Enucleation With Unwrapped Porous and Nonporous Orbital Implants: A 15-Year Experience

Purpose: To compare the rates of implant exposure and implant migration among patients who received an unwrapped nonporous spherical implant versus an unwrapped porous spherical implant immediately after enucleation. Methods: Retrospective analysis of a series of 258 patients who received either an unwrapped nonporous spherical implant (n = 68) or an unwrapped porous spherical implant (n = 190). Actuarial rates of migration of the implant and conjunctival dehiscence leading to implant exposure were computed. Results: Sixty-eight patients received an unwrapped nonporous implant (polymethylacrylate [PMMA]) and 190 patients received an unwrapped porous implant (139 hydroxyapatite [HA] and 51 porous polyethylene [Medpor]). Median follow-up duration in this study was 37.6 months. Implant exposure occurred in 1 of the 68 nonporous implant cases (1.5%) and in 4 of the 190 porous implant cases (2.1%). This difference is not statistically significant (P = 0.85). In contrast, clinically significant implant migration occurred substantially more frequently in the patients who received a nonporous implant. The cumulative actuarial probability of implant migration at 60 months was 15.5% for the nonporous implants versus 0.7% for the porous implants. This difference was statistically significant (P = 0.0003). Conclusions: Orbital implant migration occurred in a significantly greater proportion of patients who received a nonporous implant than in those who received a porous implant. Implant exposure occurred at a low rate that was not significantly different in the two subgroups.

[1]  Ashutosh Kumar Singh,et al.  Lack of complications of the hydroxyapatite orbital implant in 250 consecutive cases. , 1993, Transactions of the American Ophthalmological Society.

[2]  J. Bonnin,et al.  Exposure Rate of Hydroxyapatite Spheres in the Anophthalmic Socket: Histopathologic Correlation and Comparison with Silicone Sphere Implants , 1993, Ophthalmic plastic and reconstructive surgery.

[3]  J. Nerad,et al.  A preliminary report on the Universal Implant. , 1987, Archives of ophthalmology.

[4]  S. Dresner,et al.  High-density porous polyethylene (Medpor) as a successful anophthalmic socket implant. , 1994, Ophthalmology.

[5]  J. Bilyk,et al.  Comparison of Fibrovascular Ingrowth into Hydroxyapatite and Porous Polyethylene Orbital Implants , 1994, Ophthalmic plastic and reconstructive surgery.

[6]  B. Haik,et al.  Wrapping hydroxyapatite orbital implants with posterior auricular muscle complex grafts. , 1999, American journal of ophthalmology.

[7]  C. Shields,et al.  Progressive enlargement of acquired retinal astrocytoma in 2 cases. , 2004, Ophthalmology (Rochester, Minn.).

[8]  C. Beard.  Remarks on Historical and Newer Approaches to Orbital Implants , 1995, Ophthalmic plastic and reconstructive surgery.

[9]  S. R. Klapper,et al.  Wrapping hydroxyapatite implants. , 1999, Ophthalmic surgery and lasers.

[10]  A. Bawazeer,et al.  Experience with 120 Synthetic Hydroxyapatite Implants (FCI3) , 2001, Ophthalmic plastic and reconstructive surgery.

[11]  H. Buettner,et al.  Tissue breakdown and exposure associated with orbital hydroxyapatite implants. , 1992, American journal of ophthalmology.

[12]  W. Bearden,et al.  Enucleation: Is Wrapping the Implant Necessary for Optimal Motility? , 2003, Ophthalmic plastic and reconstructive surgery.

[13]  J. Oestreicher,et al.  Complications of hydroxyapatite orbital implants. A review of 100 consecutive cases and a comparison of Dexon mesh (polyglycolic acid) with scleral wrapping. , 1997, Ophthalmology.

[14]  J. Collin,et al.  Baseball orbital implants: a review of 39 patients. , 1985, The British journal of ophthalmology.

[15]  S. Kaltreider,et al.  Orbital implants in enucleation surgery: a report by the American Academy of Ophthalmology. , 2003, Ophthalmology.

[16]  B. Biesman,et al.  Current Techniques of Enucleation: A Survey of 5,439 Intraorbital Implants and a Review of the Literature , 1995, Ophthalmic plastic and reconstructive surgery.

[17]  D. Holck,et al.  Bovine Pericardium as a Wrapping for Orbital Implants , 2001, Ophthalmic plastic and reconstructive surgery.

[18]  J. O'Brien,et al.  Intraorbital implants after enucleation and their complications: a 10-year review. , 1998, Archives of ophthalmology.

[19]  L. Mawn,et al.  The Synthetic Hydroxyapatite Implant: A Report on 65 Patients , 1998, Ophthalmic plastic and reconstructive surgery.

[20]  M. Duffy,et al.  Exposure Rates of Wrapped and Unwrapped Orbital Implants Following Enucleation , 2001, Ophthalmic plastic and reconstructive surgery.

[21]  D. Robertson,et al.  Long-term follow-up of the Allen implant. 1967 to 1991. , 1995, Ophthalmology.

[22]  J. Dutton.  Coralline hydroxyapatite as an ocular implant. , 1991, Ophthalmology.

[23]  C. Shields,et al.  Histopathologic evidence of fibrovascular ingrowth four weeks after placement of the hydroxyapatite orbital implant. , 1991, American journal of ophthalmology.

[24]  S. Kaltreider,et al.  Prevention and Management of Complications Associated with the Hydroxyapatite Implant , 1996, Ophthalmic plastic and reconstructive surgery.

[25]  S. Brownstein,et al.  Abscessed hydroxyapatite orbital implants. A report of two cases. , 1996, Ophthalmology.

[26]  K. V. Jahrling,et al.  Complications of porous spherical orbital implants. , 1995, Ophthalmology.

[27]  M. Mazow,et al.  Use of the hydroxyapatite ocular implant in the pediatric population. , 1995, Archives of ophthalmology.

[28]  P. Mullaney,et al.  Porous polyethylene orbital implant in patients with retinoblastoma. , 1998, Ophthalmology.

[29]  Richard L. Anderson,et al.  The Quasi-Integrated Porous Polyethylene Orbital Implant , 2002, Ophthalmic plastic and reconstructive surgery.

[30]  N. Davies,et al.  Exposure of primary orbital implants in postenucleation retinoblastoma patients. , 2000, Ophthalmology.

[31]  J. O'Brien,et al.  Evaluation of efficacy and complications: primary pediatric orbital implants after enucleation. , 2000, Archives of ophthalmology.

[32]  D. Soll,et al.  The anophthalmic socket. , 1982, Ophthalmology.

[33]  S. C. Kao,et al.  The use of rectus abdominis sheath for wrapping of the hydroxyapatite orbital implants. , 1999, Ophthalmic surgery and lasers.

[34]  A. McNab.  Hydroxyapatite orbital implants. Experience with 100 cases. , 1995, Australian and New Zealand journal of ophthalmology.