Post enucleation reconstruction of orbit using silicone orbital implant and dermis fat graft

Abstract

The aim of this study was to study the cosmetic appearance of patients after Post-enucleation reconstruction of the orbit with silicone implant and dermis fat graft. this is a prospective interventional study conducted at the department of Oculoplasty and Orbital disorder of a tertiary care eye hospital between 2014 and 2016. 30 cases of which 16 were males and 14 females were included in the study. Patients between the age group 10- 40 years who had painful blind eye, anterior staphyloma and Pthisis bulbi were included in the study. Patients who had enucleation because of malignancies like retinoblastoma and malignant melanoma were excluded from study. Informed consent obtained from the adult patients and consent of one of the parent was obtained from patients who were under 18 years of age after explaining the procedure in patients own language. All patients included were examined by an experienced ophthalmologist using slit lamp, transparent scale, exophthalmometer, A scan, B scan. In single sitting enucleation was done, silicon spherical orbital implant was placed in orbit in posterior sub tenon’s space. Dermis fat harvested from upper and outer quadrant of buttock was placed over the Orbital implant in the posterior sub tenon’s space. Recti muscles were sutured to the edge of dermis fat and conjunctiva sutured to the edge of dermis fat. Conformer placed and Suture tarsorraphy done. Cases followed post operatively on day one, and after 2 week and after 3 months. After 3rd month prosthetic eye was placed. Palpebral aperture height, enophthalmos and superior orbital sulcus deformity and cosmetic appearance was noted. 20 cases had 1mm difference in palpebral aperture height when compare to normal eye. 9 cases had 2mm, and one case had 4mm difference in palpebral aperture height. Enophthalmos with prosthesis was measured by exophthalmometer. 20 cases had 1mm of enophthalmos when compared to normal eye. 9 cases had 2 mm of Enophthalmos and one case had 4 mm of enophthalmos. 20 cases had fullness of superior orbital sulcus. 10 cases had 1-3 mm of superior orbital sulcus deformity.Cosmetic appearance was judged by doctors and attenders of patient. 20 cases had good cosmetic appearance. Whereas, 9 had fair cosmetic appearance and one had poor cosmetic appearance. It is concluded that doing enucleation and implanting orbital implant primarily along with Dermis fat graft reduces implant exposure to nil, and gives good cosmetic results as shown by measurement of Palpebral aperture height, Enophthalmos and Superior orbital sulcus deformity.