EPOS

European Paediatric Ophthalmological Society

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Enucleation in childhood - a threat for bony orbital development in humans?

Hintschich Christoph, Zonneveld Frans, Baldeschi Catey, Bunce Catey, Koornneef Leo
¹Department of Ophthalmology, Ludwig-Maximilians-University, D-80336 Munich, Germany, ²Department of Radiology, University of Utrecht, Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands, ³Orbital Centre, University of Amsterdam, Amsterdam, Netherlands, ⁴Moorfields Eye Hospital, City Road, London EC1V 2PD, United Kingdom

Purpose: It is the omnipresent belief that orbital growth is checked following enucleation in childhood, resulting in more or less maldevelopment and facial asymmetry depending upon the age at which enucleation was performed. This is based on observations of orbital malformations after early enucleation in animal studies in the past. However, until recently uncertainty existed about the possible long-term effects and the clinical relevance in children who were subjected to enucleation (1). This paper summarises our data on the incidence and extent of orbital growth retardation after enucleation in man. Methods: Volumetric studies on bony orbital volumes based on 3D reconstructions acquired from high resolutional CT scans were performed in 29 patients with acquired anophthalmia and 4 patients before enucleation (controls). Eight patients (follow-up 25 to 52 years) were enucleated in childhood aged between 0.4 and 8 years (group I), 21 in adulthood aged between 15 and 53 years. Fifteen of these patients (group II a) had long-standing anophthalmia (follow-up 7 to 53 years), 6 patients (group II b) were enucleated 9 months to 4 years before examination. Results: Bony orbital volumes were reduced in all patients with long-standing anophthalmia. The mean percentage reduction in enucleated orbits was 7.0% in group I, 3.8% in group II a and 1.9% in group II b. In patients with long-standing anophthalmia (I and IIa) the reductions were statistically significant (p < 0.01) to zero. We found some evidence of a correlation between orbital volume reduction and age at enucleation (rho = 0.36, p = 0.09, Spearman rank-order correlation) and a statistically significant correlation between volume reduction and time interval since enucleation (rho = -0.5, p = 0.003). Clinically none of the patients showed significant facial asymmetry. Conclusion: Our data provide strong evidence that enucleation both in children and adults is associated with a reduction of bony orbital volume and that this decrease in volume is associated with increasing time. However, the reduction is smaller than generally assumed and does not cause obvious facial asymmetry. It is more related to the time interval since enucleation then the age at enucleation, which makes a mechanism of volume adaptation more likely than just retardation of growth. In case of necessary enucleation in young children both parents and paediatricians can be reassured, that there is no threat for the bony orbital development and no obvious facial maldevelopment will be induced.