The mersilene covered intraorbital implant

The use of mersilene mesh for wrapping of hydroxyapatite orbital implants: mid-term result

PURPOSE

To report the results of Mersilene mesh wrapped hydroxyapatite orbital implantation.

MATERIALS AND METHODS

Records of 63 patients operated between April 2002 and March 2006 were retrospectively reviewed. Parameters studied included sex, cause of enucleation, length of follow-up after operation, implant exposure, secondary implantation, and surgeon experience. Student's t-test and χ(2) were used for comparison group having implant exposure and those without implant exposure.

RESULTS

The rate of exposure with use of Mersilene mesh was found to be 4.7%. Gender and cause of enucleation did not influence incidence of implant exposure in this study. The surgeon related factor, reported in terms of oculoplasty surgeon and non-oculoplasty surgeon, was a statistically significant factors that affected implant exposure.

CONCLUSION

Mersilene showed favorable results in wrapping of hydroxyapatite orbital implants.

Mersilene mesh versus sclera in wrapping hydroxyapatite orbital implants

PURPOSE

To compare Mersilene mesh versus sclera in wrapping hydroxyapatite orbital implants used in primary enucleation.

METHODS

In a prospective, randomized, interventional comparative case series, 60 eyes from 60 consecutive patients were included and randomly allocated for primary enucleation and either Mersilene mesh-wrapped hydroxyapatite (MHA) orbital implant (30 cases, 50%) or sclera-wrapped hydroxyapatite (SHA) orbital implant (30 cases, 50%) under general anesthesia. Complete socket examination was performed at 1 week, 1 month, and then every 3 months after surgery.

RESULTS

Mean age was not significantly different (P = 0.08) between patients with MHA (36.43 years) and SHA (28.50 years) orbital implants. The most common cause of enucleation was trauma in both groups (P = 0.09). Patients with MHA had significantly (P = 0.005) longer follow-up time (mean, 11.40 months) than those with SHA (mean, 9.40 months). No exposure was found at last follow-up in the MHA group, but one patient in the SHA group had a small exposure (1 x 1 mm) 1 month after surgery that was conservatively treated. There were no significant postoperative soft tissue complications in either group.

CONCLUSIONS

Sclera and Mersilene mesh could be used as a wrapping material for hydroxyapatite orbital implants without significant complications. Absence of disease transmission, low cost, and availability are the main advantages of Mersilene mesh.

The sclera, the prion, and the ophthalmologist

Prions have emerged in the past 5 years as serious transmissible infective agents. Ocular tissue transplantation has come under scrutiny after potential infected tissue was transplanted into healthy patients. In this review we examine the evidence for the risk of transmission of prions after scleral transplantation and explore alternative materials that may be used in ocular surgery.

Comparison of artificial eye amplitudes with acrylic and hydroxyapatite spherical enucleation implants

PURPOSE

To compare artificial eye amplitudes in patients who randomly received either a hydroxyapatite or an acrylic, scleral-covered spherical implant after enucleation.

DESIGN

Randomized, controlled trial.

PARTICIPANTS

Thirty-four consecutive patients who underwent enucleation because of an intraocular melanoma and 21 healthy control participants from the hospital staff.

METHODS

Eligible patients randomly received a hydroxyapatite or an acrylic, scleral-covered spherical orbital implant. Fourteen patients were fitted with a hydroxyapatite implant, and 16 were fitted with an acrylic implant. We measured horizontal and vertical saccadic amplitudes of both the artificial eye and the healthy eye. Measurements were performed with the magnetic search coils technique. Saccadic amplitudes of the artificial eye were compared with the healthy eye of the patient. The amplitudes of the healthy eyes were compared with saccadic amplitudes of control participants. The interval from surgery to measurements was at least 3 months in all patients. Saccadic gain (artificial eye and eye amplitude divided by target amplitude) and saccadic symmetry (artificial eye amplitude divided by healthy eye amplitude) were calculated.

MAIN OUTCOME MEASURES

Saccadic gain and saccadic symmetry.

RESULTS

The gain in the healthy eyes of the patients was comparable with the gain of the control eyes. Saccadic symmetry was 1.0 in control participants. In patients, it was 0.334 in horizontal saccades and 0.577 in vertical saccades. However, saccadic symmetry did not differ significantly between the acrylic group and the hydroxyapatite group (P: > 0.1 for any saccadic direction). Equivalence was detectable with a power more than 90% for horizontal saccades and more than 80% for vertical saccades. Curvilinearity was rejected for both patient groups and for all saccadic directions (P: > 0.5).

CONCLUSIONS

When no motility peg is placed, acrylic and hydroxyapatite spherical implants yield comparable saccadic amplitudes of the artificial eye. Artificial eye amplitudes were markedly more restricted horizontally than vertically. In all saccadic directions, the relation between target amplitude and artificial eye amplitude was linear.

The 'baseball' orbital implant: a prospective study

The 'baseball' orbital implant was described by Frueh and Felker in 1976. Although this implant was originally described for use as a secondary implant, it has also been widely used as a primary implant at the time of enucleation. This prospective study evaluated the effectiveness of this implant used both primarily and secondarily. Forty-four patients were implanted between April 1990 and May 1991, 19 of the implants being primary and 25 secondary. A standardised operative and post-operative protocol was followed. The mean follow-up time was 31 months (range 24-36 months). The patients were evaluated for the degree of volume replacement, implant and associated prosthesis motility, secondary eyelid and socket problems, patient satisfaction, the need for further surgery and post-operative complications. The overall results achieved by primary implantation were superior to those of secondary implantation. Our results suggest that this implant provides a satisfactory functional and cosmetic rehabilitation of the anophthalmic patient with few complications.