“Efficacy and safety of expanded polytetrafluoroethylene implantation in the correction of long-term posttraumatic enophthalmos”

Abstract

ong-term posttraumatic enophthalmos (PTE) is one of the most common orbital fracture sequelae. Prompt orbital reconstruction effectively prevents long-term ocular symptoms. However, scarring and permanent changes in the skeletal structure portend residual enophthalmos. 1,2 Orbital wall and floor reconstruction using autografts or alloplastic implants is the mainstream PTE management. [3][4][5][6] Autografts have ideal biocompatibility, but are prone to resorption, with donor-site morbidity. 7 Alloplastic implants include porous polyethylene sheets 8 or titanium mesh. 9,10 The advent of Summary: Long-term enophthalmos is a common orbital fracture sequela. Various autografts and alloplastic materials have been studied in posttraumatic enophthalmos repair. However, expanded polytetrafluoroethylene (ePTFE) implantation in late enophthalmos repair has rarely been reported. The authors report novel use of ePTFE for late posttraumatic enophthalmos repair. This retrospective study included patients with posttraumatic long-term enophthalmos who underwent hand-carved ePTFE intraorbital implantation for enophthalmos correction. Computed tomography data were collected preoperatively and at follow-up. The volume of ePTFE, the degree of proptosis (DP), and enophthalmos were measured. Postoperative and preoperative DP and enophthalmos were compared using the paired t test. The correlation between ePTFE volume and DP increment was established using linear regression. Complications were identified by chart review. From 2014 to 2021, 32 patients were included, with a mean follow-up of 19.59 months. The mean volume of implanted ePTFE was 2.39 ± 0.89 mL. After surgery, the DP of the affected globe improved significantly, from 12.75 ± 2.12 mm to 15.06 ± 2.50 mm (P < 0.0001). A significant linear correlation was found between ePTFE volume and DP increment (P < 0.0001). Enophthalmos was substantially ameliorated from 3.35 ± 1.89 mm to 1.09 ± 2.07 mm (P < 0.0001). Twenty-five patients (78.23%) had postoperative enophthalmos of less than 2 mm. Infection and implant dislocation were not observed. The authors concluded that ePTFE intraorbital implantation exhibited long-term efficacy and safety for late posttraumatic enophthalmos repair and represents an effective and predictable alternative.

The Use of Functional Biomaterials in Aesthetic and Functional Restoration in Orbital Surgery

“…Zhou and colleagues conducted a retrospective analysis of 32 patients who underwent hand-carved ePTFE intraorbital reconstruction, which demonstrated significant improvements in enophthalmos. Their approach proved safe and effective, suggesting ePTFE is a viable alternative for late post-traumatic enophthalmos [61]. However, scattered case reports have highlighted late complications with these implants, such as complex fistula formations, prompting a shift towards newer materials [62].…”