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Orbital Implants

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Clinical Ophthalmic Oncology

Abstract

Loss of an eye to tumor, trauma, or end-stage ocular disease is devastating. There is a loss of binocular vision with reduced peripheral visual field and loss of depth perception. Job limitations may arise and affected individuals may experience a sense of facial disfigurement. Because eye contact is such an essential part of human interaction, it is extremely important for the patient with an artificial eye to maintain a natural, normal appearing prosthetic eye. In the past two decades, there have been numerous developments and refinements in anophthalmic socket surgery with respect to implant material and design, implant wrapping, implant-prosthesis coupling, and socket volume considerations. It is now possible than ever before to provide the anophthalmic patient with an artificial eye that looks and moves almost as naturally as a normal eye.

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References

  1. Perry AC. Advances in enucleation. Ophthal Plast Reconstr Surg. 1991;4:173–82.

    Google Scholar 

  2. Dutton JJ. Coralline hydroxyapatite as an ocular implant. Ophthalmology. 1991;98:370–7.

    Article  PubMed  CAS  Google Scholar 

  3. Nunery WR, Heinz GW, Bonnin JM, Martin RT, Cepela MA. Exposure rate of hydroxyapatite spheres in the anophthalmic socket: histopathologic correlation and comparison with silicone sphere implants. Ophthal Plast Reconstr Surg. 1993;9:96–104.

    Article  PubMed  CAS  Google Scholar 

  4. Goldberg RA, Holds JB, Ebrahimpour J. Exposed hydroxyapatite orbital implants: report of six cases. Ophthalmology. 1992;99:831–6.

    Article  PubMed  CAS  Google Scholar 

  5. Kim YD, Goldberg RA, Shorr N, Steinsapir KD. Management of exposed hydroxyapatite orbital implants. Ophthalmology. 1994;101:1709–15.

    Article  PubMed  CAS  Google Scholar 

  6. Remulla HD, Rubin PAD, Shore JW, Sutula FC, Townsend DJ, Woog JJ, Jahrling KV. Complications of porous spherical orbital implants. Ophthalmology. 1995;102:586–93.

    Article  PubMed  CAS  Google Scholar 

  7. Oestreicher JH, Liu E, Berkowitz M. Complications of hydroxyapatite orbital implants: a review of 100 consecutive cases and a comparison of Dexon mesh (polyglycolic acid) with scleral wrapping. Ophthalmology. 1997;104:324–9.

    Article  PubMed  CAS  Google Scholar 

  8. Jordan DR, Brownstein S, Jolly SS. Abscessed hydroxyapatite orbital implants: a report of two cases. Ophthalmology. 1996;103:1784–7.

    Article  PubMed  CAS  Google Scholar 

  9. Blaydon SM, Shepler TR, Neuhaus RW, White WL, Shore JW. The porous polyethylene (Medpor) spherical orbital implant: a retrospective study of 136 cases. Ophthal Plast Reconstr Surg. 2003;19:364–74.

    Article  PubMed  Google Scholar 

  10. Karesh JW, Dresner SC. High density porous polyethylene (Medpor) as a successful anophthalmic implant. Ophthalmology. 1994;101:1688–96.

    Article  PubMed  CAS  Google Scholar 

  11. Rubin PAD, Popham J, Rumeldts S, et al. Enhancement of the cosmetic and functional outcomes of enucleation with the conical orbital implant. Ophthalmology. 1998;105:919–25.

    Article  PubMed  CAS  Google Scholar 

  12. Anderson RL, Yen MT, Lucci LM, et al. The quasi-integrated porous polyethylene orbital implant. Ophthal Plast Reconstr Surg. 2002;18:50–5529.

    Article  PubMed  Google Scholar 

  13. Mawn LA, Jordan DR, Gilberg S. Proliferation of human fibroblasts in vitro after exposure to orbital implants. Can J Ophthalmol. 2001;36:245–51.

    PubMed  CAS  Google Scholar 

  14. Ma Y, Schou KR, Maloney-Schou M, Harwin FM, Ng J. The porous polyethylene/Bioglass spherical orbital implant: a retrospective study of 170 cases. Ophthal Plast Reconstr Surg. 2011;27:21–7.

    Article  PubMed  CAS  Google Scholar 

  15. Mawn L, Jordan DR, Gilberg S. Scanning electron microscopic examination of porous orbital implants. Can J Ophthalmol. 1998;33:203–9.

