Abstract
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The advent of porous orbital implants has greatly advanced the field of anophthalmic surgery.
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The development of hydroxyapatite (HA) implants initiated a new generation of porous implants. Porous polyethylene and aluminum oxide are now commonly used alternatives.
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Orbital implants are available in spherical, mounded, egg, and conical shapes.
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Implant material selection is determined by several factors, including patient age and medical history, cost, availability, and surgeon preference.
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A variety of techniques may be utilized to determine the appropriate implant size. Adults undergoing enucleation surgery most frequently require a 20- to 22-mm sphere, whereas 18- to 20-mm spherical implants may be adequate for evisceration procedures.
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Patients younger than 5 years old typically receive a nonporous implant as this facilitates replacement with a larger porous implant later in childhood or adolescence. Older pediatric patients may do well with porous implants. Appropriate implant size selection depends on the age and development of the patient.
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Surgeons who use porous polyethylene as their implant of choice commonly do not use an implant-wrapping material. Wrapping HA and aluminum oxide implants facilitates implant insertion and rectus muscle attachment to the implant.
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Several implant-wrapping materials are commercially available. Polyglactin 910 (Vicryl®) is simple to use, is readily available, and may permit earlier implant fibrovascularization than other available materials.
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Porous implants can be coupled to the overlying artificial eye with a titanium peg system. These coupling systems may allow for greater prosthesis motility. Implant peg use has declined due to the high incidence of postpegging complications (increased discharge, recurrent pyogenic granulomas, implant exposure around the peg, implant infection, tissue overgrowth, clicking).
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References
Ainbinder DJ, Haik BG, Tellado M (1994) Hydroxyapatite orbital implant abscess: histopathologic correlation of an infected implant following evisceration. Ophthal Plast Reconstr Surg 10:267–270
Alwitry A, West S, King J et al (2007) Long-term follow-up of porous polyethylene spherical implants after enucleation and evisceration. Ophthal Plast Reconstr Surg 23:11–15
Anderson RL, Thiese SM, Nerad JA et al (1990) The universal orbital implant: indications and methods. Adv Ophthalmic Plast Reconstr Surg 8:88–99
Anderson RL, Ye n MT, Lucci LM et al (2002) The quasi-integrated porous polyethylene orbital implant. Ophthal Plast Reconstr Surg 18:50–55
Apt L, Isenberg S (1973) Changes in orbital dimensions following enucleation. Arch Ophthalmol 90:393–395
Arat YO, Shetlar DJ, Boniuk M (2003) Bovine pericardium versus homologous sclera as a wrapping for hydroxyapatite orbital implants. Ophthal Plast Reconstr Surg 19:189–193
Arora V, Weeks K, Halperin EC et al (1992) Influence of coralline hydroxyapatite used as an ocular implant on the dose distribution of external beam photon radiation therapy. Ophthalmology 99:380–382
Bentley R P, Sgouros S, Natarajan K et al (2002) Normal changes in orbital volume during childhood. J Neurosurg 96:742–746
Blaydon SM, Shepler TR, Neuhaus RW et al (2003) The porous polyethylene (Medpor) spherical orbital implant: a retrospective study of 136 cases. Ophthal Plast Reconstr Surg 19:364–371
Brooke FJ, Boyd A, Klug GM et al (2004) Lyodura use and the risk of iatrogenic Creutzfeldt—Jakob disease in Australia. Med J Aust 180:177–181
Cepela MA, Nunery WR, Martin RT (1992) Stimulation of orbital growth by the use of expandable implants in the anophthalmic cat orbit. Ophthal Plast Reconstr Surg 8:157–167
Cheng MS, Liao SL, Lin LL (2004) Late porous polyethylene implant exposure after motility coupling post placement. Am J Ophthalmol 138:420–424
