Enduragen patch grafts for exposed orbital implants

Burnishing of exposed porous polyethylene orbital implant: is it useful?

OBJECTIVE

To describe and report the surgical outcomes of the burnishing technique for exposed porous polyethylene (PP) orbital implants.

METHODS

A retrospective review of consecutive patients who underwent repair of an exposed PP orbital implant at Hong Kong Eye Hospital and Queen Elizabeth Hospital, Hong Kong, between January 2002 and April 2022 was conducted. Exposed PP orbital implants were burnished with an electric drill. The exposed area was then covered by a donor scleral graft followed by conjunctival wound closure. Patients with a shallow lower eyelid fornix would undergo additional fornix deepening procedures that mobilize the conjunctiva and provide adequate coverage of the implant.

RESULTS

Six patients who had exposed PP orbital implants following enucleation (n = 4) and evisceration (n = 2) underwent repair. Five of the six patients did not experience any recurrence at an average follow-up of 25 months (range, 7-42 months). One patient who suffered from endophthalmitis experienced orbital implant re-exposure 16 months after the revision was managed by reimplantation of an acrylic implant and wrapping with both donor scleral graft and dermis fat graft.

CONCLUSION

In conclusion, we described a burnishing technique for repairing exposed PP orbital implants. Our technique is effective in preventing implant re-exposure and is easy to perform.

Surgical management of orbital implant exposures after evisceration or enucleation: Retrospective study - Limoges University Hospital

INTRODUCTION

Implant exposure is the most frequent complication after evisceration or enucleation, and multiple surgical techniques for the management of orbital implant exposure. The goal of our study is to investigate the success rate and risk factors for failure of various surgical procedures.

METHODS

This was a retrospective study performed at the University Hospital of Limoges. We collected data from the files of every patient operated on for implant exposure between January 2005 and December 2020. The main criterion was the percentage of success for each procedure. Secondary objectives were to identify risk factors for failure of Müller's muscle flaps and to determine the incidence of post-enucleation socket syndrome depending on whether the orbital implant was maintained.

RESULTS

Fifty-one patients were included: 26 patients who underwent Müller's muscle flap, 16 dermis-fat graft, 3 conjunctival flap, 2 amniotic membrane graft, 1 temporalis fascia graft, 1 buccal mucosa graft, 1 implant rotation, and 1 implant exchange. The dermis-fat grafts were more successful (87.5%) than the Müller's muscle flaps (52.2%) (P=0.0213). The study highlighted the importance of good vascularization of the implant (OR=32.00, P-value=0.0245) for the success of Müller's muscle flaps, and we found no statistically significant difference between the patients who maintained their implants and those who did not (P=0.3865) with regard to the incidence of post-enucleation socket syndrome.

CONCLUSION

Müller's muscle flap may remain a reasonable option in the management of medium-sized implant exposures of well-vascularized implants confirmed on MRI in patients with no systemic healing disorders. Dermis-fat graft remains the option of choice in other cases, especially in large exposures or complicated orbits.

Correction of orbital implant exposure using a supra-brow island flap pedicled with orbicularis oculi muscle

PURPOSE

To describe our experience of the supra-brow island flap pedicled with orbicularis oculi muscle technique for correcting orbit implant exposure.

MATERIALS AND METHODS

This retrospective study reviewed 32 patients that underwent orbit implant exposure surgery using a supra-brow island flap pedicled with orbicularis oculi muscle. All data were reviewed from patients in Eye & ENT Hospital of Fudan University, Shanghai during January 2018 to July 2020. The patient demographics, the original etiology, surgical procedures, implant types, and follow-up interval were recorded. The primary outcome was the long-term coverage of the supra-brow island flap pedicled with orbicularis oculi muscle, and the post-surgical complications and management were secondary outcomes.

RESULTS

28 eyes of 28 patients had functional results and satisfactory cosmetic outcomes at final follow up(range, 9-29 months). Among the other 4 patients, the recurrence of exposure was recorded during the follow-up, two of these patients successfully underwent dermis fat grafts(DFGs), one recovered after conservative treatment, and one refused treatment.

