6. The remaining bulbar conjunctiva has been incised 3 to 5 mm posterior to the limbus, and the extraocular muscles transected
near their scleral attachments.
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To improve the cosmetic appearance postoperatively, place an orbital meshwork of nonabsorbable monofilament suture (such as
4-0 nylon), anchored to the orbital rim periosteum, in a continuous pattern (Figure 8). Close the conjunctiva and subcutaneous tissues with 5-0 absorbable polyglactin 910 in a simple continuous pattern. Appose
the skin with 4-0 nonabsorbable monofilament nylon or polypropylene in a simple interrupted or cruciate pattern (Figure 9).
7. The retractor muscle fibers and optic nerve have been severed, and the globe can be removed after the remaining conjunctiva
is excised.
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Patients may be discharged the same day and should be given appropriate postoperative antibiotic, anti-inflammatory, and analgesic
medications. In addition, Elizabethan collars are recommended until suture removal to prevent self-trauma.
DISCUSSION
8. An orbital meshwork of nylon suture has been anchored to the periosteum.
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This article describes a modification to the routine subconjunctival enucleation technique3 that involves removing the eyelids and nictitating membrane before excising the globe. This method offers good visibility
and better access to the globe and extraocular muscles. After eyelid margin and nictitating membrane removal, the globe is
easily visualized and manipulated. Extraocular muscles can be easily followed to their attachments, and the globe can be positioned
to see the optic nerve before transection. Some authors advocate clamping the optic nerve with hemostats or ligating the associated
vasculature before optic nerve transection7,8 ; however, omitting these procedures has not had a negative impact on the surgical outcome in previous studies or in the
case series described here (see boxed text).9 Easier access to the optic nerve is particularly important in cats because their tight palpebral fissures and short optic
nerves make enucleation more challenging. The optic chiasm can be damaged if excessive traction is placed on the globe, resulting
in possible blindness in the contralateral eye after enucleation.7,10
9. The conjunctiva and subcutaneous tissues are closed in a continuous pattern, and the skin is apposed in either a simple
interrupted or cruciate (shown here) pattern.
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The modified subconjunctival enucleation technique offers an alternative approach for globe removal in dogs and cats. This
technique is not indicated in patients with corneal ulcers or ocular infections. In such cases, a transpalpebral technique
is more appropriate.
A modified subconjunctival enucleation technique: A case series
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In our case series, this method was not associated with any adverse complications, and we think it may be particularly useful
in general practice, where enucleation may not be a routine procedure. Long-term follow-up was not obtained in our case series.
Keep in mind that a potential adverse effect related to enucleation using this or any technique is mucocele formation.
Robert L. Swinger, DVM
Karl A. Schmidt, Jr., DVM, DACVO
Animal Eye Specialty Clinic
20290 N.W. 2nd Ave.
Miami, FL 33169
Susan M. Carastro, DVM, MS, DACVO
Animal Eye Specialty Clinic
372 S. Powerline Road
Deerfield Beach, FL 33442
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