Choi JC, Iwamoto MA, Bstandig S et al (1999) Medpore motility coupling post: a rabbit model. Ophthal Plast Reconstr Surg 15:190–201
Choo PH, Carter SR, Crawford JB et al (1999) Exposure of expanded polytetrafluoroethylene-wrapped hydroxyapa-tite orbital implant: a report of two patients. Ophthal Plast Reconstr Surg 15:77–78
Christel P (1992) Biocompatibility of alumina. Clin Orthop 282:10–18
Chuo JY, Dolman PJ, Ng TL et al (2009) Clinical and histo-pathologic review of 18 explanted porous polyethylene orbital implants. Ophthalmology 116:349–354
Colen T P, Paridaens DA, Lemij HG et al (2000) Comparison of artificial eye amplitudes with acrylic and hydroxyapatite spherical enucleation implants. Ophthalmology 107:1889–1894
Cook S, Dalton J (1992) Biocompatibility and biofunction-ality of implanted materials. Alpha Omegan 85:41–47
Custer PL (2000) Enucleation: past, present, and future. Ophthal Plast Reconstr Surg 16:316–321
Custer PL (2001) Reply to Dr. D.R. Jordan's letter on polyg-lactin mesh wrapping of hydroxyapatite implants. Ophthal Plast Reconstr Surg. 17:222–223
Custer PL, Kennedy RH, Woog JJ et al (2003) Orbital implants in enucleation surgery: a report by the American Academy of Ophthalmology. Ophthalmology 110:2054–2061
Custer PL, Trinkaus KM (1999) Volumetric determination of enucleation implant size. Am J Ophthalmol 128:489–494
Custer PL, Trinkaus KM (2007) Porous implant exposure: incidence, management, and morbidity. Ophthal Plast Reconstr Surg 23:1–7
Custer PL, Trinkaus KM, Fornoff J (1999) Comparative motility of hydroxyapatite and alloplastic enucleation implants. Ophthalmology 106:513–516
DePotter P, Shields CL, Shields JA et al (1992) Role of magnetic resonance imaging in the evaluation of the hydroxy-apatite orbital implant. Ophthalmology 99:824–830
DePotter P, Shields CL, Shields JA et al (1994) Use of the hydroxyapatite ocular implant in the pediatric population. Arch Ophthalmol 112:208–212
Dutton JJ (1991) Coralline hydroxyapatite as an ocular implant. Ophthalmology 98:370–377
Edelstein C, Shields CL, DePotter P et al (1997) Complications of motility peg placement for the hydroxyapatite orbital implant. Ophthalmology 104:1616–1621
Fahim DK, Frueh BR, Musch DC et al (2007) Complications of pegged and non-pegged hydroxyapatite orbital implants. Ophthal Plast Reconstr Surg 23:206–210
Fountain TR, Goldberger S, Murphree AL (1999) Orbital development after enucleation in early childhood. Ophthal Plast Reconstr Surg 15:32–36
Gayre GS, DeBacker CM, Lipham W et al (2001) Bovine pericardium as a wrapping for orbital implants. Ophthal Plast Reconstr Surg 17:381–387
Gayre GS, Lipham W, Dutton JJ (2002) A comparison of rates of fibrovascular ingrowth in wrapped versus unwrapped hydroxyapatite spheres in a rabbit model. Ophthal Plast Reconstr Surg 18:275–280
Goldberg RA, Holds JB, Ebrahimpour J (1992) Exposed hydroxyapatite orbital implants: report of six cases. Ophthalmology 99:831–836
Guillinta P, Vasani SN, Granet DB et al (2003) Prosthetic motility in pegged versus unpegged integrated porous orbital implants. Ophthal Plast Reconstr Surg 19:119–122
Heckmann JG, Lang CJ, Petruch F et al (1997) Transmission of Creutzfeldt-Jakob disease via a corneal transplant. J Neurol Neurosurg Psychiatry 63:388–390
Heher KL, Katowitz JA, Low JE (1998) Unilateral dermis-fat graft implantation in the pediatric orbit. Ophthal Plast Reconstr Surg 14:81–88
Heimann H, Bechrakis NE, Zepeda LC et al (2005) Exposure of orbital implants wrapped with polyester-urethane after enucleation for advanced retinoblastoma. Ophthal Plast Reconstr Surg 21:123–128
Hintschich C, Zonneveld F, Baldeschi L et al (2001) Bony orbital development after early enucleation in humans. Br J Ophthalmol 85:205–208
Hogan RN, Brown P, Heck E et al (1999) Risk of prion disease transmission from ocular donor tissue transplantation. Cornea 18:2–11
Howard GM, Kinder RS, Macmillan AS Jr. (1965) Orbital growth after unilateral enucleation in childhood. Arch Ophthalmol 73:80–83
Hsu WC, Green J P, Spilker MH et al (2003) Primary placement of a titanium motility post in a porous polyethylene orbital implant. Ophthal Plast Reconstr Surg 16:370–379