CONCLUSIONS

The supra-brow island flap pedicled with orbicularis oculi muscle is a technique available to manage orbital implant exposure when other simpler and more direct techniques have been tried and failed.

PRECIS

A new flap for orbital implant exposure.

Helium-neon laser therapy in the treatment of hydroxyapatite orbital implant exposure: A superior option

The aim of the present study was to evaluate the efficacy of helium-neon laser therapy in the treatment of hydroxyapatite orbital implant exposure and compare the results with those of a combined drugs and surgery regimen. A total of 70 patients with hydroxyapatite orbital implant exposure in 70 eyes were randomly divided into two groups: Helium-neon laser therapy (group A) and drugs plus surgery (group B). Each group contained 35 patients. The healing rates and times of the conjunctival wound were recorded and compared following helium-neon laser treatment or the drugs plus surgery regimen. Changes in the hydroxyapatite orbital implant prior to and following helium-neon laser irradiation were analyzed. A similar animal study was conducted using 24 New Zealand white rabbits, which received orbital implants and were then received drug treatment or helium-neon therapy. In the human experiment, the rates for conjunctival wound healing were 97.14% in group A and 74.29% in group B, with a significant difference between the groups (χ²=5.71, P<0.05). Patients with mild exposure were healed after 7.22±2.11 days of helium-neon laser therapy and 14.33±3.20 days of drugs plus surgery. A statistically significant difference was found between the groups (t=8.97, P<0.05). Patients with moderate to severe exposure were healed after 18.19±2.12 days of helium-neon laser therapy and 31.25±4.21 days of drugs plus surgery. The difference between the groups was statistically significant (t=7.91, P<0.05). Enhanced magnetic resonance imaging showed that the helium-neon laser therapy significantly promoted vascularization of the hydroxyapatite orbital implant. These results, combined with pathological findings in animals, which showed that a helium-neon laser promoted vascularization and had anti-inflammatory effects, suggest that helium-neon laser irradiation is an effective method for treating hydroxyapatite orbital implant exposure, thereby avoiding secondary surgery.

Repair of orbital implant exposure using Müller's muscle flap

INTRODUCTION

The purpose of this study is to analyse the 2-stage Müller's muscle flap technique for the treatment of orbital implant exposure and its results.

MATERIALS AND METHODS

This retrospective study reviewed all patients undergoing surgery using this technique in our university hospital over a 14-year period (1999-2012) in terms of success (no re-exposure of the implant) or failure.

RESULTS

Nineteen patients were managed using this 2-stage procedure. Orbital implant exposure occurred 94.4 months (2-240) after implantation. The success rate was 68.4% (13/19) and failure rate 31.6% (6/19). Risk factors for exposure were enucleation for melanoma followed by radiation therapy, acrylic implant, and early exposure probably due to excessive suture tension.

DISCUSSION

Implant exposure is the most common complication after evisceration, enucleation or socket surgery. Several techniques to repair exposures have been described. Two-stage Müller's muscle flap is an interesting option, especially for patients presenting defects larger than 4mm(2) and without previous radiation therapy treatment.

CONCLUSION

The two-stage Müller's muscle flap procedure allows for an autologous vascularized pedicle flap from the ipsilateral upper eyelid. It is a reliable technique with a success rate of 68% in our study.

Evisceration in the modern age

Evisceration is an ophthalmic surgery that removes the internal contents of the eye followed usually by placement of an orbital implant to replace the lost ocular volume. Unlike enucleation, which involves removal of the entire eye, evisceration potentially causes exposure of uveal antigens; therefore, historically there has been a concern about sympathetic ophthalmic (SO) associated with evisceration. However, critical review of the literature shows that SO occurs very rarely, if ever, as a consequence of evisceration. Its clinical applications overlap with those of enucleation in cases of penetrating ocular trauma and blind painful eyes, but it is absolutely contraindicated in the setting of suspected intraocular malignancy and may be preferred for treatment of end-stage endophthalmitis. From a technical standpoint, traditional evisceration has a limitation in the orbital implant size. Innovations with scleral modification have overcome this limitation, and accordingly, due to its simplicity, efficiency, and good cosmetic results, evisceration has once again been gaining popularity.