the patient becomes symptomatic or seeks ophthalmic care,” he said. “However, eviscerating an eye with a melanoma certainly can’t be good for the patient and certainly has potentially negative medical legal consequences.”
These tumors have a 50% chance of producing metastatic disease, and a surgeon who inadvertently eviscerates an eye with melanoma has a “pretty good chance of being sued,” Eagle added.
Tube shunt implantation for glaucoma patients can also have negative consequences if done on eyes with tumors. In several cases it had been shown that tumor cells were found in the episcleral reservoir.
“Tube shunts provide an excellent avenue for extraocular extension of intraocular tumor cells,” Eagle said.
These include several cases of children with neovascular glaucoma, which should always be considered an intraocular tumor until it is proven not to be, according to Eagle. – by Rebecca L. Forand
Reference:
Eagle R. Enucleation and evisceration disasters. Presented at: Wills Eye Conference; March 9-11, 2017; Philadelphia.
Disclosure: Eagle reports no relevant financial disclosures.