Exposure Rate of Hydroxyapatite Orbital Implants: A 15-Year Experience of 802 Cases
Presented at: American Academy of Ophthalmology Annual Meeting, November 2006, Las Vegas, Nevada.
Received 24 January 2007; received in revised form 6 June 2007; accepted 6 June 2007. published online 13 September 2007.
Objective
To document the long-term experience with hydroxyapatite (HA) orbital implants (Bio-Eye) and analyze the factors influencing implant exposure, including surgical type, procedural modification, use of different wrapping materials and peg materials.
Design
Retrospective observational case series.
Participants
Eight hundred two eyes from 802 patients who underwent anophthalmic socket surgery (eviscerations, enucleations, secondary implant placements) using HA implants, performed by one surgeon between May 1990 and December 2005.
Methods
All patients’ clinical records were reviewed. Baseline age, cause of anophthalmic surgery, surgical type, size of HA implant, wrapping material, and peg system were recorded.
Main Outcome Measures
Postoperative complications, especially implant exposure, were recorded separately before and after pegging, and compared according to type of surgery, wrapping material, and peg system.
Results
The main cause of anophthalmic surgery was trauma (73%). A variety of wrapping materials have been used, including Tutoplast-dura, Vicryl mesh, autogenous sclera, and polyester–urethane. Implant exposure occurred in 17 patients (2.1%) before pegging and 14 (4.0%) after pegging. The exposure rate was significantly higher in eyes eviscerated without (7.2%) than with (1.1%) keratectomy (P = 0.018), but did not differ according to type of surgery (P = 0.710). When distributed according to 5-year periods, the exposure rate was higher from 1990 to 1994 (4.7%) than in later periods (P = 0.004). In patients who underwent enucleation or secondary implantation, there was no difference in exposure rate between Tutoplast-dura– and Vicryl mesh–wrapped implants (P = 0.235). Among the 353 patients (44.0%) who underwent pegging, those who received titanium-pegged implants had a significantly lower incidence of peg extrusion (5.2%), major discharge (5.2%), and pyogenic granuloma (9.1%) than those with nonsleeved polymethyl methacrylate and sleeved polycarbonate peg materials (P<0.05).
Conclusions
Exposures associated with HA orbital implants decreased with the improvement of surgical technique over time and have been managed successfully, both before and after pegging. The incidence of peg-related complications have decreased since the introduction of the titanium peg system.
Available online: September 13, 2007.
1Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.
2Department of Ophthalmology, Pochun CHA University College of Medicine, Pundang CHA Hospital, Sungnam, Korea.
3Department of Ophthalmology, Konyang University College of Medicine, Kim’s Eye Hospital, Seoul, Korea.
Correspondence to Sang Yeul Lee, MD, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, CPO Box 8044, Seodaemoongu Shinchondong 134, Seoul, Korea 120-752.
The authors have no commercial or proprietary interest in the products or companies mentioned in the article.
ABSTRACT