Elsevier

Mayo Clinic Proceedings

Volume 68, Issue 12, December 1993, Pages 1191-1195
Mayo Clinic Proceedings

Hydroxyapatite Orbital Implant After Enucleation—Experience With 200 Cases

https://doi.org/10.1016/S0025-6196(12)60071-8Get rights and content

The recently introduced hydroxyapatite orbital implant was designed to provide improved motility of the prosthesis in patients who have undergone enucleation. To date, little has been written about the use of the hydroxyapatite orbital implant in eyes that harbored malignant neoplasms. We have performed hydroxyapatite orbital implantation in approximately 200 patients, including children as young as 1 month of age, who underwent enucleation primarily for malignant intraocular tumors. During a median follow-up of 24 months, no cases of orbital hemorrhage, orbital infection, implant extrusion, or implant migration have occurred. Three patients have had conjunctival erosion, which was successfully repaired. Motility of the socket and fornices has been excellent, and all patients have cosmetically satisfactory motility of the prosthesis. Use of the hydroxyapatite implant has had no adverse effect on the clinical course of the intraocular neoplasms, and it has not hindered postoperative evaluation for recurrent orbital tumor. Overall, the hydroxyapatite orbital implant seems to be well tolerated, provides improved motility of the prosthesis, and is associated with few complications.

Section snippets

TECHNIQUE

Our technique of enucleation and placement of the hydroxyapatite implant has recently been reported1, 5 and is similar to a method described by another investigator6 except for a few modifications. With use of general anesthesia (or local anesthesia, if necessary), the patient is prepared for enucleation. A 360-degree limbal peritomy is performed, and the intermuscular fascia is gently separated by spreading it with a scissors. All six extraocular muscles are identified, gently hooked, tagged

RESULTS

Very few problems occurred after implant placement. Analysis of our first 200 cases disclosed excessive wound edema during the first 2 weeks in 2 patients, 1 of whom had persistent edema for several more weeks. Of our 200 patients, 3 had development of an erosion through the conjunctival wound and exposure of the implant because of a poorly fitting prosthesis: This complication was successfully repaired with a scleral patch graft and high vaulting of the posterior surface of the prosthesis. No

DISCUSSION

Porous hydroxyapatite is a material derived from the skeletal structure of specific marine corals, and it has been shown to be nontoxic, biocompatible, and nonallergenic in humans.11 Initially, this material was used as a bone substitute in the fields of orthopedics and maxillofacial-dental reconstruction. When used as a bone implant, this porous structure has been shown to provide a scaffold for ingrowth of connective tissue and vascular elements and eventual ossification with woven and,

CONCLUSION

The hydroxyapatite orbital implant allows improved motility of the artificial eye and is associated with few postoperative problems. It seems to be the best tolerated of the integrated implants and is a foundation for future advancements in the rehabilitation of patients with an enucleated socket. This implant provides patients not only with better cosmesis but also with improved satisfaction and personal adjustment to living with an artificial eye.21

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This study was supported in part by the Eye Tumor Research Foundation Inc., Philadelphia, the Macula Foundation, New York, and the Robert Beckman Endowment Fund, Philadelphia.

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