Purpose Enucleation is a standard surgical treatment modality for many end-stage eye diseases. Indications for enucleation vary with changing trends in disease management. Few studies have addressed the issue of the frequency and indications of enucleation of eyes in India. We aimed to determine the frequency and the current clinical indications for enucleation in patients at a tertiary eye care centre in India, and attempted a clinico-pathological correlation.
Methods Medical records of patients undergoing enucleation at a tertiary eye care centre over a period of 3½ years (January 1995 to July 1998) were reviewed to obtain patients' demographic data and socio-economic status. The clinical indications and predisposing factors were assessed. The formalin-fixed, paraffin-embedded sections of all enucleated eyes were re-evaluated and histopathological findings were correlated with the clinical diagnosis. The prevalence of enucleation was calculated, and age adjustments were done using the Indian population data from 1998 mid-year statistics.
Results Enucleation of the eye was performed in 150 patients (151 eyes) out of 88 991 new ophthalmic cases, constituting 0.17% of the cases seen in the hospital, and amounting to a prevalence of 0.33% (95% CI, 0.27-0.40). Males outnumbered females in a ratio of 1.85:1 (98 males, 53 females). The median age was 8 years (mean 16.8 ± 18.3 years). Children below 15 years of age constituted 85.2% (95% CI, 81.2-89.21%) of cases that underwent enucleation. Clinical indications for enucleation included tumours in 74 (49%); staphyloma in 38 (25%); acute injury in 20 (13%); absolute glaucoma in 9 (6%); painful blind eye in 5 (3%); phthisis bulbi in 1 (1%); and others in 4 (3%). Of the 74 cases with a clinical diagnosis of tumour, histopathology revealed retinoblastoma in 55 (74%) cases, melanoma in 6 (8%) and ocular surface tumours in 4 (6%). Clinico-pathological correlation was 100% in cases with a definite clinical diagnosis of retinoblastoma and melanoma. Nine blind eyes (6%) in which an intraocular tumour was one of the differential diagnoses, were negative for a tumour on histopathology. Staphyloma was more prevalent in the low socio-economic group (p = 0.0004), with a history of childhood trauma in 34% cases.
Conclusions The prevalence of enucleation in the population reporting to this tertiary eye care centre was 33 per 10 000 population over the study period of 3½ years. Major indications for enucleation were tumours, staphyloma and trauma (88% of all cases). Increased frequency in the young was due to the high proportion of retinoblastoma and staphyloma. Childhood trauma, inflammation and malnutrition may together play a role in the pathogenesis of staphyloma. Awareness at the level of primary health care providers, paediatricians and general practitioners should be promoted to identify the disease process at an early stage and facilitate early intervention measures that could result in eye and vision salvage.
Luce CM . A short history of enucleation. Int Ophthalmol Clin 1970;10:681–7.
Shields JA, Shields CL, Sivalingam V . Decreasing frequency of enucleation in patients with retinoblastoma. Am J Ophthalmol 1989;108:185–8.
Foulds W . Management of intraocular melanoma. Br J Ophthalmol 1990;74:559–60.
Williams DF, Mielder WF, Abrams GW, Lewis H . Results and prognostic factors in penetrating ocular injuries with retained foreign bodies. Ophthalmology 1988;95:911–6.
Dohlman CH, D'Amico DJ . Can an eye in phthisis be rehabilitated? A case of improved vision with 1 year follow-up. Arch Ophthalmol 1999;117:123–4.
Porricha D, Aurora AL . Causes of enucleation and evisceration of eye balls in adults: a clinico-pathological study. Indian J Med Sci 1982;36:1–8.
Porricha D, Aurora AL . Causes of enucleation and evisceration of eye balls in children: a clinico-pathological study. Indian J Medical Sci 1982;36:72–9.
Kapoor S, Sood GC, Satish N, Sood N . Analysis of causes of enucleation, evisceration and exenteration in S. India. East Arch Ophthalmol 1976;8:865–8.
US Bureau of the Census. Report WP/98. World population profile: 1998. Washington, DC: US Government Printing Office, 1999.
Sigurdsson H, Thorisdottir S, Bjornsson JK . Enucleation and evisceration in Iceland 1964-1992: study in a defined population. Acta Ophthalmol Scand 1998;76:103–7.
Erie JC, Nevitt MP, Hodge D, Ballard DJ . Incidence of enucleation in a defined population. Am J Ophthalmol 1992;113:138–44.
Scat Y, Liolet S, Bellefqih S . Etiology of enucleation: apropos 3246 cases. J Fr Ophtalmol 1996;19:242–7.
Gunalp I, Gunduz K, Ozkan M . Causes of enucleation: a clinico-pathological study. Eur J Opthalmol 1997;7:223–8.
Steibel H, Sela M, Pe'er J . Changing indications for enucleations in Hadassah University Hospital, 1960-89. Ophthalmic Epidemiol 1995;2:123–7.
Spraul CW, Grossniklaus HE . Analysis of 24 444 surgical specimens accessioned over 55 years in an ophthalmic pathology laboratory. Int Ophthalmol 1997-8;21:283–304.
Naumann GD, Portwich E . Etiology and final clinical cause of 100 enucleations (a clinico-pathological study). Klin Monatsbl Augenheilkd 1976;168:622–30.
Lim JKS, Cinotti AA . Causes of removal of the eye: a study of 890 eyes. Am J Ophthalmol 1976;8:865–9.
Batten KI . Causes of enucleation as seen in Jerusalem. Br J Ophthalmol 1971;55:174–6.
Haile M, Alemayehu W . Causes of removal of the eye in Ethiopia. East Afr Med J 1995;72:735–8.
Schultz KR, Ranade S, Neglia JP, Ravindranath Y . An increased relative frequency of retinoblastoma at a rural regional referral Hospital in Miraj, Maharashtra, India. Cancer 1993;72:282–6.
Gottrau P, Holbach LM, Naumann GH . Clinicopathological review of 1146 enucleations (1980-90). Br J Ophthalmol 1994;78:260–5.
Sahu S, Banavali SD, Pai SK, Nair CN, Kurkure PA, Motwanti SA, et al. Retinoblastoma: problems and perspective from India. Pediatr Hematol Oncol 1998;15:501–8.
Majekodunmi S . Causes of enucleation of the eye at Lagos University teaching hospital over a period of 10 years. West Afr J Med 1989;8:299–91.
Grossniklaus HE, Green WR . Pathologic findings in pathologic myopia. Retina 1992;12:127–33.
Mullaney PB, Risco JM, Heinz GW . Congenital corneal staphyloma. Arch Ophthalmol 1995;113:1206–7.
Mason GI, Peyman GA, Jampol LM, Lesser RL . Staphyloma: a complication of surgery for hyphema. J Pediatr Ophthalmol Strabismus 1978;15:386–91.
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Vemuganti, G., Jalali, S., Honavar, S. et al. Enucleation in a tertiary eye care centre in India: Prevalence, current indications and clinico-pathological correlation. Eye 15, 760–765 (2001). https://doi.org/10.1038/eye.2001.245
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