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Modified evisceration with posteriorly detached petals for management of deficient sclera

Aim The aim of this work was to evaluate the effectiveness of modified evisceration technique compared with standard technique in cases associated with deficient sclera. Patients and methods A prospective interventional study was conducted that included 34 eyes of 31 patients with deficient sclera scheduled for modified evisceration technique with intraconal placement of nonporous acrylic implants. Outcome was assessed in terms of implant extrusion, exposure, as well as other early or late postoperative complications. Results Adequate volume replacement was achieved in 32 (94.12%) of 34 eyes. Overall, two (5.88%) eyes had mild upper sulcus deficit, and three (8.8%) eyes had mild to moderate prominence of the prosthesis compared with the fellow eye, but no true exposure, extrusion, migration, socket contracture, or sympathetic ophthalmia was encountered. All of the patients were satisfied with the cosmetic and functional outcomes of the procedure, except for the two (5.88%) cases with upper sulcus deficit. Conclusion A modified evisceration technique for deficient sclera provides superior cosmetic and functional results compared with the standard technique. It has the advantage of allowing placement of relatively large orbital implants in cases associated with insufficient sclera with very low rates of implant extrusion, exposure, migration, or socket contracture.