Enucleation in an Infant
This is Richard Allen at the University of Iowa. This video demonstrates some of the intricacies of performing an enucleation in an infant. First, it can be noted that the palpebral fissure width is much narrower giving less room. The patient's rectus muscles have been tagged and transected. The optic nerve will now be cut. This can be very difficult from a lateral approach due to the amount of room. Sometimes a lateral canthotomy will need to be performed, or more recently I am preferring a medial approach to the nerve. The patient's socket is then sized. In general, the largest implant possible should be placed. I would try very hard to place either an 18 or 20 millimeter implant. In some patients, a primary dermis fat pad fat can be placed which will grow with the patient. I think I'm doing this more and more for my younger patients.
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