Abstract
Purpose:
The purpose of this study is to analyze rates of exposure and extrusion of Medpor and silicone orbital implants after enucleation or evisceration and to identify other significant factors affecting those rates of complication.
Methods:
A retrospective chart review was performed for 129 eyes in 127 patients that underwent primary enucleation or evisceration with orbital implant placement in the UT Southwestern system from April 27, 2001 to February 6, 2013.
Results:
One hundred (77.5%) eyes were enucleated and 29 (22.5%) eyes were eviscerated. Ninety-two (71%) Medpor and 37 (29%) silicone implants were used. The 22-mm spherical orbital implant was used in 74 (57%) cases, the 20-mm orbital implant was used in 31 (24%) cases and the 18-mm orbital implant was used in 17 (13%) cases. There were a total of six episodes of exposure or extrusion (4.6%). Five of these complications occurred with Medpor orbital implants (5 of 92, 5.4%) and one occurred with a silicone orbital implant (1 of 37, 2.7%). There were 5 episodes of exposure or extrusion in the enucleation group (5 of 100, 5%) and there was one event in the evisceration group (1 of 29, 3.4%). There was no significant difference between rates of exposure and extrusion for Medpor versus silicone orbital implants (p = 0.727) or enucleation versus evisceration (p = 0.505). Current smoking (p = 0.048), implant size of 18-mm (p = 0.009) and Hispanic ethnicity (p = 0.028) were statistically-significant factors affecting rates of serious complications after enucleation and evisceration. Logistic regression found one significant factor leading to a higher rate of exposure or extrusion: current smoking (p = 0.041). In our case series, most episodes of Medpor implant exposure or extrusion required partial or complete removal of the implant with dermal fat graft placement.
Conclusions:
No significant difference was identified in the complication rates of Medpor versus silicone spherical implants. Current smoking is a significant factor leading to an increased rate of serious complication. Early partial or complete removal of the Medpor implant should be considered by a surgeon faced with implant exposure.