    PubMed  CAS  Google Scholar 

  16. Jordan DR, Munro SM, Brownstein S, Gilberg SM, Grahovac SZ. A synthetic hydroxyapatite implant: the so-called counterfeit implant. Ophthal Plast Reconstr Surg. 1998;14(4):244–9.

    Article  PubMed  CAS  Google Scholar 

  17. Jordan DR, Bawazeer A. Experience with 120 synthetic hydroxyapatite implants (FCI3). Ophthal Plast Reconstr Surg. 2001;17:184–90.

    Article  PubMed  CAS  Google Scholar 

  18. Jordan DR, Pelletier C, Gilberg SM, Brownstein S, Grahovac SZ. A new variety of hydroxyapatite: the Chinese implant. Ophthal Plast Reconstr Surg. 1999;15(6):420–4.

    Article  PubMed  CAS  Google Scholar 

  19. Jordan DR, Hwang I, McEachren TM, Brownstein S, Gilberg SM, Grahovac SZ, Mawn L. Brazilian hydroxyapatite implant. Ophthal Plast Reconstr Surg. 2000;16:363–9.

    Article  PubMed  CAS  Google Scholar 

  20. Jordan DR, Brownstein S, Gilberg S, Matthew B, Mawn L, Khouri L. Investigation of a bioresorbable orbital implant. Ophthal Plast Reconstr Surg. 2002;18:342–8.

    Article  PubMed  Google Scholar 

  21. Klett A, Guthoff R. Deckung von Orbitaimplantaten mit muskelgestielter autologer sklera. Ophthalmologe. 2003;100:449–52.

    PubMed  CAS  Google Scholar 

  22. Christel P. Biocompatibility of alumina. Clin Orthop. 1992;282:10–8.

    PubMed  Google Scholar 

  23. Jordan DR, Mawn L, Brownstein S, McEachren TM, Gilberg SM, Hill V, Grahovac SZ, Adenis JP. The bioceramic orbital implant: a new generation of porous implants. Ophthal Plast Reconstr Surg. 2000;16:347–55.

    Article  PubMed  CAS  Google Scholar 

  24. Jordan DR, Gilberg S, Mawn LA. The bioceramic orbital implant: experience with 107 implants. Ophthal Plast Reconstr Surg. 2003;19:128–35.

    Article  PubMed  Google Scholar 

  25. Jordan DR, Klapper SK, Gilberg SM, Dutton JJ, Wong A, Mawn L. The bioceramic implant: evaluation of implant exposures in 419 implants. Ophthal Plast Reconstr Surg. 2010;26:80–2.

    Article  PubMed  Google Scholar 

  26. Wang JK, Lai PC, Liao SL. Late exposure of the bioceramic orbital implant. Am J Ophthalmol. 2009;147:162–70.

    Article  PubMed  CAS  Google Scholar 

  27. Karslioglu SK, Buttanri IB, Fazil K, Serin D, Akbaba M. Long-term outcomes of pegged and unpegged bioceramic orbital implants. Ophthal Plast Reconstr Surg. 2012;28:264–7.

    Article  PubMed  Google Scholar 

  28. Jordan DR, Gilberg SM, Bawazeer A. The coralline hydroxyapatite orbital implant (Bio-EyeTM): experience with 170 patients. Ophthal Plast Reconstr Surg. 2004;20(1):69–71.

    Article  PubMed  Google Scholar 

  29. Su GW, Yen MT. Current trends in managing the anophthalmic socket after primary enucleation and evisceration. Ophthal Plast Reconstr Surg. 2004;20(4):274–80.

    Article  PubMed  Google Scholar 

  30. Guillinta P, Vasani SN, Granet DB, Kikkawa DO. Prosthetic motility in pegged versus unpegged integrated porous orbital implants. Ophthal Plast Reconstr Surg. 2000;19:119–22.

    Article  Google Scholar 

  31. Custer PL, Kennedy RH, Woog JJ, Kaltreider SA, Meyer DA. Orbital implants in enucleation surgery, a report by the American Academy of Ophthalmology. Ophthalmology. 2003;110:2054–61.

