To evaluate the frequency of anterior surface breakdown for three techniques of evisceration with primary implant placement: the "classic" technique, the "scleral modification" technique, and the novel "scleral patch" technique.Retrospective comparative case series with 73 consecutive eviscerations with primary implants that were performed in the Eye Clinic Rotterdam between January 2003 and January 2007.The operations involved the classic technique for 55% of the patients, scleral modification for 29%, and the novel scleral patch technique for 16%. In all, 9.6% of the patients had conjunctival breakdown: six in the classic group and one in the patch group. Although the frequency of this complication was higher in the classic group, the difference was not significant (P>0.05, chi-square test). Anterior surface breakdown was not related to implant size or prior eye surgery.Compared with the scleral modification and scleral patch techniques, conjunctival breakdown and implant extrusion were seen more frequently after classic evisceration with implant placement. Implant size or indication for surgery were not related to the frequency of these complications.