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Esther Lee, Carlo Rob Bernardino, Flora Levin; Orbital Volume Augmentation Using Expandable Hydrogel Implants in Acquired Anophthalmia and Phthisis Bulbi. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2783.
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Insufficient orbital volume following enucleation or evisceration can result in post-enucleation socket syndrome (PESS), and long-standing phthisis can result in orbital volume deficiency similar to PESS. Patients may achieve volume augmentation using a variety of available implants, but there continues to be little consensus regarding the ideal choice of orbital implant. Hydrogel is a hydrophilic, self-expanding material that offers many advantages of the ideal implant. While it has been used successfully for congenital anophthalmia and microphthalmia, we present our initial experience with hydrogel implants in cases of acquired anophthalmia and phthisis bulbi.
This is a retrospective review of the clinical records of all adult patients who received an expandable spherical hydrogel implant or injectable hydrogel pellets for orbital volume augmentation in cases of orbital atrophy following enucleation or phthisis bulbi at the Emory Eye Center between 2004 and January 2007 and the Yale Eye Center between 2009 and 2011.
Nine women and five men were included in the study. The average age was 51.2 years old, with a range of 35 to 76 years. Follow-up spanned from 2 to 31 months, with a mean follow-up time period of 15.1 months. Four patients received spherical hydrogel implants and 10 patients underwent hydrogel pellet injections. An average of 9 pellets (range 5-16) were placed in each patient over an average of 1.7 injections (range 1-3). Most commonly, five pellets were injected per session, as was the case for 13 of the 17 total treatment sessions. All patients experienced an overall subjective improvement in cosmesis. Post-operative complications included two cases of pellet migration, one subcutaneously and one anteriorly, due to insufficiently posterior implant placement, as well as one hospital admission for pain after injection of 10 pellets in one sitting.
Hydrogel implants offer several advantages over other existing options for orbital volume augmentation, as they are easy to place, well-tolerated, volume-titratable, and, to the extent that our follow-up shows, appear safe and durable. Further studies will be necessary to assess the longer-term use of these implants, but our experience suggests they are a promising means of treating orbital atrophy in acquired anophthalmia or phthisis bulbi.
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