Comparative analysis of use of porous orbital implant with mucus membrane graft and dermis fat graft as a primary procedure in reconstruction of severely contracted socket.

Purpose: The purpose of our study is to present a surgical technique of primary porous orbital ball implantation with overlying mucus membrane graft (MMG) for reconstruction of severely contracted socket and to evaluate prosthesis retention and motility in comparison to dermis fat graft (DFG). Study Design: Prospective comparative study. Materials and Methods: A total of 24 patients of severe socket contracture (Grade 2‑4 Krishna’s classification) were subdivided into two groups, 12 patients in each group. In Group I, DFG have been used for reconstruction. In Group II, porous polyethylene implant with MMG has been used as a primary procedure for socket reconstruction. In Group I DFG was carried out in usual procedure. In case of Group II, vascularized scar tissues were separated 360° and were fashioned into four strips. A scleral capped porous polyethylene implant was placed in the intraconal space and four strips of scar tissue were secured to the scleral cap and extended part overlapped the implant to make a twofold barrier between the implant and MMG. Patients were followed‑up as per prefixed proforma. Prosthesis motility and retention between the two groups were measured. Results: In Group I, four patients had recurrence of contracture with fall out of prosthesis. In Group II stable reconstruction was achieved in all the patients. In terms of prosthesis motility, maximum in Group I was 39.2% and Group II, was 59.3%. The difference in prosthesis retention (P = 0.001) and motility (P = 0.004) between the two groups was significant. Conclusion: Primary socket reconstruction with porous orbital implant and MMG for severe socket contracture is an effective method in terms of prosthesis motility and prosthesis retention.

Outcomes of Autogenous Dermis Fat Grafting with Different Donor Sites in Exposed Porous Orbital Implants

PURPOSE: To compare the outcomes of autogenous dermis fat grafting with different donor sites in the treatment of exposed porous orbital implants. METHODS: The present study retrospectively evaluated the medical records of 17 patients (17 anophthalmic eyes) who had undergone autogenous dermis fat grafting based on the diagnosis of exposed porous orbital implants and were regularly followed up for at least 12 months since the surgery from January 2001 to December 2010. The patients were divided into 2 groups (thigh and abdomen) according to the site of the donor grafting. The treatment outcome and complications were compared between the 2 groups. RESULTS: The success rate of thigh dermis fat grafting was 88.9% (8/9) and 100.0% (8/8) in the abdominal dermis fat grafting, and there was no statistically significant difference between the 2 groups (p = 1.000). Regarding ocular complications, graft tissue infection (thigh 11.1%, abdomen 0%) and superior sulcus deformity (thigh 22.2%, abdomen 25.0%) were present. Regarding donor site complications, tenderness (thigh 55.6%, abdomen 25.0%), dehiscence (thigh 22.2%, abdomen 25.0%) and scar formation (thigh 33.3%, abdomen 25.0%) were observed. In the gait associated complications, pain (thigh 55.6%, abdomen 25.0%) and limping (thigh 22.2%, abdomen 12.5%) were observed. The rate of all complications showed no statistically significant difference between the thigh dermis fat grafting and the abdominal dermis fat grafting (all p > 0.05). CONCLUSIONS: Thigh and abdomen can both be considered as an effective donor site for the autogenous dermis fat grafting in the treatment of exposed porous orbital implants.

Wrapping of Porous Orbital Implant Using Acellular Dermal Allograft

PURPOSE: To investigate the results when using the acellular dermal allograft (SureDerm(R), Hans Biomed Co., Korea) as a new wrapping material for porous orbital implants. METHODS: The charts of 11 patients who underwent either primary or secondary insertion of Medpor(R) orbital implants after enucleation or a new insertion after removal of previous orbital implants were reviewed. Medpor(R) orbital implants either 18 or 20 mm were wrapped with SureDerm(R) in 4x4 cm sections that were 1-mm-thick. Four rectus muscles were fixed to the SureDerm(R) wrapped implant, and a conjunctival suture was made with 6-0 Vicryl. All patients had follow-up periods longer than 10 months and were evaluated to determine the success of wrapping and to identify any complications. RESULTS: The average age of the patients was 48.3 years. The patients wore artificial eyes for 9 weeks after the operation, and the follow-up periods were 22.4 months on average. There was no case of implant or SureDerm(R) exposure, inflammation, and other significant complications except in one case that required fornix reconstruction to allow the subject to wear an artificial eye. CONCLUSIONS: Acellular dermal allograft appears to be a good substitute material if preserved sclera is not available when inserting orbital implants with wrapping.

A Case of Orbital Abscess following Porous Orbital Implant Infection

PURPOSE: We present a case of orbital abscess following porous orbital implant infection in a 73-year-old woman with rheumatoid arthritis. METHODS: Just one month after a seemingly uncomplicated enucleation and porous polyethylene (Medpor(R)) orbital implant surgery, implant exposure developed with profuse pus discharge. The patient was unresponsive to implant removal and MRI confirmed the presence of an orbital pus pocket. Despite extirpation of the four rectus muscles, inflammatory granulation debridement and abscess drainage, another new pus pocket developed. RESULTS: After partial orbital exenteration, the wound finally healed well without any additional abscess formation. CONCLUSIONS: A patient who has risk factors for delayed wound healing must be examined thoroughly and extreme care such as exenteration must be taken if there is persistent infection.

Exposure Incidence of Porous Orbital Implants

PURPOSE: We evaluated clinical results and incidence of exposures of orbital implants according to operative methods (enucleation or evisceration) and types of orbital implants. METHODS: We retrospectively reviewed the charts of 222 patients who underwent hydroxy apatite or Medpor(R) implantation after enucleation or evisceration and were followed up for more than 3 months from July, 1992 to November, 2001 at department of ophthalmology, Busan Paik hospital. RESULTS: In 222 eyes of 222 patients, who underwent hydroxyapatite and Medpor(R) implantaion, the exposure of implants occurred in 21 eyes (9.5%). In these cases, the exposure of implants occurred in 16 (12.8%) of 125 eyes with hydroxyapatite implantation and 5 (5.2%) of 97 eyes with Medpor(R) implantation. The exposure of implants occurred in 6 (7.1%) of 84 eyes after enucleation and in 15(10.8%) of 138 eyes after evisceration. The exposure of implants occurred in 12 (12.2%) of 98 eyes that used standard evisceration and in 3 (7.5%) of 40 eyes that used modified evisceration. CONCLUSIONS: The exposure of Medpor(R) implants was less than that of hydroxyapatite implants. But, it was influenced by types of orbital implants as well as operator and operative skill. There are few differences of exposure rate between the modified evisceration and enucleation.