Clinical application of biomaterials in orbital implants: a systematic review.

PURPOSE: Various materials have been proposed for reconstructing orbital fractures. The materials used must meet certain criteria to ensure their suitability for restoring the structure and function of the organ. These criteria include biocompatibility, ease of application, non-toxicity, hypo-allergenicity, and non-carcinogenicity. In this study, we systematically reviewed the studies regarding the biomaterials in orbital implants and their clinical application. METHODS: A comprehensive search across various databases, including PubMed, Scopus, EMBASE, Cochrane Library, and Web of Science, was conducted until April 10th, 2023. After retrieving the search results and eliminating duplicates, final studies were included after screening through defined criteria. Human and animal studies assessing the clinical application of biomaterials in orbital implants were included. The quality of the case series and controlled intervention studies were evaluated using the NIH tool, and for animal studies, the risk of bias was assessed using SYRCLE's tool. RESULTS: Seventeen studies were included according to defined criteria. These studies aimed to explore the clinical application of biomaterials and examine the associated complications in orbital implants. CONCLUSION: We found that using biomaterials did not result in elevated intraocular pressure (IOP). However, we did observe certain complications, with infection, residual diplopia, and enophthalmos being the most frequently reported issues.

Matrixmidface Preformed Orbital Implants for Three-Dimensional Reconstruction of Orbital Floor and Medial Wall Fractures: A Prospective Clinical Study.

Study Design: Prospective Interventional study. Objective: To evaluate the efficiency of Matrixmidface preformed Orbital plates for three-dimensional reconstruction of orbital floor and medial wall fractures. Methods: This prospective institutional clinical study was conducted on a group of 14 patients who underwent repair of orbital floor and medial wall fracture defects using Matrixmidface Preformed Orbital plates and open reduction and internal fixation of associated fractures. The following parameters were studied preoperative and postoperative enophthalmos, hypoglobus, orbital volume; correction of diplopia, intraoperative and postoperative complications. Results: All 14 patients were males aged between 19 and 42 years. The most common mode of injury was found to be road traffic accidents (RTAs) followed by self-fall and trauma at workplace. Orbital fractures were associated with other concomitant maxillofacial fractures in 12 patients (85.7%) while 2 patients (14.3%) had pure blowout fractures. Significant improvement of enophthalmos was noted from preoperative period to 1 week, 6 weeks, and 6 months postoperatively (P value .02, .01, and .01, respectively). Out of 11 patients with preoperative hypoglobus, 5 patients (45.45%) had persistent hypoglobus in the immediate postoperative period which reduced to 4 patients (36.36%) at 6 weeks postoperatively (p value .00). The postoperative orbital volume of fractured side ranged from 20.3 cm3 to 26.76 cm3 with a mean of 23.50 cm3 ± 1.74. The mean difference between the volumes of the repaired and uninjured sides was found to be .27 cm3 ± .39 (P value .02) denoting that the reconstruction of the orbit closely approximated that of the uninjured side. Conclusions: The Matrixmidface Preformed Orbital plate provides exceptional reconstruction of the orbital blowout fracture defects and ensures satisfactory results clinically and radiographically. The plate ensures an approximate recreation of topographical anatomy of the orbit and adequately restores the orbital volume. It provides adequate correction of asymmetry, hypoglobus, enophthalmos and attempts to restore eye movements, without causing any significant postoperative complication.

The Use of Functional Biomaterials in Aesthetic and Functional Restoration in Orbital Surgery.

The integration of functional biomaterials in oculoplastic and orbital surgery is a pivotal area where material science and clinical practice converge. This review, encompassing primary research from 2015 to 2023, delves into the use of biomaterials in two key areas: the reconstruction of orbital floor fractures and the development of implants and prostheses for anophthalmic sockets post-eye removal. The discussion begins with an analysis of orbital floor injuries, including their pathophysiology and treatment modalities. It is noted that titanium mesh remains the gold standard for orbital floor repair due to its effectiveness. The review then examines the array of materials used for orbital implants and prostheses, highlighting the dependence on surgeon preference and experience, as there are currently no definitive guidelines. While recent innovations in biomaterials show promise, the review underscores the need for more clinical data before these new materials can be widely adopted in clinical settings. The review advocates for an interdisciplinary approach in orbital surgery, emphasizing patient-centered care and the potential of biomaterials to significantly enhance patient outcomes.

