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A. Wu, D. Georgescu, J. Burroughs, R. Anderson; Cross-Linked Porcine Dermal Collagen Xenografts to Patch Extruding Ocular Implants. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1489.
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The most common serious complication after enucleation or evisceration is ocular implant exposure. The exposure rates of porous implants range from 5-10% in a variety of studies. The most successful method of repair utilizes either autogenous or non-autogenous patch grafts to cover the exposed implant, although observation alone results in a small percentage (13% in one series) of spontaneous resolutions. In the United States, Enduragen (Tissue Science Laboratories), a cross-linked porcine dermal collagen xenograft, has been marketed for soft tissue reinforcement, augmentation, and repair in facial plastic and reconstructive surgery. The material's collagen and elastin matrix is thought to allow fibrovascular ingrowth, which creates a strong, biocompatible covering for exposed implants. In Europe, this material is marketed as Permacol, and one case series of 3 patients published on its use for surgical treatment of implant exposure showed subsequent exposure through the patch graft in all their study subjects within 2 weeks to 8 months. We describe our different experience using Enduragen patch grafts for the repair of exposed orbital implants.
A retrospective, interventional, noncomparative case series of patients who had Enduragen to assist in closure of Tenon's capsule and conjunctiva at the time of ocular implant exposure. Medical records were reviewed and the following parameters were collected: age, gender, indication for surgery, type of surgery, laterality, type of orbital implant, further exposure of implant after repair, length of follow-up, and complications.
Three patients were identified of which two were males and one was female. One patient had a secondary quad-motility implant with a conjunctival defect over the supertemporal portion of the exposed implant. One patient had a secondary implant with a fistula at the lateral aspect of the socket. The final patient had an exposed hydroxyapatite implant through conjunctiva and tenons. All patients received Enduragen patch grafts for a defect in the conjunctiva and to cover their implant. Follow up ranged from 19 to 34 months (mean, 25 months). There were no operative or early complications observed.
This consecutive three-case series suggests that Enduragen is safe and effective for use as a patch graft for extruding ocular implants. The Enduragen patch allows for adequate vascularization where tenons and conjunctiva can reform a structurally sound socket. More cases and longer follow up are indicated.
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