    Article  PubMed  Google Scholar 

  32. Custer PL, Trinkaus KM, Fornoff J. Comparative motility of hydroxyapatite and alloplastic enucleation implants. Ophthalmology. 1999;106:513–6.

    Article  PubMed  CAS  Google Scholar 

  33. Colen TP, Paridaens DA, Lemij HG, et al. Comparison of artificial eye amplitudes with acrylic and hydroxyapatite spherical enucleation implants. Ophthalmology. 2000;107:1889–94.

    Article  PubMed  CAS  Google Scholar 

  34. Wells T, Harris GJ. Direct fixation of extra-ocular muscles to a silicone sphere: a cost sensitive, low-risk enucleation procedure. Ophthal Plast Reconstr Surg. 2011;27:364–7.

    Article  PubMed  Google Scholar 

  35. Trichopoulas N, Augsburger JJ. Enucleation with unwrapped porous and non-porous implants: a 15 year experience. Ophthal Plast Reconstr Surg. 2005;21:331–6.

    Article  Google Scholar 

  36. Kaltreider SA. The ideal ocular prostheses. Analysis of prosthetic volume. Ophthal Plast Reconstr Surg. 2000;16(5):388–92.

    Article  PubMed  CAS  Google Scholar 

  37. Kaltreider SA. The ideal ocular prosthesis: analysis of prosthetic volume. Ophthal Plast Reconstr Surg. 2000;16:388–92.

    Article  PubMed  CAS  Google Scholar 

  38. Kaltreider SA, Lucarelli MJ. A simple algorithm for selection of implant size for enucleation and evisceration. Ophthal Plast Reconstr Surg. 2002;18:336–41.

    Article  PubMed  Google Scholar 

  39. Custer PL, Trinkaus KM. Volumetric determination of enucleation implant size. Am J Ophthalmol. 1999;128:489–94.

    Article  PubMed  CAS  Google Scholar 

  40. Thaller VT. Enucleation volume measurement. Ophthal Plast Reconstr Surg. 1997;13:18–20.

    Article  PubMed  CAS  Google Scholar 

  41. Kaltreider SA, Jacobs JL, Hughes MO. Predicting the ideal implant size before enucleation. Ophthal Plast Reconstr Surg. 1999;15(3):37–43.

    Article  PubMed  CAS  Google Scholar 

  42. Perry JD. Hydroxyapatite implants (letter). Ophthalmology. 2003;110:1281.

    Article  PubMed  Google Scholar 

  43. Long JA, Tann TM, Bearden WH, Callahan MA. Enucleation: is wrapping the implant necessary for optimal motility. Ophthal Plast Reconstr Surg. 2003;19(3):194–7.

    Article  PubMed  Google Scholar 

  44. Suter AJ, Molteno AC, Becin TH, et al. Long term follow-up of bone derived hydroxyapatite orbital implants. Br J Ophthalmol. 2002;86:1287–992.

    Article  PubMed  CAS  Google Scholar 

  45. Nunery WR. Risk of prion transmission with the use of xenografts and allografts in surgery. Ophthal Plast Reconstr Surg. 2003;17:389–94.

    Article  Google Scholar 

  46. Seiff SR, Chang Jr JS, Hurt MH, Khayam-Bashi H. Polymerase chain reaction identification of human immunodeficiency virus-1 in preserved human sclera. Am J Ophthalmol. 1994;118:528–9.

    PubMed  CAS  Google Scholar 

  47. Long CJ, Heckman JG, Neunderfer B. Creutzfeldt-Jakob disease via dural and corneal transplants. J Neurol Sci. 1998;160:128–39.

    Article  Google Scholar 

  48. Hogan RN, Brown P, Heck E, Cavanagh H. Risk of prion disease transmission from ocular donar tissue transplantation. Cornea. 1999;18:2–11.

    Article  PubMed  CAS  Google Scholar 

  49. Heckman JG, Lang CJ, Petruch F, et al. Transmission of Creutzfeldt-Jakob disease via a corneal transplant. J Neurol Neurosurg Psychiatry. 1997;63:388–90.

    Article  Google Scholar 

  50. Simonds RJ, Holmberg SD, Hurwitz RL, Coleman TR, Bottenfield S, Conley LJ, Kohlenberg SH, Castro KG, Dahan BA, Schable CA, Rayfield MA, Rogers MF. Transmission of human immunodeficiency virus type 1 from a seronegative organ and tissue donor. N Engl J Med. 1992;326:726–32.

