Surgical treatment of anophthalmic socket - an experience with 42 intra orbital implants

ABSTRACT

We operated upon 42 eyes of 42 patients of different age groups [six-month to sixty-seven years] from December, 1995 to December, 1998. Intra orbital implant used were of Allen type in 24 eyes and Lowa type in 18 eyes. Fifteen, out of forty-two, were primary while remaining twenty-seven were secondary Implantations. Six months to three years follow-up [average being one year and eight months] showed excellent results in primary except one, which migrated inferiorly. Four, out of twenty-seven, secondary implants extruded out while six migrated from their normal position. Thirty-three [78.8%] had moderate to severe non-infective orbital cellulitis in early postoperative period which subsided with short course of systemic steroids. Prosthetic motility was much better in Allen type as compared to Lowa type implant. Improper dissection of extra ocular muscles, early absorbable suture [catgut], large size implant, severe postoperative orbital cellulitis [aseptic], excessive use of local steroids appear to be important causes of extrusion and migration. Implantation, in the patients whose eye were enucleated in early childhood, is another important cause of implant extrusion and migration. Primary orbital implant with adequate size Allen type acrylic mould after proper dissection and repair of all the six extra ocular muscles, using nonabsorbable sutures [6/0 prolene], tension-free closure of Tenon and conjunctiva give fairly acceptable cosmetic result: