Anterior surface breakdown and implant extrusion following secondary alloplastic orbital implantation surgery

Abstract

Background: Secondary orbital implantation surgery can be complex due to scarring of the orbital tissues and can be complicated by implant exposure and extrusion.

Purpose: To evaluate the incidence and risk factors of implant exposure and extrusion following secondary alloplastic orbital implantation surgery in anophthalmic patients.

Methods: Retrospective analysis of a consecutive series of patients who underwent secondary placement of an alloplastic orbital implant by one surgeon between 2001 and 2016 in the Rotterdam Eye Hospital.

Outcome parameters: implant exposure or extrusion. Other complications.

Results: Sixty-three patients underwent secondary orbital placement of scleral-wrapped acrylic (60) or silicone (three) spherical implants. A subset of 25 patients had undergone earlier secondary orbital implant placement (by other surgeons) with exposure/extrusion necessitating additional implant surgery. Two patients were excluded due to lack of follow-up (<3 months). Mean age was 49 years (range: 1-84.5 years). The mean follow-up was 4.1 years (range: 0.25-13, 6 years). Implant exposure or extrusion occurred in six of 18 (33%) patients in whom no muscle had been reattached during secondary orbital implantation and in five of 43 (12%) patients in whom the extraocular recti muscles had been attached, but the follow-up time was shorter for the latter group. Surgical treatment for implant exposure/extrusion was required in eleven of 61 patients (18%). Other complications included postoperative volume deficiency despite optimal prosthesis (five of 61, 8%), inclusion cysts (four of 61, 7%) and conjunctivitis sicca (two of 61, 3%). Seven of 61 (11%) patients required fornix deepening and seven (11%) blepharoptosis correction.

Conclusion: Secondary orbital implantation of sclera-wrapped alloplastic implants was complicated by implant extrusion or exposure in 12% of cases in which the extraocular muscles were attached to the implant.

Keywords: alloplastic implant; enucleation; evisceration; extraocular muscle fixation; orbit; secondary implantation.