From the Guidelines
Before clearing a patient for enucleation surgery, a comprehensive medical history and evaluation of key medical issues, including cardiovascular conditions, bleeding disorders, and diabetes, should be performed to minimize surgical risks and ensure the best possible outcomes, as recommended by the most recent guidelines 1.
Key Medical Issues to Evaluate
The evaluation should include:
- A thorough medical history, including demographic data, chief complaint, history of present illness, ocular symptoms, ocular history, systemic history, medications, allergies, family history, and social history 1
- Review of current medications, particularly anticoagulants, and consideration of temporary discontinuation 5-7 days before surgery 1
- Laboratory tests, including complete blood count, coagulation profile, and basic metabolic panel 1
- Assessment of cardiovascular conditions, such as unstable coronary syndromes, decompensated heart failure, and significant arrhythmias, and consideration of evaluation and treatment before noncardiac surgery 1
- Evaluation of anesthesia risks, particularly for patients with respiratory conditions or previous adverse reactions to anesthesia 1
Importance of Preoperative Evaluation
The preoperative evaluation is crucial to identify potentially reducible cardiac risks and to minimize surgical complications, such as excessive bleeding, poor wound healing, and anesthesia-related problems 1.
Recommendations
- Patients with diabetes should have well-controlled blood glucose levels, ideally with HbA1c below 7.5% 1
- Blood pressure should be optimized, generally below 140/90 mmHg 1
- Any active infections, especially ocular or respiratory, should be treated before surgery 1
- Psychological readiness for the cosmetic and functional changes following enucleation is essential, and patients should understand the postoperative care requirements and orbital implant options 1
From the Research
Preoperative Evaluation for Enucleation Surgery
The decision to undergo enucleation surgery requires careful consideration of various medical issues. Some of the key factors to be evaluated before clearing a patient for enucleation surgery include:
- The underlying indication for surgery, such as intraocular malignancy, trauma, or a blind, painful eye 2
- The patient's overall health and any potential risks associated with surgery 3
- The need for alternative treatments, such as cryotherapy, laser photocoagulation, diathermy, chemotherapy, and radiation therapy 2
- The type of implant and wrapping materials to be used, and the potential risks and benefits associated with each 2, 4, 5
Medical Issues to be Evaluated
Some of the specific medical issues that should be evaluated before enucleation surgery include:
- The presence of any infectious diseases, and the potential risk of postoperative infection 4, 5
- The patient's bleeding and clotting history, and the potential risk of bleeding complications during or after surgery
- The patient's medical history, including any pre-existing conditions that may affect their ability to undergo surgery or recover from it 3
- The patient's current medications, and any potential interactions with medications that may be used during or after surgery
Importance of Preoperative Evaluation
A thorough preoperative evaluation is essential to identify any potential risks or complications associated with enucleation surgery, and to develop a plan to mitigate these risks 3. This evaluation should be tailored to the individual patient's needs and medical history, and should include a comprehensive review of their medical records and current health status. By carefully evaluating these factors, healthcare providers can help ensure that patients are properly prepared for enucleation surgery, and that they receive the best possible care before, during, and after the procedure 6, 2, 4, 5.