A net for extending the optic nerve at enucleation of the eyeball.

Abstract

SUMMARY A long section of optic nerve can be obtained during enucleation, when the eyeball is caught in a net made specifically for this purpose. The net is knitted from surgical thread and is in the shape of a barrel with two openings: one wide, one narrow. Separate thread is wrapped around the edge of the wide opening. When the eyeball is freed from the extrinsic muscles and Tenon's capsule, it is drawn into the net, and the wide opening is closed round the optic nerve. At the narrow opening there are three slip-knots by which the net is pulled forward and out of the orbit. Then the optic nerve is exposed and the surgeon is able to cut it close to the apex of the orbit. The length of severed optic nerve amounts as a rule to about 15 mm or more, depending on the age of patient.

Intraoperative Sub-Tenon Injection Increases Optic Nerve Length Transection During Enucleation

“…Furthermore, some techniques may induce high intraocular pressures, which could theoretically spread malignancy. [1][2][3][4][5][6][7] This technique calls for no added instrumentation, and the maneuver is familiar to all enucleation surgeons. It does not call for undue manipulation of the optic nerve, and it minimizes risks to the specimen and remaining visual pathway.…”

“…[1][2][3][4] Some instruments may increase optic nerve specimen lengths by providing more traction on the entire globe to increase globe subluxation. 5,6 Such pressure on the globe may theoretically express tumor cells intravascularly from the eye. 7 Clips and other techniques may introduce crush artifact at the optic nerve surgical margin.…”

Obtaining Maximal Optic Nerve Length During Enucleation Procedures

“…Second, no attempt was made to mimic the presence of orbital soft tissues, which can play an important role in enucleation for retinoblastoma and other intraocular tumors. 7,8 Third, we attached sutures on the simulated globe and used these sutures to put forward traction on the globe. We were unable to simulate the use of hemostats on the muscle stump for traction, a technique commonly used for enucleation of eyes containing retinoblastoma.…”