Imhof SM, Mourits M P, Hofman P et al (1996) Quantifi-cation of orbital and mid-facial growth retardation after megavoltage external beam irradiation in children with retinoblastoma. Ophthalmology 103:263–268
Inkster CF, Ng SG, Leatherbarrow B (2002) Primary banked scleral patch graft in the prevention of exposure of hydroxy-apatite orbital implants. Ophthalmology 109:389–392
Iordanidou V, De PP (2004) Porous polyethylene orbital implant in the pediatric population. Am J Ophthalmol 138:425–429
Jordan DR (2001) Spontaneous loosening of hydroxyapa-tite peg sleeves. Ophthalmology 108:2041–2044
Jordan DR (2004) Localization of extraocular muscles during secondary orbital implantation surgery: the tunnel technique: experience in 100 patients. Ophthalmology 111:1048–1054
Jordan DR, Allen LH, Ells A et al (1995) The use of Vicryl mesh (polyglactin 910) for implantation of hydroxyapatite orbital implants. Ophthal Plast Reconstr Surg 11:95–99
Jordan DR, Anderson RL, Nerad JA et al (1987) A preliminary report on the universal implant. Arch Ophthalmol 105:1726–1731
Jordan DR, Bawazeer A (2001) Experience with 120 synthetic hydroxyapatite implants (FCI3). Ophthal Plast Reconstr Surg 17:184–190
Jordan DR, Brownstein S, Faraji H (2004) Clinicopathologic analysis of 15 explanted hydroxyapatite implants. Ophthal Plast Reconstr Surg 20:285–290
Jordan DR, Brownstein S, Gilberg S et al (2002) Investigation of a bioresorbable orbital implant. Ophthal Plast Reconstr Surg 18:342–348
Jordan DR, Brownstein S, Jolly SS (1996) Abscessed hydroxyapatite orbital implants: a report of two cases. Ophthalmology 103:1784–1787
Jordan DR, Chan S, Mawn L et al (1999) Complications associated with pegging hydroxyapatite orbital implants. Ophthalmology 106:505–512
Jordan DR, Ells A, Brownstein S et al (1995) Vicryl-mesh wrap for the implantation of hydroxyapatite orbital implants: an animal model. Can J Ophthalmol 30:241–246
Jordan DR, Gilberg S, Bawazeer A (2004) Coralline hydroxyapatite orbital implant (bio-eye): experience with 158 patients. Ophthal Plast Reconstr Surg 20:69–74
Jordan DR, Gilberg S, Mawn LA (2003) The bioceramic orbital implant: experience with 107 implants. Ophthal Plast Reconstr Surg 19:128–135
Jordan DR, Hwang I, McEachren TM et al (2000) Brazilian hydroxyapatite implant. Ophthal Plast Reconstr Surg 16:363–369
Jordan DR, Klapper SR (1999) Wrapping hydroxyapatite implants. Ophthalmic Surg Lasers 30:403–407
Jordan DR, Klapper SR (2000) A new titanium peg system for hydroxyapatite orbital implants. Ophthal Plast Reconstr Surg 16:380–387
Jordan DR, Klapper SR, Gilberg SM (2003) The use of Vicryl mesh in 200 porous orbital implants. Ophthal Plast Reconstr Surg 19:53–61
Jordan DR, Klapper SR, Mawn L et al (1998) Abscess formation within a synthetic hydroxyapatite orbital implant. Can J Ophthalmol 33:329–332
Jordan DR, Mawn L, Brownstein S et al (2000) The biocer-amic orbital implant: a new generation of porous implants. Ophthal Plast Reconstr Surg 16:347–355
Jordan DR, Munro SM, Brownstein S et al (1998) A synthetic hydroxyapatite implant: the so-called counterfeit implant. Ophthal Plast Reconstr Surg 14:244–249
Jordan DR, Pelletier C, Gilberg S et al (1999) A new variety of hydroxyapatite: the Chinese implant. Ophthal Plast Reconstr Surg 15:420–424
Kaltreider SA (2000) The ideal ocular prosthesis: analysis of prosthetic volume. Ophthal Plast Reconstr Surg 16:388–392
Kaltreider SA, Jacobs JL, Hughes MO (1999) Predicting the ideal implant size before enucleation. Ophthal Plast Reconstr Surg 15:37–43
Kaltreider SA, Lucarelli MJ (2002) A simple algorithm for selection of implant size for enucleation and evisceration. Ophthal Plast Reconstr Surg 18:336–341
Kao L (2000) Polytetrafluoroethylene as a wrapping material for a hydroxyapatite orbital implant. Ophthal Plast Reconstr Surg 16:286–288
Kao SCS, Chen S (1999) The use of rectus abdominis sheath for wrapping of the hydroxyapatite orbital implants. Ophthalmic Surg Lasers 30:69–71
Karesh JW (1987) Polytetrafluoroethylene as a graft material in ophthalmic plastic and reconstructive surgery: an experimental and clinical study. Ophthal Plast Reconstr Surg 3:179–185
Karesh J W, Dresner SC (1994) High-density porous polyethylene (Medpor) as a successful anophthalmic socket implant. Ophthalmology 101:1688–1695
Kaste SC, Chen G, Fontanesi J et al (1997) Orbital development in long-term survivors of retinoblastoma. J Clin Oncol 15:1183–1189
