The Scleral Cap Technique for Porous and Nonporous Orbital Implants

Abstract

Purpose:To describe the results and potential benefit of a banked homologous donor scleral cap over the anterior surface of polyglactin 910 mesh-wrapped porous and nonporous orbital implants during enucleation and secondary orbital implant surgery.Methods: This is a single center, retrospective, clinical case series of 83 patients who received a polyglactin 910 mesh (Vicryl knitted mesh, undyed, Ethicon, Sommerville, New Jersey, USA) wrapped bioceramic or polymethylmethacrylate orbital implant (sphere or mounded) following enucleation and secondary orbital implant surgery by one surgeon over a 10-year period. A homologous donor scleral cap (approximately 1.5 × 1.5 cm diameter) was also placed over the anterior meshwrapped implant surface as an additional barrier. A minimum of 1-year follow up was required to be included in the study. The author analyzed patient demographics, type of surgery, implant type, implant size, follow-up duration, and presence or absence of implant exposure. The data from patients with greater than 1-year follow up are detailed in this report.Results: The author identified 100 patients in his case files that had a scleral cap put in place over their implant. Seventeen patients were either lost to follow up or did not have at least a 1-year follow up, leaving 83 patients (44 enucleations, 39 secondary implants) that were followed for 12 to 120 months (average 60.5 months). There were no cases of implant exposure identified in either group of patients during this time period.Conclusions: Implant exposure can occur anytime post implant placement with a porous or nonporous orbital implant. This review suggests that a homologous donor scleral cap (approximately 1.5 × 1.5 cm diameter) over the polyglactin 910 mesh-wrapped implant surface may help prevent implant exposure. Patients with porous and nonporous orbital implants should be followed on a long-term basis as exposure can occur at anytime postsurgery, even several years later.

Long-Term Outcome of Staged Socket Surgery for Acquired Anophthalmos

“…[4][5][6] Many techniques for secondary ball implantation have been described. These include trans-conjunctival 11,[13][14][15][16][17] or lateral brow approaches, 18 and also several ways to localize and handle the muscles. 2,3,11,[13][14][15][16][17] Most reports do not differentiate between secondary ball implantation (i.e., placement in a socket without a ball) and implant exchange, but we believe that (even if misplaced) a preexisting ball implant helps orientate a surgeon during secondary surgery, and facilitates preparation of the deeper socket tissues.…”

“…2 A very similar technique, but dividing the scleral remnant into 4, has also been described. 13 With the exception of young children and developmentally small orbits, a 20-22 mm diameter ball is our preferred size for adequate volume replacement, but an implant sizer is used where there is any doubt about the ability to close surface tissues without tension. In all cases it is imperative to insert the implant through a sterile glide (readily fashioned from the thumb of a sterile polythene glove; Fig.…”

Anophthalmic socket in retinoblastoma: Exploring complications and risk factors in a tertiary centre in Malaysia

“…24,26 Jordon et al also found no difference in donor scleral caps preventing implant exposure. 27 Previously, surgeons wrapped porous implants to ease insertion into the orbit, smooth the anterior surface, and shield the conjunctiva from erosion and underlying inflammation in order to prevent exposure. 28,29 In a survey done in 2003, more than half of ASOPRS surgeons did not wrap their orbital implants after the twentieth century.…”