Orbital Complications and Cost Analysis of Enucleation by Myoconjunctival versus Conventional Techniques for Retinoblastoma.

Introduction: The aim of the study was to compare complication rates and hospital costs of myoconjunctival versus conventional enucleation techniques in retinoblastoma. Methods: This retrospective cohort and cost analysis reviewed patients with retinoblastoma treated by primary or secondary enucleation between 2003 and 2021 and a minimum 6-month follow-up. Cases were reviewed for three postsurgical complications: chronic conjunctivitis, implant exposure/extrusion, and cellulitis. Cases were excluded if surgery was performed elsewhere or documentation was incomplete. Treatment costs were estimated based on two sample cases billed in 2021 that manifested the studied complications and represented each of the two surgical techniques. Univariate and multivariate analyses were applied to compare complication rates and treatment costs. Results: Included were 180 eyes (179 patients); 239 eyes (227 patients) were excluded. Patients had median age of 18.9 (0-104.4) months at diagnosis, the majority were male (94, 52%), with unilateral (115, 64%) group D or E (163, 91%) eyes. Enucleation was performed by conventional techniques in 107 eyes (59%) and by myoconjunctival approach in 73 (41%). Orbital complications occurred in 61 eyes (34%) during a median follow-up of 7.9 (0.5-33.7) years, more frequently in the conventional technique group (p = 0.014). The myoconjunctival technique had significantly lower costs for implant price (p < 0.001) and estimated treatment cost, including complication management (p < 0.001). Conclusion: Enucleation by myoconjunctival technique showed significantly less complication burden and treatment cost, indicating advantages over conventional approaches. Study limitations include the retrospective nature, confounders' complexity, and follow-up time variations.

Accuracy of surgical navigation for patient-specific reconstructions of orbital fractures: A systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to review the recent literature on the technical accuracy of surgical navigation for patient-specific reconstruction of orbital fractures using a patient-specific implant, and to compare surgical navigation with conventional techniques. MATERIALS AND METHODS: A systematic literature search was conducted in PubMed (Medline), Embase, Web of Science, and Cochrane (Core Collection) databases on May 16, 2023. Literature comparing surgical navigation with a conventional method using postoperative three-dimensional computed tomography imaging was collected. Only articles that studied at least one of the following outcomes were included: technical accuracy (angular accuracy, linear accuracy, volumetric accuracy, and degree of enophthalmos), preoperative and perioperative times, need for revision, complications, and total cost of the intervention. MINORS criteria were used to evaluate the quality of the articles. RESULTS: After screening 3733 articles, 696 patients from 27 studies were included. A meta-analysis was conducted to evaluate volumetric accuracy and revision rates. Meta-analysis proved a significant better volumetric accuracy (0.93 cm3 ± 0.47 cm3) when surgical navigation was used compared with conventional surgery (2.17 cm3 ± 1.35 cm3). No meta-analysis of linear accuracy, angular accuracy, or enophthalmos was possible due to methodological heterogeneity. Surgical navigation had a revision rate of 4.9%, which was significantly lower than that of the conventional surgery (17%). Costs were increased when surgical navigation was used. CONCLUSION: Studies with higher MINORS scores demonstrated enhanced volumetric precision compared with traditional approaches. Surgical navigation has proven effective in reducing revision rates compared to conventional approaches, despite increased costs.

Revisiting bilateral bony orbital volumes comparison using 3D reconstruction in Korean adults: a reference study for orbital wall reconstruction, 3D printing, and navigation by mirroring.