Kennedy RE (1964) The effect of early enucleation on the orbit in animals and humans. Trans Am Ophthalmol Soc 62:459–510
Kim YD, Goldberg RA, Shorr N et al (1994) Management of exposed hydroxyapatite orbital implants. Ophthalmology 101:1709–1715
Klapper SR, Jordan DR, Brownstein S et al (1999) Incomplete fibrovascularization of a hydroxyapatite orbital implant 3 months after implantation. Arch Ophthalmol 106:1640–1641
Klapper SR, Jordan DR, Ells A et al (2003) Hydroxyapatite orbital implant vascularization assessed by magnetic resonance imaging. Ophthal Plast Reconstr Surg. 19:46–52
Klapper SR, Jordan DR, Punja K et al (2000) Hydroxyapatite implant wrapping materials: analysis of fibrovascular ingrowth in an animal model. Ophthal Plast Reconstr Surg 16:278–285
Klett A, Guthoff R (2003) Muscle pedunculated scleral flaps. A microsurgical modification to improve prosthesis motility. Ophthalmologe 100:449–452
Lang CJ, Heckmann JG, Neundorfer B (1998) Creutzfeldt– Jakob disease via dural and corneal transplants. J Neurol Sci 160:128–139
Lee SY, Jang J W, Lew H et al (2002) Complications in motility PEG placement for hydroxyapatite orbital implant in anophthalmic socket. Jpn J Ophthalmol 46:103–107
Li T, Shen J, Duffy MT (2001) Exposure rates of wrapped and unwrapped orbital implants following enucleation. Ophthal Plast Reconstr Surg 17:431–435
Liao SL, Chen MS, Lin LL (2005) Primary placement of a titanium sleeve in hydroxyapatite orbital implants. Eye 19:400–405
Liao SL, Shih MJ, Lin LL (2005) Primary placement of a hydroxyapatite-coated sleeve in bioceramic orbital implants. Am J Ophthalmol 139:235–241
Lin CJ, Liao SL, Jou JR et al (2002) Complications of motil-ity peg placement for porous hydroxyapatite orbital implants. Br J Ophthalmol 86:394–396
Long JA, Tann TM, III, Bearden WH III et al (2003) Enucleation: is wrapping the implant necessary for optimal motility? Ophthal Plast Reconstr Surg 19:194–197
Marx DP, VagefiMR, Bearden WH et al (2008) The quasi-integrated porous polyethylene implant in pediatric patients enucleated for retinoblastoma. Orbit 27:403–406
Mawn L, Jordan DR, Gilberg S (1998) Scanning electron microscopic examination of porous orbital implants. Can J Ophthalmol 33:203–209
Mawn LA, Jordan DR, Gilberg S (2001) Proliferation of human fibroblasts in vitro after exposure to orbital implants. Can J Ophthalmol 36:245–251
Migliori ME, Putterman AM (1991) The domed dermis-fat graft orbital implant. Ophthal Plast Reconstr Surg 7:23–30
Miller DM, Murray T, Suarez F et al (2007) Motility assessment and clinical outcomes of a magnetically integrated microporous implant. Ophthalmic Surg Lasers Imaging 38:339–341
Mitchell KT, Hollsten DA, White WL et al (2001) The autogenous dermis-fat orbital implant in children. J AAPOS 5:367–369
Naik MN, Murthy RK, Honavar SG (2007) Comparison of vascularization of Medpor and Medpor-Plus orbital implants: a prospective, randomized study. Ophthal Plast Reconstr Surg 23:463–467
Naugle TC Jr, Fry CL, Sabatier RE et al (1997) High leg incision fascia lata harvesting. Ophthalmology 104:1480–1488
Naugle TC Jr, Lee AM, Haik BG et al (1999) Wrapping hydroxyapatite orbital implants with posterior auricular muscle complex grafts. Am J Ophthalmol 128:495–501
Nunery WR (2003) Risk of prion transmission with the use of xenografts and allografts in surgery. Ophthal Plast Reconstr Surg 17:389–394
Nunery WR, Heinz G W, Bonnin JM et al (1993) Exposure rate of hydroxyapatite spheres in the anophthalmic socket: histopathologic correlation and comparison with silicone sphere implants. Ophthal Plast Reconstr Surg 9:96–104
Nunery WR, Hetzler KJ (1985) Dermal-fat graft as a primary enucleation technique. Ophthalmology 92:1256–1261
Oestreicher JH, Liu E, Berkowitz M (1997) Complications of hydroxyapatite orbital implants: a review of 100 consecutive cases and a comparison of Dexon mesh (polygly-colic acid) with scleral wrapping. Ophthalmology 104:324–329
Pelletier CR, Jordan DR, Gilberg SM (1998) Use of tem-poralis fascia for exposed hydroxyapatite orbital implants. Ophthal Plast Reconstr Surg 14:198–203
Perry AC (1991) Advances in enucleation. Ophthal Plast Reconstr Surg 4:173–182
Perry JD (2003) Hydroxyapatite implants [letter]. Ophthalmology 110:1281.
