Abstract
Purpose :
The ideal orbital implant type for enucleation or evisceration is not yet determined. One consideration is the frequency of implant exposures and extrusions which can occur many years following the initial procedure. This study analyzes long term complication rates following porous orbital implant wrapping with a posterior auricular muscle complex graft (PAMCG) post-enucleation.
Methods :
This is a multi-center retrospective study of patients who underwent orbital implantation following enucleation using this technique between 1992 and 2013. Cases of three surgeons at two academic institutions were included. This study was IRB approved and HIPAA compliant. Only cases with a minimum of 18 months of follow-up were included. No patients underwent peg implantation. Patient’s demographics, follow-up time, type of implant, complications including wound dehiscence, exposure, postoperative infection, and extrusion were recorded.
Results :
This study included 36 orbits of 36 patients with a mean age of 39.3 ± 23.2 years (range, 3 - 84 years). Thirty patients had hydroxyapatite implants and six had porous polyethylene. The average follow-up time was 12.6 ± 5.6 years (range, 1.5 - 30.3 years) (Table 1). There was one orbital infection necessitating implant removal (2.8%) with a likely mechanism of iatrogenic micro-exposure during a subsequent surgery for a forniceal contracture 14 years following implantation. One patient had anophthalmic enophthalmos which was treated with a secondary contralateral PAMCG graft. Other complications included one each of lagophthalmos, a fibrous lesion with lymphoid hyperplasia, and chronic conjunctivitis. There were no other known exposures, extrusions, or donor site complications.
Conclusions :
Wrapping porous orbital implants with the PAMCG resulted in low complication rates over a thirty-year period. This tissue should be considered especially in patients with otherwise compromised orbital sockets, whether from radiation or other previous damage.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.