Clinical Results of Hydroxyapatite Orbital Implantations using Autologous Sclera as a Wrapping Material

PURPOSE: To evaluate the clinical result of hydroxyapatite implantation using autologous sclera as wrapping material. METHODS: From December 2001 to February 2003, we performed 20 cases of hydroxyapatite implantation with autologous sclera as wrapping material. Eyes were enucleated for severe phthisis because evisceration could not provide adequate space for hydroxyapatite implantation or secondary hydroxyapatite implantation after prior evisceration. Postoperative complications were evaluated at postoperative 1 week, 2 weeks, 3 weeks - 1 month, 2 months, 3 months, and every 2 or 3 months thereafter. RESULTS: The mean follow up period was 12.1 +/- 4.52 months (4~18 months). During the follow up period, conjunctival erosions developed in 2 cases, which were controlled by conservative management only. No such postoperative complications as implant exposure, orbital infection, extrusion, inflammatory reaction occured. CONCLUSIONS: Autologous sclera is the suitable wrapping material of hydroxyapatite implant when enucleation is needed in primary surgery for severe phthisis, or for secondary hydroxyapatite implantation after prior evisceration surgery.

The Clinical Experience of Hydroxyapatite Implantation using Autologous Sclera and Vicryl Mesh

The hydroxyapatite implant, recetnly widely used new intraorbital implant, in light, highly biocompatible, characterized by easy fibrovascular proliferation. Thus, when inserted after evisceration, it has some beneficial effect cosmetically: it can cause less protrusion of implant or alteration of position and can have good artificial eye motion by linking to the implant. However, in case of hydroxyapatite implantation after evisceration with the cornea preserved, there is a risk of cornea melting by contact with the implant, and in case with the cornea preserved of the eyeball size being too small, hydroxyapatite implant is impossible after evisceration. Hydroxyapatite implantation is done after enucleation using donor sclera, which is not readily available in Korea. Thus we inserted hydroxyapatite implant covered with circular from of Vicryl mesh on endothelium after evisceration in 11 eyes, and inserted hydroxyapatite implant using autologous sclera with Vicryl mesh after enucleation in 3 eyes, in which 18 mm-sized implant could not be implanted after evisceration from August 195 to July 1996. Follow-up examination was done during 6 to 20 (mean 12.9) months postoperatively. Motion of extraocular muscle was very good. During follow-up examination, adverse effects such as conjunctival wound dehiscence and exposure or protrusion of hydroxyapatite implant through the conjunctiva didn`t occur. It should be considered an excellent operative method, because the hydroxyapatite implantation using autologous sclera with Vicryl mesh decreases the risk of exposure or protrusion of the implant and can be performed without the use of donor sclera.