    Article  PubMed  CAS  Google Scholar 

  51. Arat YO, Shetlar DJ, Boniuk M. Bovine pericardium versus homologous sclera as a wrapping for hydroxyapatite orbital implants. Ophthal Plast Reconstr Surg. 2003;19:189–93.

    Article  PubMed  Google Scholar 

  52. Gayre GS, DeBacker CM, Lipham W, Tawfik HA, Holck DEE, Dutton JJ. Bovine pericardium as a wrapping for orbital implants. Ophthal Plast Reconstr Surg. 2001;17:381–7.

    Article  PubMed  CAS  Google Scholar 

  53. Pelletier C, Gilberg S, Jordan DR. Use of Temporalius fascia for management of exposed hydroxyapatite implants. Ophthal Plast Reconstr Surg. 1998;14:198–203.

    Article  PubMed  CAS  Google Scholar 

  54. Naugle Jr TC, Fry CL, Sabatier RE, Elliot LF. High leg incision fascia lata harvesting. Ophthalmology. 1997;104:1480–8.

    Article  PubMed  Google Scholar 

  55. Kao SCS, Chen S. The use of rectus abdominis sheath for wrapping of the hydroxyapatite orbital implants. Ophthalmic Surg Lasers. 1999;30:69–71.

    PubMed  CAS  Google Scholar 

  56. Naugle Jr TC, Lee AM, Haik BG, Callahan MA. Wrapping hydroxyapatite orbital implants with posterior auricular muscle complex grafts. Am J Ophthalmol. 1999;128:495–501.

    Article  PubMed  Google Scholar 

  57. Karesh JW. Polytetrafluoroethylene as a graft material in ophthalmic plastic and reconstructive surgery: an experimental and clinical study. Ophthal Plast Reconstr Surg. 1987;3:179–85.

    Article  PubMed  CAS  Google Scholar 

  58. Choo PH, Carter SR, Crawford JB, Seiff SR. Exposure of expanded polytetrafluoroethylene-wrapped hydroxyapatite orbital implant: a report of two patients. Ophthal Plast Reconstr Surg. 1999;15:77–8.

    Article  PubMed  CAS  Google Scholar 

  59. Kao L. Polytetrafluoroethylene as a wrapping material for a hydroxyapatite orbital implant. Ophthal Plast Reconstr Surg. 2000;16:286–8.

    Article  PubMed  CAS  Google Scholar 

  60. Jordan DR, Allen LH, Ells A, Gilberg S, Brownstein S, Munro S, Grahovac S, Raymond F. The use of vicryl mesh (polyglactin 910) for implantation of hydroxyapatite orbital implants. Ophthal Plast Reconstr Surg. 1995;11:95–9.

    Article  PubMed  CAS  Google Scholar 

  61. Jordan DR, Ells A, Brownstein S, Munro S, Grahovac S, Raymond F, Allen LH. Vicryl-mesh wrap for the implantation of hydroxyapatite orbital implants: an animal model. Can J Ophthalmol. 1995;30:241–6.

    PubMed  CAS  Google Scholar 

  62. Klapper SR, Jordan DR, Punja K, Brownstein S, Gilberg SM, Mawn L, Grahovac SZ. Hydroxyapatite implant wrapping materials: analysis of fibrovascular ingrowth in an animal model. Ophthal Plast Reconstr Surg. 2000;16:278–85.

    Article  PubMed  CAS  Google Scholar 

  63. Gayre GS, Lipham W, Dutton JJ. A comparison of rates of fibrovascular ingrowth in wrapped versus unwrapped hydroxyapatite spheres in a rabbit model. Ophthal Plast Reconstr Surg. 2002;18:275–80.

    Article  PubMed  Google Scholar 

  64. Jordan DR, Klapper SR, Gilberg SM. The use of vicryl mesh in 200 porous orbital implants. Ophthal Plast Reconstr Surg. 2003;19:53–61.

    Article  PubMed  Google Scholar 

  65. Custer PL. Enucleation: past, present, and future. Ophthal Plast Reconstr Surg. 2000;16:316–21.

    Article  PubMed  CAS  Google Scholar 

  66. Custer PL. Reply to Dr. D.R. Jordan’s letter on polyglactin mesh wrapping of hydroxyapatite implants. Ophthal Plast Reconstr Surg. 2001;17:222–3.

