Long-Term Outcomes of Pegged and Unpegged Bioceramic Orbital Implants

Karslıoğlu, Şafak; Buttanrı, İbrahim Bülent; Fazıl, Korhan; Serin, Didem; Akbaba, Müslime

doi:10.1097/iop.0b013e3182541315

Cited by 22 publications

(18 citation statements)

References 17 publications

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“…Peg system is also reported to play a role in the increased rate of late-onset complications, exposure and infection. [14] Three of our patients have peg fitted in the orbital implant. One of them presents with loosened peg and fragile coral.…”

Section: Discussionmentioning

confidence: 97%

Use of Extraocular Muscle Flaps in the Correction of Orbital Implant Exposure

et al. 2013

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PurposesThe study is to describe a new surgical technique for correcting large orbital implant exposure with extraocular muscle flaps and to propose a treatment algorithm for orbital implant exposure.MethodsIn a retrospective study, seven patients with orbital implant exposure were treated with extraocular muscle flaps. All data were collected from patients in Chang Gung Memorial Hospital, Taiwan during 2007–2012. All surgeries were performed by one surgeon (Y.J.T). Patient demographics, the original etiology, details of surgical procedures, implant types, and follow-up interval were recorded. Small exposure, defined as exposure area smaller than 3 mm in diameter, was treated conservatively first with topical lubricant and prophylactic antibiotics. Larger defects were managed surgically.ResultsSeven patients consisting of two males and five females were successfully treated for orbital implant exposure with extraocular muscle flaps. The average age was 36.4 (range, 3–55) years old. Five patients were referred from other hospitals. One eye was enucleated for retinoblastoma. The other six eyes were eviscerated, including one for endophthalmitis and five for trauma. Mean follow-up time of all seven patients was 19.5 (range, 2–60) months. No patient developed recurrence of exposure during follow-up. All patients were fitted with an acceptable prosthesis and had satisfactory cosmetic and functional results.ConclusionsThe most common complication of orbital implant is exposure, caused by breakdown of the covering layers, leading to extrusion. Several methods were reported to manage the exposed implants. We report our experience of treating implant exposure with extraocular muscle flaps to establish a well-vascularized environment that supplies both the wrapping material and the overlying ocular surface tissue. We believe it can work as a good strategy to manage or to prevent orbital implant exposure.

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Section: Discussionmentioning

confidence: 97%

Use of Extraocular Muscle Flaps in the Correction of Orbital Implant Exposure

et al. 2013

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“…While early exposure of implants can often be attributed to external factors -incorrect wound closure techniques, inappropriate implant size, trauma, or infection -late exposures can be the result of implant related short-comings such as prosthesis related friction, inflammation, or pressure points. 21 In all 12 cases, satisfactory cosmesis and motility were observed. Several factors determine prosthesis motility: shape, weight, size, and effectiveness of transmitting movement from the implant to the prosthesis.…”

Section: Discussionmentioning

confidence: 82%

Alphasphere as a Successful Ocular Implant in Primary Enucleation and Secondary Orbital Implant Exchange

Shevchenko

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Shah

et al. 2013

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This initial report indicates that Alphasphere can be successfully used in the management of an anophthalmic socket. The advantages of the Alphasphere implant include: it does not require tissue wrapping, extraocular muscles can be directly sutured to the implant, it maintains a smooth surface to limit risk of exposure due to conjunctival breakdown, and undergoes anterior orbital fibrovascular ingrowth which optimizes prosthesis location and socket motility.

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“…7e17 It became clear that any porous implant may be associated with complications, including conjunctival thinning, implant exposure, pyogenic granulomas, socket discharge, implant infection, pain, and various pegging issues. 9e11, 13,14 Eventually, some surgeons began to question the use of porous implants and advocated a return to nonporous spheres because of their overall low complication rate. 16,17,21,22 Spirited debate centered on multiple questions, such as which porous implant is the best, should they be wrapped, which wrap is the best, should they be pegged, which peg system is the best, who should be pegged, when should pegging be done, are porous implants truly advantageous, do they have a lower migration rate, do they have a lower extrusion rate, is there resistance to infection, and is there any motility advantage?…”

mentioning

confidence: 99%

“…15,16,30 Porous implant exposures can occur anytime, and the longer the follow-up, the greater the number of exposures. 11,14,16 With respect to infection, nonporous implants (e.g., PMMA/silicone) have been shown to have a low infection rate (0%e1%). 4,18,27 Unpegged porous orbital implants also have a low infection rate (0%e2%).…”

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confidence: 99%