BACKGROUND: Orbital wall fractures can result in changes to the bony orbital volume and soft tissue. Restoring the bony orbital and intraconal fat volumes is crucial to prevent posttraumatic enophthalmos and hypoglobus. We aimed to establish an evidence-based medical reference point for "mirroring" in orbital wall reconstruction, which incorporates three-dimensional (3D)-printing and navigation-assisted surgery, by comparing bilateral bony orbital volumes. METHODS: We retrospectively analyzed the data obtained from 100 Korean adults who did not have orbital wall fractures, categorized by age groups. The AVIEW Research software (Coreline Soft Inc., Seoul, South Korea) was used to generate 3D reformations of the bony orbital cavity, and bony orbital volumes were automatically calculated after selecting the region of interest on consecutive computed tomography slices. RESULTS: The mean left and right orbital volume of males in their 20 s was 24.67 ± 2.58 mL and 24.70 ± 2.59 mL, respectively, with no significant difference in size (p = 0.98) and Pearson's correlation coefficient of 0.977 (p < 0.001). No significant differences were found in orbital volumes in other age groups without fractures or in patients with nasal bone fractures (p = 0.84, Pearson's correlation coefficient 0.970, p < 0.001). The interclass correlation coefficients (2,1) for inter- and intrarater reliability were 0.97 (p < 0.001) and 0.99 (p < 0.001), respectively. CONCLUSIONS: No significant differences were found in the bilateral bony orbital volumes among males of any age. Thus, the uninjured orbit can be used as a volumetric reference point for the contralateral injured orbit during orbital wall reconstruction.

Augmented and Virtual Reality for Preoperative Trauma Planning, Focusing on Orbital Reconstructions: A Systematic Review.

BACKGROUND: This systematic review summarizes recent literature on the use of extended reality, including augmented reality (AR), mixed reality (MR), and virtual reality (VR), in preoperative planning for orbital fractures. METHODS: A systematic search was conducted in PubMed, Embase, Web of Science and Cochrane on 6 April 2023. The included studies compared extended reality with conventional planning techniques, focusing on computer-aided surgical simulation based on Computed Tomography data, patient-specific implants (PSIs), fracture reconstruction of the orbital complex, and the use of extended reality. Outcomes analyzed were technical accuracy, planning time, operative time, complications, total cost, and educational benefits. RESULTS: A total of 6381 articles were identified. Four articles discussed the educational use of VR, while one clinical prospective study examined AR for assisting orbital fracture management. CONCLUSION: AR was demonstrated to ameliorate the accuracy and precision of the incision and enable the better identification of deep anatomical tissues in real time. Consequently, intraoperative imaging enhancement helps to guide the orientation of the orbital reconstruction plate and better visualize the precise positioning and fixation of the PSI of the fractured orbital walls. However, the technical accuracy of 2-3 mm should be considered. VR-based educational tools provided better visualization and understanding of craniofacial trauma compared to conventional 2- or 3-dimensional images.

Current Guidelines and Opinions in the Management of Orbital Floor Fractures.

Orbital floor fractures are a common manifestation of facial trauma that is encountered by ophthalmology, otolaryngology, and oral maxillofacial specialists. Surgical intervention is required emergently in cases of tissue entrapment and less urgently in cases of presenting with persistent diplopia, enophthalmos greater than 2 mm, and/or fractures involving greater than 50% of the orbital floor. Surgical management is a debated topic with differing opinions among surgeons regarding timing of repair, type of implant, and surgical approach.

Patient-Specific Orbital Implants Vs. Pre-Formed Implants for Internal Orbital Reconstruction.

