Primary vs Delayed Implant in Evisceration

To the Editor. —We read with interest the recent article by Shore et al 1 concerning delayed primary wound closure. Although their idea of eviscerating a blind eye with endophthalmitis and delayed secondary implant after several days of local wound care is supported by current knowledge of wound dehiscence and bacterial counts, we find that an important argument has been neglected. In the preantibiotic era, Burch 2 pointed out that infection is a frequent cause of implant extrusion after evisceration. It is intuitive that the risk of implant infection and subsequent extrusion will be higher in an evisceration performed for endophthalmitis. Nonetheless, one must weigh the risks and benefits of placing an orbital implant at the time of the evisceration vs local wound care followed by a secondary implant some days later. In the case of local wound care followed by a secondary implant, the patient must endure several days