Porous Versus Nonporous Orbital Implants After Enucleation for Uveal Melanoma: A Randomized Study

Ho, Vivian; Hussain, Rumana; Czanner, Gabriela; Sen, Jyotsna; Heimann, Heinrich; Damato, Bertil

doi:10.1097/iop.0000000000000824

Cited by 14 publications

(11 citation statements)

References 18 publications

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“…Studies comparing the use of nonporous and porous implants on adult populations have found that complication rates are low and comparable, with acrylic implants possibly providing better prosthetic movement. 11,12 A recent study by Mourits, et al 20 directly comparing porous and nonporous implants in retinoblastoma patients found that the use of HA led to more exposures (12.7%) than nonporous acrylic implants (4.9%), although the difference was not statistically significant. 20 In non-comparison studies, the rates of complications with porous implants are generally higher than with nonporous implants.…”

Section: Discussionmentioning

confidence: 99%

Porous orbital implant after enucleation in retinoblastoma patients: indications and complications

Lang

Kim

McGovern

et al. 2018

Orbit

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This study aims to identify risk factors associated with complications in retinoblastoma patients following primary and secondary enucleations with porous implant placement. A retrospective case-control study was performed between 2010 and 2015. Data pertaining to subjects' demographics, medical history, clinical, and pathological findings, implant characteristics and complications were collected. The analysis included 103 eyes of 101 patients age 27.8 ± 21.9 months undergoing enucleation for retinoblastoma. Postoperatively, 19/103 (18%) eyes developed exposure, extrusion, or hematoma requiring subsequent surgery. Exposure was the most common postoperative complication (12/19, 63%). Age at enucleation 24 months or younger, Hispanic ethnicity, female gender, and intravenous chemotherapy prior to enucleation were associated with increased odds of implant complications. In contrast, patients who were given intravitreal melphalan (IM), subtenons carboplatin (SC), or external beam radiation therapy (EBRT) did not demonstrate an increased risk of complications. In this cohort of retinoblastoma patients undergoing primary or secondary enucleation with porous implants, implant exposure was the most common postoperative complication. Our findings suggest that female gender, Hispanic ethnicity, age at enucleation 24 months or younger, and intravenous chemotherapy prior to enucleation may increase the risk of complications.

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Section: Discussionmentioning

confidence: 99%

Porous orbital implant after enucleation in retinoblastoma patients: indications and complications

Lang

Kim

McGovern

et al. 2018

Orbit

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“…Thus, treatment differences are probably attributable to pre-treatment differences between treatment groups, and unlikely to be a consequence of enucleation. The equivalence of appearance concerns between enucleation and PBR may reflect either recent advances in the development of implants and prostheses [14,26] or a generally low concern about appearance in our sample of older patients [25].…”

Section: Discussionmentioning

confidence: 93%

Comparison between patient-reported outcomes after enucleation and proton beam radiotherapy for uveal melanomas: a 2-year cohort study

Hope‐Stone

Brown

Heimann

et al. 2019

Eye

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Background Uveal melanomas affect 2-8 per million Europeans each year. Approximately 35%, are treated by enucleation. Proton beam radiotherapy (PBR) can be an eye-conserving alternative to enucleation for patients who wish to retain the eye. Both treatments have adverse effects, and it is difficult for clinicians and patients to make fully informed choices between them because the relative effects of enucleation and PBR on patient-reported outcomes are unknown. Methods We compared differential effects of enucleation and PBR on patient-reported outcomes on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Ophthalmological module (EORTC QLQ-OPT30) in a consecutive sample of 115 treated patients~6, 12 and 24 months after diagnosis. Pre-treatment demographic variables, unrelated health problems, vision in the fellow eye, tumour characteristics and prognosis for metastatic disease were statistically controlled. Results Patients treated by enucleation experienced greater functional problems at 6 months, which abated at 12 and 24 months (P = 0.020). PBR patients reported greater impairments of central and peripheral vision (P = 0.009) and reading difficulties (P = 0.002) over 24 months. Treatment modality did not influence difficulty in driving (P = 0.694), ocular irritation (P = 0.281), headaches (P = 0.640), appearance concerns (P = 0.187) or worry about recurrence (P = 0.899). Conclusions When making treatment decisions, it is important that patients and clinicians consider long-standing difficulties of visual impairment associated with PBR and temporary 6-month difficulties in activities related to depth perception associated with enucleation.

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“…The cost difference itself may be prohibitive to convince the patient for surgery. [ 26 ] This leaves us with the option of DFG. However, the requirement for a second site incision and the higher rate of graft necrosis in repeat socket surgeries makes this procedure an unattractive choice.…”

Section: Discussionmentioning

confidence: 99%

Low-cost three-dimensional printed orbital template-assisted patient-specific implants for the correction of spherical orbital implant migration

Dave

Tiple

Vempati

et al. 2018

Indian J Ophthalmol

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Purpose:To describe the outcomes of a patient-specific implant (PSI), fabricated using a three-dimensional (3D) printed orbital template and placed in the basin of the inferior orbital fissure to correct inferotemporally migrated spherical orbital implant.Methods:This is a single-center, prospective, consecutive, interventional, case series of six patients, with non-porous, spherical, orbital implant migration that underwent implant recentration surgically with a novel technique. Migration was subclassified either as decentration that did not affect the prosthetic retention or as displacement that affected the prosthetic retention in the eye socket. Only implant displacements were treated. The primary outcome measure was centration of the implant clinically and radiologically, with ability to retain the prosthesis.Results:At a mean follow-up of 21 months, all six orbital spherical implants remained centered. There were no cases of extrusion, exposure, or migration of either implants. There were no cases of PSI displacement. Additional procedures to optimize the aesthetic outcome of the customized ocular prosthesis (COP) required were simultaneous fornix formation suture in three patients, subsequent fornix formation with mucus membrane graft in two patients, and levator resection and sulcus hyaluronic acid gel injection in one patient each. The mean PSI implant weight was 2.66 ± 0.53 g. The mean COP weight was 2.2 ± 0.88 g postoperatively. The median patient satisfaction with the procedure was 9 on 10.Conclusion:A 3D printing-assisted PSI placed in the basin of the inferior orbital fissure allows recentration of the migrated implant over a follow-up of 21 months without complications.

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Porous Versus Nonporous Orbital Implants After Enucleation for Uveal Melanoma: A Randomized Study

Cited by 14 publications

References 18 publications

Porous orbital implant after enucleation in retinoblastoma patients: indications and complications

Porous orbital implant after enucleation in retinoblastoma patients: indications and complications

Comparison between patient-reported outcomes after enucleation and proton beam radiotherapy for uveal melanomas: a 2-year cohort study

Low-cost three-dimensional printed orbital template-assisted patient-specific implants for the correction of spherical orbital implant migration

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