PURPOSE: To compare the outcome of orbital blowout fracture repair by means of pre-formed porous-polyethylene titanium implants (PFI) vs patient-specific porous-polyethylene implants (PSI). METHODS: Retrospective cohort study. Baseline characteristics, ophthalmic examination results, ocular motility, fracture type, the timing of surgery, implant type, and final relative enophthalmos of all patients operated on for blow-out fractures in a single center were collected and analyzed. RESULTS: Twenty-seven patients (mean age 39 years, 9 females) were enrolled. Sixteen underwent fracture repair with PFI and 11 with PSI at 11 months (median) post-trauma. Mean follow-up duration was 1.1 years. Both groups showed significant postoperative improvement in primary or vertical gaze diplopia (P = .03, χ2). Relative enophthalmos improved from -3.2 preoperative PFI to -1.7 mm postoperative PFI, and from -3.0 mm preoperative PSI to -1.1 mm postoperative PSI (P= .1). PSI patients had non-significantly less postoperative enophthalmos and globe asymmetry than PFI patients. The outcome was not influenced by previous surgery, age, sex, number of orbital walls involved in the initial trauma, or medial wall involvement (linear regression). Both groups sustained complications unrelated to implant choice. CONCLUSION: Both PSI and PFI yielded good outcomes in this study. PSI may be a good alternative to PFI in primary or secondary orbital blowout fracture repair with less enophthalmos and globe asymmetry, in spite of the possible disadvantages of production time, a relatively larger design, and challenging insertion. Since it is a mirror image of the uninjured orbit, it may be beneficial in extensive fractures.

Orbital reconstruction: a systematic review and meta-analysis evaluating the role of patient-specific implants.

The purpose of this study is to execute an evidence-based review answering the following question (PICO): "Do patient-specific implants (PSI), manufactured or designed using computer-assisted technology, improve outcomes (orbital volume change, enophthalmos, diplopia, and operative duration) compared to conventional methods in orbital reconstruction following traumatic orbital injury in the adult patient population?" We performed a systematic review and meta-analysis in accordance with PRISMA guidelines. Inclusion criteria included any comparative paper whereby computer-assisted technology was used in the prefabrication or design process of implants for use in post-traumatic orbital reconstruction. Paediatric patient populations were excluded. Eight databases were systematically searched for relevant studies. Risk of bias was assessed through the NOS and RoB2 tools. Random-effects models were used to identify differences in outcomes between groups where possible. Analysis was performed using R 4.0.0. Eleven of 4784 identified studies were included, comprising 628 adult patients, with 302 and 326 patients in the patient-specific and conventional groups, respectively. Weighted mean difference between unaffected and post-operative orbital volume was 0.32 ml (SD 0.75) and 0.95 ml (SD 1.03) for patient-specific and conventional groups, respectively. Significant improvement was identified in post-operative orbital volume reconstitution with the use of PSI, compared to conventional implants, in 3 of the 5 reporting studies. Equally, post-operative enophthalmos trended towards lower severity in the patient-specific group, with 11.2% of patients affected in the patient-specific group and 19.2% in the conventional group, and operative duration was significantly reduced with the use of PSI in 3 of the 6 reporting studies. Despite a tendency to favour PSI, no statistically significant differences in key outcomes were identified on meta-analysis. Although there is some encouraging data to support improved outcomes with the use of patient-specific orbital implants in post-traumatic reconstruction, there is, at present, no statistically significant evidence to objectively support their use over conventional implants based on the currently available comparative studies. Based on the results of this study, the choice of implant used should, thus, be left to the discretion of the surgeon.

Application of digital technology in the reconstruction of orbital fractures: research progress / 中华创伤杂志

Orbital fracture often leads to facial collapse, diplopia, enophthalmos, and even blindness. Traditional surgery relies on the experiences of physicians to achieve fracture reduction and orbital wall reconstruction, but the repair effect is not satisfactory. In recent years, with the development of digital technology, technologies such as computer-assisted surgery, 3D printing, surgical navigation systems, and intraoperative CT imaging have become increasingly widespread in the field of orbital reconstruction. Such techniques can avoid dependence on physicians′ experiences and make it easy for estimating and positioning the implantation sites, which subsequently contributes to better surgery efficiency and precise reconstruction of the orbit, improving aesthetics and visual function of patients. To this end, the authors reviewed the recent progress in application of digital technology for orbital fracture reconstruction, so as to provide reference and theoretical basis for clinical practice.

