Treatment of Exposed Hydroxyapatite Orbital Implants Wrapped with a Synthetic Dura Substitute

PURPOSE: To describe cases of exposed hydroxyapatite (HA) implants wrapped with the synthetic dura substitute Neuro-Patch treated via simple Neuro-Patch removal. METHODS: The medical records of seven patients who experienced exposure of their HA implant were reviewed. All patients had been enucleated and implanted with HA wrapped with Neuro-Patch. For treatment, Neuro-Patch was removed to the greatest extent possible. After applying local anesthesia with lidocaine, blunt dissection was performed to separate the conjunctiva and Neuro-Patch via the site of exposure. Pressure was applied to the remaining Neuro-Patch with forceps and removed with scissors. RESULTS: Neuro-Patch was visible at the area of exposure in all patients. No surgery beyond initial Neuro-Patch removal was necessary in six of the seven patients. In five cases, the exposed area began to heal rapidly after Neuro-patch removal without primary closure of the defect. In one case, the Neuro-Patch material and all necrotic tissue was removed aggressively due to inflammation around the orbital implant. Lastly, an infection was noted in one case, prompting complete removal of the Neuro-Patch–wrapped HA implant. CONCLUSIONS: Wrapping material may hinder implant vascularization. Exposure of HA in wrapped implants can be successfully treated by a simple removal procedure if detected and managed early.

Tube Erosion with Scleral Melting after Ahmed Valve Implantation Using a Synthetic Dural Substitute

PURPOSE: The objective of this case report was to present tube erosion of Ahmed valve implantation using a synthetic dura substitute (Neuro-Patch®, B. Braun, Boulogne, France). CASE SUMMARY: Tube erosion was caused by dissolution of the conjunctiva and partial-thickness scleral tunnel in 5 patients who received Ahmed valve implantation using a synthetic dura substitute for glaucoma treatment 2 to 4 months after the operation. Furthermore, the patients required re-operation for preventing secondary complications such as endophthalmitis. CONCLUSIONS: This case series using a synthetic dura substitute in Ahmed valve implantation demonstrated the risk of tube erosion with scleral tunnel melting and following secondary complications even with a partial-thickness scleral tunnel method.