A comparison of implant extrusion rates and postoperative pain after evisceration with immediate or delayed implants and after enucleation with implants.

PURPOSE To examine implant extrusion rates after evisceration with immediate or delayed implants in patients with culture-proven endophthalmitis. To compare postevisceration and postenucleation pain. METHODS This prospective, nonrandomized interventional case series included four groups of patients: group 1, 25 endophthalmitis patients undergoing evisceration with immediate implants; group 2, 15 endophthalmitis patients undergoing evisceration with delayed implants; group 3, 31 patients without endophthalmitis undergoing evisceration with immediate implants; and group 4, eight patients undergoing enucleations with implants. Standardized techniques and follow-up schedules were used. Postoperative pain was assessed by weighted frequency of pain medications used during two 48-hour periods. Statistical analysis was performed. Retrospective review of two series of patients undergoing evisceration was performed. RESULTS No cases of implant extrusion occurred during an average follow-up of 37.9 months. Average implant size was 19.0 mm. Conjunctival dehiscence occurred in one patient. Average total pain scores were 20.8 in endophthalmitis patients with immediate implants; 22.1 in endophthalmitis patients with delayed implants; 20.3 in patients without endophthalmitis and with immediate implants; and 23.1 in patients with enucleations and immediate implant insertions. Retrospective review suggested possible causes of implant extrusion. CONCLUSION Both immediate and delayed implant techniques appear safe in patients with endophthalmitis, with the former being simpler, more cost-effective, and perhaps less painful. Prolonged antibiotic therapy and smaller implants may render a false sense of security against implant extrusion; good surgical technique and meticulous postoperative wound care are essential. Postenucleation pain appears more severe than postevisceration pain.