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J. R. Townley, III, D. E. E. Holck, T. Dahl, C. Reed, J. A. Foster, J. D. Ng; A Retrospective Analysis of Vascularization in Porous Polyethylene Spherical Ocular Implants With and Without Synthetic Bone Glass Particulate Determined by Magnetic Resonance Imaging (MRI). Invest. Ophthalmol. Vis. Sci. 2007;48(13):3578.
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To examine the amount of fibrovascular ingrowth in the porous polyethylene ocular implant with and without bone graft particulate. Fibrovascular ingrowth has been shown to reduce complications that might occur with nonporous orbital implants.
Twenty two patients that underwent enucleation for trauma or intraocular tumors received porous polyethylene spherical orbital implants, sixteen of which contained synthetic bone graft particulate. During preparation for implantation the air was evacuated from all of the implants and exchanged with isotonic saline containing gentamicin. After enuclation, the same surgeon placed all of the implants into the orbit and they were covered with acellular dermis, and the extraocular muscles were attached to the underside of the acellular dermis. The wound was closed in a standard fashion. Patients were evaluated with MRI with gadolinium at 5 and 10 weeks post-op for evidence of fibrovascular ingrowth in the implants. A radiologist masked to the implant type evaluated the degree of fibrovascular ingrowth using pre and post contrast fat suppressed T-1 weighted images. Five to six sections of each axial and coronal planes were reviewed and the area of vascularization was calculated as a percent.
The postoperative course was uneventful in all patients. There was also no statistically significant difference in the amount of vascularization between the two types of implants studied. Of the 22 patients that received implants, by five weeks, 4 had minimal vascularization, 2 implants had between 29 and 39% vascularition, and the remaining had >40% (1 with 97% vascularization). By ten weeks, 7 patients failed to obtain MRIs, 3 patients had minimal, and the remaining had greater than 43% (5 with >90% vascularization).
Although this study did not find any significant differences in the amount post-operative vascularization in either implant, it did appear to show greater amount of vascularity in a shorter period of time when compared to previous studies with similar patient populations and similar methods to estimate fibrovascular ingrowth. This may have been due to using a different technique of evacuating air from the implant and replacing it with an isotonic solution not readily described in other orbital implant fibrovascular ingrowth studies.
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