Experience with the Polymer-Coated Hydroxyapatite Implant after Enucleation in 126 Patients
Received 4 February 2006; accepted 3 August 2006.
Objective
To evaluate the new polymer-coated hydroxyapatite implant.
Design
Retrospective nonrandomized single-center case series.
Participants
One hundred twenty-six patients managed with enucleation and placement of the polymer-coated hydroxyapatite implant at the Ocular Oncology Service at Wills Eye Hospital of Thomas Jefferson University.
Methods
A retrospective analysis was performed on 126 patients managed with enucleation and placement of the polymer-coated hydroxyapatite implant.
Main Outcome Measures
Ease of placement, functional ocular motility, tissue complications, and patient satisfaction.
Results
The preenucleation diagnoses included uveal melanoma (n = 76; 61%), retinoblastoma (n = 34; 27%), blind painful eye (n = 8; 6%), neovascular glaucoma from intraocular tumors or retinal detachment (n = 5; 4%), and others (n = 3; 2%). Previous ocular therapies for posterior segment conditions such as plaque radiotherapy, retinal detachment repair, and chemoreduction, thermotherapy, and cryotherapy had been performed in 22% of patients (n = 27). The implant size was 20 mm (n = 103; 82%), 18 mm (n = 22; 17%), and 16 mm (n = 1; 1%). Implant preparation and placement was uncomplicated in all patients, without adhesion to surrounding tissue. Four rectus muscles were attached to the implant in all patients. Socket motility was judged to be good (n = 118; 94%), fair (n = 6; 5%), and poor (n = 2; 2%). Complications included conjunctival thinning (n = 1; <1%), pyogenic granuloma (n = 1; <1%), conjunctival cyst (n = 3; 2%), implant infection (n = 1; <1%), and implant exposure (n = 3; 2%). There were no cases of implant extrusion or allergic reaction to the polymer. Patient satisfaction was reported as good (n = 123; 98%), fair (n = 2; 2%), and poor (n = 1; <1%).
Conclusions
The polymer-coated hydroxyapatite implant is smoothly placed into the orbit after enucleation without the need for additional tissue wrap. With proper placement, this implant provides satisfactory functional motility and shows favorable tissue tolerance with no clinical evidence of allergic reaction or extrusion.
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
Correspondence to Carol L. Shields, MD, Ocular Oncology Service, Suite 1440, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA 19107.
Manuscript no. 2006-155.
Supported by the Eye Tumor Research Foundation, Philadelphia, Pennsylvania (CLS); Michael, Bruce, and Ellen Ratner, New York, New York (JAS, CLS); Mellon Charitable Giving from the Martha W. Rogers Charitable Trust, Philadelphia, Pennsylvania (CLS); and the Paul Kayser International Award of Merit in Retina Research, Houston, Texas (JAS).
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