Clinical and histopathological study of a hollow and posteriorly multiperforated polymethylmethacrylate implant in eviscerated rabbit eyes / Análise clínica e histopatológica de um implante de polimetilmetacrilato oco e multiperfurado em sua porção posterior em olhos eviscerados de coelhos

ABSTRACT Purpose: The study aimed to evaluate the clinical and tissue response to a hollow polymethylmethacrylate orbital implant with a multiperforated posterior surface in an animal model after evisceration. Methods: Sixteen New Zealand rabbits had their right eye eviscerated. All animals received a hollow polymethylmethacrylate implant 12 mm in diameter that is multiperforated in its posterior hemisphere. The animals were divided into four groups, and each one had the eye exenterated at 7, 30, 90, and 180 days post-evisceration. Clinical signs were assessed daily for 14 days post-evisceration and then every 7 days until 180 days. Inflammatory pattern, collagen structure, and degree of neovascularization generated with implant placement were analyzed with hematoxylin-eosin, picrosirius red, and immunohistochemistry staining. Results: There were no signs of infection, conjunctival or scleral thinning, or implant exposure or extrusion in any animal during the study. On day 7, the new tissue migrated into the implant and formed a fibrovascular network through the posterior channels. Inflammatory response reduced over time, and no multinuclea­ted giant cells were found at any time. Conclusion: Hollow polymethylmethacrylate orbital implants with a multiperforated posterior surface enable rapid integration with orbital tissues by fibrovascular ingrowth. We believe that this orbital implant model can be used in research on humans.

RESUMO Objetivo: Avaliar a resposta tecidual e clínica a um implante orbitário de polimetilmetacrilato, oco e multiperfu­rado em sua porção posterior em modelo animal após evisceração. Métodos: Dezesseis coelhos da raça Nova Zelândia foram submetidos à evisceração do globo ocular direito. Todos receberam implante oco de polimetilmetacrilato de 12 mm de diâmetro, multiperfurado em sua semiesfera posterior. O estudo foi dividido em avaliação clínica e histopatológica. A avaliação clínica foi diária até 14 dias pós-evisceração e, a cada sete dias, até completar 180 dias. Os animais foram divididos em grupos de quatro animais e cada um foi submetido à exenteração com 07, 30, 90 e 180 dias e depois à eutanásia. A análise histopatológica teve por fim caracterizar o padrão inflamatório, a estrutura do colágeno e o grau de neovascularização. Para isso, além da tradicional coloração pela hematoxilina-eosina, utilizou-se o corante Picrosirius Red (PSR) e imuno-histoquímica com o marcador CD 34. Resultados: Não houve sinais de infecção, afinamento conjuntival ou escleral, exposição ou extrusão do implante em nenhum animal durante o estudo. Já no sétimo dia, o tecido neoformado migrou para dentro do implante formando uma rede fibrovascular através dos canais posteriores. A resposta inflamatória diminuiu ao longo do tempo avaliado e não foram encontradas células gigantes multinucleadas. Conclusão: O implante analisado permite a sua integração aos tecidos orbitários pelo crescimento fibrovascular em seu interior. Os autores acreditam que este modelo de implante orbital pode fazer parte de testes com humanos.