    Article  Google Scholar 

  67. Jordan DR, Chan S, Mawn L, Gilberg SM, Brownstein S, Hill V. Complications associated with pegging hydroxyapatite orbital implants. Ophthalmology. 1999;106:505–12.

    Article  PubMed  CAS  Google Scholar 

  68. Edelstein C, Shields CL, DePotter P, Shields JA. Complications of motility peg placement for the hydroxyapatite orbital implant. Ophthalmology. 1997;104:1616–21.

    Article  PubMed  CAS  Google Scholar 

  69. Lin CJ, Lio SL, Jou JR, Kao SC, Hou PK, Chen MS. Complications of motility peg placement for porous hydroxyapatite orbital implants. Br J Ophthalmol. 2002;86:394–6.

    Article  PubMed  Google Scholar 

  70. Jordan DR. Spontaneous loosening of hydroxyapatite peg sleeves. Ophthalmology. 2001;108:2041–4.

    Article  PubMed  CAS  Google Scholar 

  71. Cheng MS, Liao SL, Lin L. Late porous polyethylene implant exposure after motility coupling post placement. Am J Ophthalmol. 2004;138:420–4.

    Article  PubMed  Google Scholar 

  72. Lee SY, Jang JW, Lew H, Kim SJ, Kim HY. Complications in motility peg placement for hydroxyapatite orbital implants in anophthalmic socket. Jpn J Ophthalmol. 2002;46:103–7.

    Article  PubMed  Google Scholar 

  73. Jordan DR, Klapper SR. A new titanium peg system for hydroxyapatite orbital implants. Ophthal Plast Reconstr Surg. 2000;16:380–7.

    Article  PubMed  CAS  Google Scholar 

  74. Johnson RLC, Ramstead CL, Nathoo N. Pegging the porous orbital implant. Ophthal Plast Reconstr Surg. 2011;27:74–5.

    Article  PubMed  Google Scholar 

  75. Ainbinder DJ, Haik BG, Tellado M. Hydroxyapatite orbital implant abscess: histopathologic correlation of an infected implant following evisceration. Ophthal Plast Reconstr Surg. 1994;10:267–70.

    Article  PubMed  CAS  Google Scholar 

  76. Klapper SR, Jordan DR, Ells A, Grahovac SZ. Hydroxyapatite orbital implant vascularization assessed by magnetic resonance imaging. Ophthal Plast Reconstr Surg. 2003;19:46–52.

    Article  PubMed  Google Scholar 

  77. Cook S, Dalton J. Biocompatibility and biofunctionality of implanted materials. Alpha Omegan. 1992;85:41–7.

    PubMed  CAS  Google Scholar 

  78. Choi JC, Iwamoto MA, Bstandig S, Rubin PA, Shore J. Medpor motility coupling post: a rabbit model. Ophthal Plast Reconstr Surg. 1999;15:190–201.

    Article  PubMed  CAS  Google Scholar 

  79. Rubin PAD, Fay AM, Remulla HD. Primary placement of motility coupling post in porous polyethylene orbit implants. Arch Ophthalmol. 2000;118:826–32.

    Article  PubMed  CAS  Google Scholar 

  80. Hsu WC, Green JP, Spilker MH, Rubin PAD. Primary placement of a titanium motility post in a porous polyethylene orbital implant. Ophthal Plast Reconstr Surg. 2003;16:370–9.

    Article  Google Scholar 

  81. Tawfik HA, Dutton JJ. Primary peg placement in evisceration with the spherical porous polyethylene orbital implant. Ophthalmology. 2004;111:1401–6.

    Article  PubMed  Google Scholar 

  82. Timothy NH, Feilich DE, Linberg JV. Perspective: evisceration versus enucleation, the ocularists standpoint. Ophthal Plast Reconstr Surg. 2003;19(6):417–20.

    Article  PubMed  Google Scholar 

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Correspondence to David R. Jordan MD, FRCSC, FACS or Stephen R. Klapper MD, FACS .

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Jordan, D.R., Klapper, S.R. (2014). Orbital Implants. In: Perry, J., Singh, A. (eds) Clinical Ophthalmic Oncology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40492-4_18

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  • DOI: https://doi.org/10.1007/978-3-642-40492-4_18

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