Implant and prosthesis movement after enucleation: a randomized controlled trial

Ophthalmology. 2010 Aug;117(8):1638-44. doi: 10.1016/j.ophtha.2009.12.035. Epub 2010 Apr 24.


Objective: To evaluate implant and prosthesis movement after myoconjunctival enucleation and subsequent polymethyl methacrylate (PMMA) implantation, compared with the traditional enucleation with muscle imbrication using a PMMA implant and with enucleation accompanied by porous polyethylene implantation.

Design: Randomized, controlled, observer-masked, interventional study.

Participants: One hundred fifty patients, equally and randomly allocated to the 3 groups.

Intervention: Group 1 consisted of patients in whom a PMMA implant was used after enucleation with muscle imbrication (traditional PMMA group). Group 2 consisted of patients in whom a PMMA implant was used after enucleation with a myoconjunctival technique (myoconjunctival PMMA group). Group 3 consisted of patients in whom a porous polyethylene implant was used after enucleation by the scleral cap technique (porous polyethylene group). Fifty patients were included in each group. Patients were allocated to 1 of the 3 groups using stratified randomization. Informed consent was obtained. Acrylic prostheses custom made by a trained ocularist were fitted 6 weeks after surgery in all patients. A masked observer measured implant and prosthesis movement 6 weeks after surgery using a slit-lamp device with real-time video and still photographic documentation. Analysis of implant and prosthesis movement was carried out using the Mann-Whitney U test, and a P value of < or =0.03 was considered significant. Complications including implant displacement and exposure also were noted.

Main outcome measures: Implant and prosthesis movement.

Results: Myoconjunctival PMMA implant movement was better than the traditional PMMA implant (P = 0.001), but was similar to that of the porous polyethylene implant. Prosthesis movement with the myoconjunctival PMMA implant was better than that of either the traditional PMMA (P = 0.001) or porous polyethylene (P = 0.002) implants.

Conclusions: Myoconjunctival enucleation technique with a PMMA implant provides statistically and clinically significantly better implant and prosthesis movement than the traditional PMMA implant and better prosthesis movement than the porous polyethylene implant.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Eye Enucleation*
  • Eye Movements / physiology*
  • Eye, Artificial*
  • Follow-Up Studies
  • Humans
  • Oculomotor Muscles / physiology*
  • Orbital Implants*
  • Polyethylene
  • Polymethyl Methacrylate
  • Prosthesis Fitting
  • Prosthesis Implantation
  • Suture Techniques
  • Time Factors


  • Polyethylene
  • Polymethyl Methacrylate