Mejoramiento estético en paciente con tisis bulbi

Introducción: El ojo es un órgano esencial para la relación con el entorno y para el desarrollo del ser humano, es fundamental poseer una adecuada salud visual. Objetivo: Describir la confección de una prótesis ocular para el mejoramiento estético en un paciente con tisis bulbi en ojo derecho. Caso clínico: Paciente masculino, de raza blanca, de 59 años de edad que llega a la consulta de Prótesis del Policlínico Universitario Julio Antonio Mella de la provincia Camagüey remitido de Servicios de Oftalmología con diagnóstico de tisis bulbi del ojo derecho. Al interrogatorio plantea que cuando niño, jugando con su hermano recibió un golpe en el ojo, por el cual fue tratado en el servicio de Oftalmología del Hospital Pediátrico Eduardo Agramonte Piña de la ciudad de Camagüey. Tuvo una pérdida visual progresiva que finalizó en ceguera y cambio de coloración del ojo. Refiere que nunca ha tenido dolor, pero le preocupa su estética. Conclusiones: El tratamiento protésico de la tisis del globo ocular, es una situación desafiante para el equipo rehabilitador, dada las características de este defecto. Con la utilización de este tipo de prótesis oculares en la rehabilitación del paciente, se logró mejorar su estética, lo que condujo a la recuperación física, psíquica y social.

Introduction: The eye is an essential organ for the relationship with the environment, and for the development of the human being it is essential to have adequate visual health. Objective: To describe the preparation of an ocular prosthesis for aesthetic improvement in a patient with phthisis bulbi in the right eye. Clinical case: A 59-year-old white male patient who arrived at the prosthesis clinic of the Julio Antonio Mella University Polyclinic in the province of Camagüey, referred from Ophthalmology Services with a diagnosis of phthisis bulbi of the right eye. Upon interrogation, he states that when he was a child, playing with his brother, he received a blow to the eye, for which he was treated at the ophthalmology service of the Eduardo Agramonte Piña Pediatric Hospital in the city of Camagüey. He had progressive visual loss that ended in blindness and eye color change. He says that he has never had pain, but he is concerned about his aesthetics. Conclusions: The prosthetic treatment of ocular globe phthisis is a challenging situation for the rehabilitation team, given the characteristics of this ocular defect. With the use of this type of ocular prosthesis in the patient's rehabilitation, it was possible to improve their aesthetics, which led to physical, mental and social recovery.

Next-generation finely controlled graded porous antibacterial bioceramics for high-efficiency vascularization in orbital reconstruction.

Eyeball loss due to severe ocular trauma, intraocular malignancy or infection often requires surgical treatment called orbital implant reconstruction to rehabilitate the orbital volume and restore the aesthetic appearance. However, it remains a challenge to minimize the postoperative exposure and infection complications due to the inert nature of conventional orbital implants. Herein, we developed a novel Ca-Zn-silicate bioceramic implant with multi-functions to achieve the expected outcomes. The porous hardystonite (Ca2ZnSi2O7) scaffolds with triply periodic minimal surfaces (TPMS)-based pore architecture and graded pore size distribution from center to periphery (from 500 to 800 µm or vice versa) were fabricated through the digital light processing (DLP) technique, and the scaffolds with homogeneous pores (500 or 800 µm) were fabricated as control. The graded porous scaffolds exhibited a controlled bio-dissolving behavior and intermediate mechanical strength in comparison with the homogeneous counterparts, although all of porous implants presented significant antibacterial potential against S. aureus and E. coli. Meanwhile, the pore size-increasing scaffolds indicated more substantial cell adhesion, cell viability and angiogenesis-related gene expression in vitro. Furthermore, the gradually increasing pore feature exhibited a stronger blood vessel infiltrating potential in the dorsal muscle embedding model, and the spherical implants with such pore structure could achieve complete vascularization within 4 weeks in the eyeball enucleation rabbit models. Overall, our results suggested that the novel antibacterial hardystonite bioceramic with graded pore design has excellent potential as a next-generation orbital implant, and the pore topological features offer an opportunity for the improvement of biological performances in orbital reconstruction.

The Dilemma of Reconstructive Material Choice for Orbital Floor Fracture: A Narrative Review.