Perry JD, Tam RC (2004) Safety of unwrapped spherical orbital implants. Ophthal Plast Reconstr Surg 20:281–284
Pfieffer RL (1945) The effect of enucleation on the orbit. Trans Am Acad Ophthalmol 49:236–239
Remulla HD, Rubin PAD, Shore JW et al (1995) Complications of porous spherical orbital implants. Ophthalmology 102:586–593
Rubin PA, Popham J, Rumelt S et al (1998) Enhancement of the cosmetic and functional outcome of enucleation with the conical orbital implant. Ophthalmology 105:919–925
Rubin PAD, Fay AM, Remulla HD (1999) Primary placement of motility coupling post in porous polyethylene orbital implants. Arch Ophthalmol 118:826–832
Seiff SR, Chang JS Jr, Hurt MH et al (1994) Polymerase chain reaction identification of human immunodefi-ciency virus-1 in preserved human sclera. Am J Ophthal-mol 118:528–529
Shoamanesh A, Pang N, Oestreicher JH (2007) Complications of orbital implants; a review of 542 patients who have undergone orbital implantation and 275 subsequent peg placements. Orbit 25:173–182
Simonds RJ, Holmberg SD, Hurwitz RL et al (1992) Transmission of human immunodeficiency virus type 1 from a seronegative organ and tissue donor. N Engl J Med 326:726–732
Su G W, Yen MT (2004) Current trends in managing the anophthalmic socket after primary enucleation and evisceration. Ophthal Plast Reconstr Surg 20:274–280
Suter AJ, Molteno AC, Bevin TH et al (2002) Long term follow up of bone derived hydroxyapatite orbital implants. Br J Ophthalmol 86:1287–1292
Taylor W (1939) Effect of enucleation of one eye in childhood upon subsequent development of the face. Trans Ophthalmol Soc U K 59:368–373
Thaller VT (1997) Enucleation volume measurement. Ophthal Plast Reconstr Surg 13:18–20
Trichopoulos N, Augsburger JJ (2005) Enucleation with unwrapped porous and nonporous orbital implants: a 15-year experience. Ophthal Plast Reconstr Surg 21:331–336
Wang JK, Lai PC, Liao SL (2009) Late exposure of the bio-ceramic orbital implant. Am J Ophthalmol 147:162–170
Wang JK, Liao SL, Lai PC et al (2007) Prevention of exposure of porous orbital implants following enucleation. Am J Ophthalmol 143:61–67
Wang JK, Liao SL, Lin LL et al (2007) Porous orbital implants, wraps, and PEG placement in the pediatric population after enucleation. Am J Ophthalmol 144:109–116
Yago K, Furuta M (2001) Orbital growth after unilateral enucleation in infancy without an orbital implant. Jpn J Ophthalmol 45:648–652
Yazici B, Akova B, Sanli O (2007) Complications of primary placement of motility post in porous polyethylene implants during enucleation. Am J Ophthalmol 143:828–834
Yoon JS, Lew H, Kim SJ et al. (2008) Exposure rate of hydroxy-apatite orbital implants. Ophthalmology 115:566–572
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Jordan, D.R., Klapper, S.R. (2010). Controversies in Enucleation Technique and Implant Selection: Whether to Wrap, Attach Muscles, and Peg?. In: Guthoff, R.F., Katowitz, J.A. (eds) Oculoplastics and Orbit. Essentials in Ophthalmology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-85542-2_14
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