Comparative Analysis of Posterior Release Sclerotomy vs Conventional Ball Implantation in Evisceration Surgery

Evisceration is a widely performed ocular procedure aimed at removing intraocular contents while preserving the scleral shell and extraocular muscles. The primary goal of evisceration is to provide a structurally stable orbital implant, ensuring optimal prosthetic motility and cosmetic appearance. Traditional evisceration with ball implantation often presents complications related to limited space within the scleral cavity, potentially leading to implant extrusion or migration.

A key advancement in evisceration techniques is posterior release sclerotomy within the scleral cup, which aims to expand the intraocular space and facilitate primary ball implantation. By creating a controlled posterior opening, this method is hypothesized to reduce intraoperative resistance to implant insertion, minimize excessive intraocular pressure, and decrease postoperative complications such as extrusion or exposure. However, comparative studies on the effectiveness of posterior release sclerotomy versus conventional ball implantation remain limited.

Conventional evisceration techniques involve creating a scleral incision to accommodate the ball implant, often requiring significant manipulation to fit the prosthesis securely. The resultant tight fit can lead to ischemic changes, delayed healing, and an increased risk of implant extrusion. In contrast, posterior release sclerotomy allows for better distribution of intraocular pressure and improved accommodation of the implant, potentially reducing postoperative complications.

Several studies have highlighted the importance of scleral integrity and orbital volume restoration in optimizing prosthetic movement and overall aesthetic outcomes. Ensuring adequate implant placement without undue pressure on the scleral shell is a crucial factor in preventing long-term complications such as conjunctival dehiscence or implant migration. Posterior release sclerotomy may offer a surgical advantage by providing additional space for implantation, reducing undue pressure, and preserving the scleral integrity.

Despite these theoretical advantages, clinical evidence comparing posterior release sclerotomy with conventional ball implantation remains scarce. Previous retrospective studies suggest that modified techniques may enhance surgical ease and reduce complications.