The aim of this study is to present a narrative review of the properties of materials currently used for orbital floor reconstruction. Orbital floor fractures, due to their complex anatomy, physiology, and aesthetic concerns, pose complexities regarding management. Since the 1950s, a myriad of materials has been used to reconstruct orbital floor fractures. This narrative review synthesises the findings of literature retrieved from search of PubMed, Web of Science, and Google Scholar databases. This narrative review was conducted of 66 studies on reconstructive materials. Ideal material properties are that they are resorbable, osteoconductive, resistant to infection, minimally reactive, do not induce capsule formation, allow for bony ingrowth, are cheap, and readily available. Autologous implants provide reliable, lifelong, and biocompatible material choices. Allogenic materials pose a threat of catastrophic disease transmission. Newer alloplastic materials have gained popularity. Consideration must be made when deliberating the use of permanent alloplastic materials that are a foreign body with potential body interactions, or the use of resorbable alloplastic materials failing to provide adequate support for orbital contents. It is vital that surgeons have an appropriate knowledge of materials so that they are used appropriately and reduce the risks of complications.

Anophthalmic Socket Syndrome: Prevalence, Impact and Management Strategies.

Anophthalmic socket syndrome determines functional deficits and facial deformities, and may lead to poor psychological outcomes. This review aims to comprehensively evaluate the features of the syndrome, based on literature review and authors' clinical and surgical experience. An electronic database (PubMed,MEDLINE and Google Scholar) search of all articles written in English and non-English language with abstract translated to English on anophthalmic socket syndrome was performed. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. Different types of orbital implants were evaluated; the management of implant exposure was examined; different orbital volume enhancement procedures such as secondary implantation, subperiosteal implants and the use of fillers in anophthalmic patients were described; the problems related to socket contraction were outlined; the treatment options for chronic anophthalmic socket pain and phantom eye syndrome were assessed; the most recent advances in the management of congenital anophthalmia were described. Current clinical evidence does not support a specific orbital implant; late exposure of porous implants may be due to pegging, which currently is seldom used; filler absorption in the orbit appears to be faster than in the dermis, and repeated treatments could be a potential source of inflammation; socket contraction results in significant functional and psychological disability, and management is challenging. Patients affected by anophthalmic socket pain and phantom eye syndrome need specific counseling. It is auspicable to use a standardized protocol to treat children affected by clinical congenital anophthalmia; dermis fat graft is a suitable option in these patients as it helps continued socket expansion. Dermis fat graft can also address the volume deficit in case of explantation of exposed implants and in contracted sockets in both children and adults. Appropriate clinical care is essential, as adequate prosthesis wearing improves the quality of life of anophthalmic patients.

Implant malposition and revision surgery in primary orbital fracture reconstructions.

The aim of the study was to assess factors leading to revision surgery and implant position of primary orbital fracture reconstructions. A retrospective cohort included patients who underwent orbital floor and/or medial wall fracture reconstruction for recent trauma. Demographics, fracture type, surgery and implant-related variables, and postoperative implant position were analyzed. The overall revision surgery rate was 6.5% (15 of 232 surgeries). The rate was highest in combined midfacial fractures with rim involvement (14.0%), lower in zygomatico-orbital fractures (8.7%), and lowest in isolated blowout fractures (3.8%). Fracture type, orbital rim fixation and implant malposition predicted revision. The best positioning was achieved with patient-specific milled titanium implants (mtPSI) and resorbable materials, whereas the poorest with preformed three-dimensional titanium plates. Combined midfacial fractures with rim involvement in particular have a high risk for orbital revision surgery. Within the limitations of the present study, mtPSIs should be preferred in the reconstruction of primary orbital fractures if possible.

Auricular cartilage versus donor sclera as a wrapping of hydroxyapatite orbital implants.

