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B. K. Williams, Jr., A. C. Schefler, S. N. Garonzik, W. Shi, D. Gologorsky, W. J. Feuer, T. G. Murray; Prosthesis Refitting to Prevent Implant Exposure in Patients With Retinoblastoma. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3528.
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Implant exposure is the most frequent and important complication of porous orbital implants. Because there is an increased risk in post-enucleation retinoblastoma patients, it is important to identify ways of reducing this exposure rate. This review was performed to analyze the effects of aggressive prosthesis refitting to minimize friction with the conjunctiva and underlying implant in retinoblastoma patients who underwent enucleation.
The charts of 102 patients who underwent porous orbital implantation after enucleation for retinoblastoma performed by one surgeon and followed by one ocularist were reviewed retrospectively. Outcome variables included the condition of the fornices, condition of the implant, and the condition and functioning ability of the prosthesis. The effect of the patient’s age at enucleation, gender, implant type, frequency of prosthesis adjustment, and use of chemotherapy or radiation on the outcome variables was analyzed.
An increased frequency of visits with the ocularist and number of prosthesis adjustments and refits significantly improved the condition of the implant, fornices and prosthesis as shown using a Pearson correlation, all with p values of <0.001. The implant type significantly affected the implant condition. No implant exposures were observed.
This study demonstrates that frequent adjustments and refits by the ocularist are significantly associated with a reduced rate of conjunctival thinning and a complete avoidance of implant exposure in patients undergoing enucleation for retinoblastoma. These findings are particularly significant in this population which historically has demonstrated a high rate of implant exposure.
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