Enucleation

Upfront removal of the eye is indicated for large tumors filling the vitreous for which there is little or no likelihood of restoring vision, in cases of extension to the anterior chamber, or in the presence of neovascular glaucoma. Patients must be monitored closely for orbital recurrence of disease, particularly in the first 2 years after enucleation.[3][Level of evidence C1]

Enucleation is also used as a salvage treatment in cases of disease progression or recurrence in patients receiving eye-salvage management. The pathology specimen must be carefully examined to identify patients who are at high risk of extraocular dissemination and who may require adjuvant chemotherapy.[4][Level of evidence C1 and C2]

In a retrospective, multicenter, global cohort of patients (n = 1,411) who underwent primary enucleation, the pathological classification of the primary tumor (pT) category (based on the American Joint Committee on Cancer [AJCC] Cancer Staging Manual, 8th edition) was predictive of orbital tumor recurrence, tumor-related metastasis, and tumor-related death. Not receiving adjuvant therapy was associated with increased tumor-related death in pT3a (P < .001), pT3b (P = .009), pT3c (P = .018), and pT4 (P < .001) eyes.[5]

Enucleation in patients younger than 3 years does not allow for the proper orbital growth during subsequent development, causing asymmetry of the final orbital size.[6]