AIM: To retrospectively compare postoperative outcomes after primary enucleation and placement of a hydroxyapatite (HA) implant without wrapping, wrapped with auricular cartilage or donor sclera. METHODS: Medical records of patients presented as intraocular tumor or severe ocular injury were identified from the electronic medical record system. Cases underwent enucleation and HA orbital implantation were enrolled in this study and were divided into 3 groups according to the wrapping material of HA implant. Cases with autogenous cartilage caps were enrolled in group A (n=11), with donor sclera caps in group B (n=12), and without any wrapping material in group C (n=9). Follow-ups were set at 1, 2wk, 1, 3, 6, and 12mo after surgery. RESULTS: Altogether 32 cases finished the follow-up and were enrolled in this study. Three cases (27.27%) in group A, 4 cases (33.33%) in group B, and 4 cases (44.44%) in group C developed one complication each after surgery. In group A, no HA exposure occurred, but conjunctival inclusion cyst occurred in one and severe conjunctive chemosis in two cases. In group B, one HA exposure occurred, conjunctive inclusion cysts occurred in one, severe conjunctive chemosis occurred in one, and conjunctival granuloma occurred in one case. In group C, one HA exposure occurred, severe conjunctive chemosis occurred in two cases, and conjunctival granuloma occurred in one case. The case of exposure of none-wrapped implant was noted in the first 6mo after placement of the orbital implant. The case of exposure of donor sclera-wrapped implant was noted at the 12mo after placement of the orbital implant. Both exposure cases were treated successfully with conservative treatment. CONCLUSION: With low incidence of implant exposure and mild complications, auricular cartilage can be a good choice of alternative wrapping material of orbit implant with satisfied outcome.

Outcomes of secondary autologus dermo-fat orbital implants in anophthalmic sockets.

OBJECTIVES: To evaluate the outcomes of secondary autologous dermis-fat graft as an orbital implant in anophthalmic sockets. METHODS: In this prospective study, which was conducted at Jinnah Post Graduate Medical Centre, Karachi, between January 2015 and January 2020, we evaluated 12 patients between the ages of four and 60 years. Most of the adults were victims of trauma, whereas children were known cases of retinoblastoma or trauma and all underwent enucleation. All of them were primarily treated elsewhere and not offered primary orbital implants. We performed autologous dermis-fat graft as an orbital implant in these patients harvesting graft from gluteal region and followed them up to look for complications. RESULTS: Out of 12 patients two went into failure, while rest of the patients showed successful outcome. All patients underwent successful surgery. Initially, a silicon conformer was placed, which was later on replaced with artificial prosthetic eye. CONCLUSION: Regardless of the small sample size, this procedure proved to be a safe and effective method for augmenting orbital volume in anophthalmic sockets in children and adults.

Orbital Implants in Orbital Fracture Reconstruction: A Ten-Year Series.

STUDY DESIGN: Retrospective comparative interventional series of all patients who had undergone orbital fracture repair by 2 senior orbital surgeons in a single tertiary trauma center from January 2005 to December 2014. OBJECTIVE: To compare the outcomes of different implants used for various types of orbital fractures. METHODS: Patients were evaluated by age, gender, etiology of fracture, clinical findings, type of fractures, and implant used. Main outcome measures included restoration of premorbid state without morbidity and complications including enophthalmos, diplopia, infraorbital hypoesthesia, and ocular motility restriction 1 year after fracture repair. Implant-related complications were collected for analysis. RESULTS: There were a total of 274 patients with 307 orbits reconstructed. Thirty-three (12.0%) patients sustained bilateral injuries; 58.0% (n = 178) of orbits had simple fractures (isolated orbital floor, medial wall, or combined floor and medial wall). The distribution of implants used were bioresorbable (n = 117, 38.1%) and prefabricated titanium plates (n = 98, 31.9%) depending upon the nature of fracture. Bioresorbables, titanium plate, and porous polyethylene were used significantly more than titanium mesh for simple fractures, and prefabricated anatomic titanium implants were used significantly more than the other implants for complex fractures. There was a statistically significant improvement in diplopia, enophthalmos, ocular motility, and infraorbital hypoesthesia (p-value < 0.001) 1 year following orbital fracture reconstruction. CONCLUSIONS: When used appropriately, diverse alloplastic materials used in orbital fracture repair tailored to the indication aid orbital reconstruction outcomes with each material having its own unique characteristics.