Indications. (i) The operation is especially suitable for anterior staphyloma following ophthalmia neonatorum. In young children the presence of the ball in the orbit assists the development of that structure.
(ii) It is also suitable for large, recently made, fairly aseptic wounds in the globe.
Operation. The first two steps are the same as for evisceration.
Third step. A glass or, better, a celluloid or gold-plated ball is inserted into the sclerotic, which is closed over it by two rows of interrupted sutures, one of catgut passing through the sclerotic, the other of silk closing over the conjunctival wound. To facilitate the closure of the conjunctival wound it is advisable to dissect the conjunctiva back from the limbus before excising the cornea. The ball inserted in the sclerotic should fit the cavity loosely.
Complications. In about 17% of the cases the ball is not retained; this is not infrequently due to too large a size being used, or to the wound being imperfectly closed by the sutures. If two rows be used, as described above, extrusion of the ball is far less frequent than if one only be inserted. If the globe be extruded the patient is in the same position as if he had had evisceration performed.
FROST’S OPERATION
In this operation the eye is enucleated, a celluloid globe is inserted into Tenon’s capsule, and the conjunctiva is closed over it by means of sutures passing through Tenon’s capsule and the conjunctiva.
Operation. The first four steps in the operation are similar to those described under enucleation.
Fifth step. A small, loosely-fitting glass globe is inserted into Tenon’s capsule. A purse-string suture of strong catgut is then inserted into the cut margin of Tenon’s capsule, taking care to include in the sutures the cut ends of the tendons of the recti muscles. The suture is drawn tight and tied so that Tenon’s capsule and the muscles are thereby drawn over the globe. The conjunctival wound is closed over this by a separate suture of silk.