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Specific Diseases and Procedures
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
Enucleation is often performed during general anesthesia but can be done in a standing sedated horse. Enucleation appears to be excessively painful because the procedure may elicit movement in an animal assessed as adequately anesthetized. Recovery from anesthesia has been documented as poorer quality after enucleation when compared with other types of ophthalmic or peripheral limb surgery.Retrobulbar/peribulbar nerve block is recommended (20 ml 2% lidocaine for a 450-kg horse) with the lidocaine injected during anesthesia but 5–10 minutes before start of surgery.Parenteral administration of analgesic agents, such as butorphanol or another opioid, or CRIs of lidocaine or an alpha-2 agonist sedative.Traction on the eye may induce bradycardia or asystole via a vagus nerve reflex. Use of a retrobulbar nerve block prevents vagal stimulation. In the past, atropine has been administered before enucleation surgery to block the vagal effect; however, atropine may have a significantly long duration (days) on intestinal motility in horses. If administered, to avoid colic, intestinal sounds must be auscultated before feeding the horse after surgery.
Retinoblastoma
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
Claire Hartnett, Mandeep S. Sagoo, M. Ashwin Reddy
Enucleation must be performed with great care to not penetrate the eye and spill tumor. A long optic nerve is important to ensure that the surgical margin is tumor-free, particularly in countries where deep invasion of the optic nerve is common. For genetic diagnosis, fresh tumor tissue harvest immediately after enucleation is very important for RB1 mutation studies, since this is the best way to determine the exact mutations and thus know if the child has heritable or non-heritable retinoblastoma.
Oncology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Gill A. Levitt, Penelope Brock, Tanzina Chowdhury, Mark Gaze, Darren Hargrave, Judith Kingston, Antony Michalski, Olga Slater
Treatment of intraocular tumours is dependent on tumour size and location. Focal therapies, laser therapy and cryotherapy are used for small localised tumours. Enucleation of the eye is the treatment of choice for E eyes and the most common treatment for unilateral disease, with 80% of unilateral children undergoing primary surgery. Children with bilateral tumours usually receive primary chemotherapy with focal consolidation therapies as indicated.
Ten things you learned in your residency about retinoblastoma that have changed the 2023 Victor T. Curtin Lecture
Published in Ophthalmic Genetics, 2023
There is no central U.S. registry, but perhaps 275 children are affected yearly in the U.S. The estimates for worldwide range from 5,000 to 8,000. Enucleation was first done for retinoblastoma hundreds of years ago and remains an effective way to cure the cancer. Recent studies from the U.S. demonstrated that primary enucleation for unilateral retinoblastoma is associated with a 4% chance of developing metastases and just under 2% chance of dying from metastatic retinoblastoma (3). Enucleation remains a useful and effective way to cure cancer but for more than 90 years Ophthalmologists have developed techniques that salvage eyes without the need for enucleation. Presently, we enucleate only 6% of eyes in New York at Memorial Sloan Kettering Cancer Center, the largest and oldest retinoblastoma center in the U.S. (4)
Sympathetic Ophthalmia - An Overview
Published in Ocular Immunology and Inflammation, 2023
Mamta Agarwal, Aleksandra Radosavljevic, Mudit Tyagi, Francesco Pichi, Aisha A. Al Dhanhani, Aditi Agarwal, Emmett T. Cunningham
In many cases, even the inciting eye may retain a good vision. Dogra et al. analyzed surgical outcomes of four inciting eyes after adequate control of intraocular inflammation and found that keratoplasty, glaucoma surgery, and silicone oil removal (in one patient each) were well tolerated, while patient who underwent PPV had poor outcome with flare up of inflammation in both eyes and phthisis bulbi in the inciting eye.109 Hence, enucleation should be considered only in cases where there is extremely poor prognosis for useful vision in the traumatized eye, especially since in the course of the disease, the exciting eye may end up with better vision. Enucleating the exciting eye after onset of the disease in the other eye does not help in treatment. Evisceration is not an acceptable alternative to enucleation. SO can develop after evisceration as a result of remaining uveal tissue in the scleral emissary channels.110
Comparison of Tumor Enucleation and Standard Partial Nephrectomy According to Trifecta Outcomes: A Multicenter Study by the Turkish Academy of Urology, Uro-Oncology Working Group
Published in Journal of Investigative Surgery, 2022
Meftun Culpan, Gokhan Atis, Oner Sanli, Yasar Bozkurt, Ali Fuat Atmaca, Bülent Semerci, Cemil Kutsal, Abdullah Erdem Canda, Fatih Akbulut, Volkan Tugcu, Ugur Boylu, Sakip Erturhan, Orhan Koca, Ferhat Ateş, Fikret Halis, Sedat Soyupek, Burak Turna, Sedat Cakmak, Selcuk Sahin, Selcuk Erdem, Asif Yildirim
With this study we showed the resection technique in PN is an independent predictive factor of trifecta failure along with BMI, tumor size, CCI, preoperative eGFR, surgical approach, and ischemia type. TE had more favorable trifecta outcomes than SPN. In a single prospective study that investigates the impact of resection techniques on trifecta outcomes, Minervini et al. reported that resection technique, warm ischemia time, and surgical approach were independent predictors of achieving trifecta. However, in this study, patients were grouped according to three different resection techniques: resection, enucleation, and enucleoresection. The authors reported enucleation had more favorable outcomes than enucleoresection [24]. Another interesting result of our study was that the laparoscopic technique was associated with less trifecta failure than the open or robotic technique. In 2020, Ghavimi et al. investigated the impact of surgical technique on trifecta rates and concluded that open and laparoscopic PN was more likely to achieve the trifecta than robotic PN [25]. We thought our results might be due to the experience level of the surgeons who performed the operations, but unfortunately, we did not have the information about surgeons’ level of experience.