Complications associated with pegging hydroxyapatite orbital implants

Jordan, David R.; Chan, Stanley M H; Mawn, Louise A.; Gilberg, Steven; Dean, T R; Brownstein, Seymour; Hill, Vivian

doi:10.1016/s0161-6420(99)90108-2

Cited by 97 publications

(42 citation statements)

References 22 publications

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“…4 Pegging may, however, increase the risk of implant exposure and infection. 5 Implant exposure seems to be a major complication with hydroxyapatite implant (1-15%). 6 The results vary vastly due to variations in surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

An Innovative Modified Orbital Implant in Enucleated Eyes for Postoperative Functionality and Cosmesis

Dokania¹,

Rizvi²,

Sinha³

2017

International Journal of Advanced and Integrated Medical Sciences

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Orbital implants replace the volume lost by enucleated eye, impart motility to the prosthesis, and maintain cosmetic symmetry with the fellow eye. They include nonintegrated, synthetic semi-integrated, integrated, bio-integrated, and biogenic varieties. The much favored hydroxyapatite (bio-integrated) implant, due to its rough surface, needs to be wrapped in donor sclera or other wrapping materials (like polyglactin-910 mesh, polytetrafluoroethylene sheet, etc.) to which the muscles could be directly sutured. Cost factor of such wrappings is often prohibitive that add to the expense of such implants.Purpose: To highlight monofilament polypropylene surgical mesh commonly used for herniorrhaphy as an alternative implant wrapping for achieving augmented implant volume and enabling easier extraocular muscle attachment in postenucleation reconstruction of artificial eye. Materials and methods:Following enucleation of a nonfunctional eye in a patient who met with a road traffic accident, a 14 mm hydroxyapatite ball was used to replace the globe. The ball was wrapped with a monofilament polypropylene surgical mesh used in herniorrhaphy and sutured. The patient achieved a satisfactory cosmesis and movements of the implant for different gazes. No ocular discomfort or implant extrusion was reported following 6 months of follow-up. Conclusion:Monofilament polypropylene mesh can be used safely as an orbital implant wrapping, economizing the implant cost.

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Section: Discussionmentioning

confidence: 99%

An Innovative Modified Orbital Implant in Enucleated Eyes for Postoperative Functionality and Cosmesis

Dokania¹,

Rizvi²,

Sinha³

2017

International Journal of Advanced and Integrated Medical Sciences

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“…Several potential complications can occur after pegging the hydroxyapatite implant, including pyogenic granuloma, clicking sound, profuse discharge, conjunctival overgrowing peg, peg drilled on an angle and implant infection etc. 7,17,18 In our study, all patients including 27 patients pursuing secondary exposure of the sleeve by conjunctival cutdown procedure and 3 patients with sleeve spontaneous exposure received peg-coupled prosthesis fitting. None of our patients experienced pyogenic granuloma, clicking sound, conjunctival overgrowing peg, and further implant infection.…”

Section: Discussionmentioning

confidence: 99%

“…An additional procedure of placing the motility peg in any setting may result in increased complications with the implant (eg, implant exposure around the peg) and with the peg itself (eg, peg extrusion and pyogenic granuloma formation). 6,7 Finally, the cost of adjunctive radiological imaging (bone, computed tomographic, or magnetic resonance imaging scan) to confirm implant vascularization (if needed in some special cases), a second surgical procedure to place the peg system, and postoperative prosthesis modification are also high. It may be the topic of interest to develop some technical modifications to simplify the procedure of placing the motility peg and achieve early-coupled prosthetic fitting.…”

Section: Introductionmentioning

confidence: 99%

Primary Placement of a Titanium Sleeve in Hydroxyapatite Orbital Implants

Liao

Chen

Lin

2004

Eye

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Background: To study a new surgical option of primary placement of a titanium sleeve into hydroxyapatite implants during enucleation or evisceration. Methods: A standard enucleation or cornea preserved evisceration was performed, followed by preplacement of a titanium sleeve into the hydroxyapatite implant by a hand drill sleeve driver. Care must be taken to ensure that the titanium sleeve is positioned centrally when the implant is put inside the orbital socket or eviscerated shell. The Tenon capsule and conjunctiva were meticulously closed with minimal tension. Complications such as sleeve exposure, coralline exposure, and infection of the titanium sleeve were closely observed. Results: In all, 30 patients were treated in the above fashion with 10 enucleation and 20 evisceration procedures. The follow-up period ranged from 9 to 24 months. Three of the sleeves were found to have exposed spontaneously at 5 and 7 weeks following original surgery. They had no further complication except one sleeve loosening. The remaining 27 sleeves that did not spontaneously expose pursued secondary exposure of the titanium sleeve and peg insertion by conjunctival cutdown procedure 3 months after original surgery. Two sleeves were found to be oblique positioned after the conjunctival cutdown procedure. Fortunately, all the 30 patients were successfully fit with a peg-coupled prosthesis with good motility. Conclusion: Primary placement of a titanium sleeve into hydroxyapatite implants has several advantages, including high patient acceptance, technical simplicity, and officebased conjunctival cutdown pegging procedure. By avoiding the expense of postoperative imaging study and additional

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“…The complications of motility peg placement for the hydroxyapatite orbital implant have been reported including discharge, pyogenic granuloma, peg falling out, poor transfer of movement, clicking, conjunctiva overgrowing peg, poor fitting sleeve, part of sleeve shaft visible, peg drilled on an angle, hydroxyapatite visible around peg hole, peg drilled off centre, popping peg, conjunctival oedema, excessive postoperative pain, excessive movement of peg, and a broken peg. [3][4][5][6][7][8][9][10][11][12][13][14] The most serious complication reported was implant infection requiring implant removal. 3 This report is the second largest review of complications occurring with the peg system of hydroxyapatite ocular implant to date.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10][11][12][13][14] The most serious complication reported was implant infection requiring implant removal. 3 This report is the second largest review of complications occurring with the peg system of hydroxyapatite ocular implant to date. Jordan et al reported that 57 (42%) of 135 patients with Bio-Eye implants had problems.…”

Section: Discussionmentioning

confidence: 99%

Complications of motility peg placement for porous hydroxyapatite orbital implants

Lin

2002

British Journal of Ophthalmology

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Complications associated with pegging hydroxyapatite orbital implants

Cited by 97 publications

References 22 publications

An Innovative Modified Orbital Implant in Enucleated Eyes for Postoperative Functionality and Cosmesis

An Innovative Modified Orbital Implant in Enucleated Eyes for Postoperative Functionality and Cosmesis

Primary Placement of a Titanium Sleeve in Hydroxyapatite Orbital Implants

Complications of motility peg placement for porous hydroxyapatite orbital implants

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