Exposure Rate of Hydroxyapatite Orbital Implants: A 15-Year Experience of 802 Cases

Published on Mar 1, 2008in Ophthalmology8.47
· DOI :10.1016/J.OPHTHA.2007.06.014
Jin Sook Yoon25
Estimated H-index: 25
(Yonsei University),
Helen Lew7
Estimated H-index: 7
+ 1 AuthorsSang Yeul Lee28
Estimated H-index: 28
(Yonsei University)
Sources
Abstract
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 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.
📖 Papers frequently viewed together
133 Citations
99 Citations
179 Citations
References26
Newest
PURPOSE: Enucleation is the main form of treatment for advanced retinoblastoma. The major complication of this procedure is orbital implant exposure. Different implants and wrapping materials are currently in use. The aim of the current study was to analyze the complications associated with the use of polyester-urethane, an artificial dura substitute, as a wrapping material for enucleation in advanced retinoblastoma. METHODS: A retrospective review of 32 cases (28 patients), who were treated wit...
20 CitationsSource
PURPOSE: To assess the problems associated with the use of 4 types of porous orbital implant (Bio-Eye coralline hydroxyapatite, FCI3 synthetic hydroxyapatite, aluminium oxide [Bioceramic], and porous polyethylene [Medpor]) after evisceration surgery. METHODS: A retrospective analysis was made of all cases of evisceration with placement of one of four types of porous orbital implants performed between 1991 and 2002 by one surgeon (n = 86). Patient age, implant type and size, surgery type (standar...
41 CitationsSource
#1Grant W. Su (BCM: Baylor College of Medicine)H-Index: 5
#2Michael T. YenH-Index: 16
Purpose:To evaluate current trends in the management of the anophthalmic socket after primary enucleation and evisceration.Methods:The active membership of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) was surveyed regarding primary enucleations and eviscerations per
133 CitationsSource
#1David R. Jordan (U of O: University of Ottawa)H-Index: 30
#2Steven GilbergH-Index: 21
Last. Ahmed BawazeerH-Index: 2
view all 3 authors...
PurposeTo assess the problems seen in 158 patients with coralline hydroxyapatite (HA) orbital implants (Bio-Eye).MethodsA consecutive case series of 170 patients receiving coralline HA implanted by two surgeons over a 5-year period were reviewed. The authors analyzed age, type of surgery, implant si
71 CitationsSource
#1Yonca Ozkan Arat (BCM: Baylor College of Medicine)H-Index: 15
#2Debra J. ShetlarH-Index: 8
Last. Milton BoniukH-Index: 26
view all 3 authors...
Purpose: To report our experience with bovine pericardium as a wrapping material for hydroxyapatite orbital implants after enucleation and to compare the exposure rates of the implants wrapped with bovine pericardium versus donor sclera. Methods: We retrospectively reviewed the records of all patients who received bovine pericardium-wrapped or donor sclera-wrapped hydroxyapatite implant after primary enucleation between March 1995 and December 2001. Results: Of the 26 patients who received donor...
32 CitationsSource
#1David R. Jordan (U of O: University of Ottawa)H-Index: 30
#2Stephen R. KlapperH-Index: 11
Last. Steven GilbergH-Index: 21
view all 3 authors...
Purpose: To report the results of a wrapping technique for porous orbital implants by using polyglactin 910 (Vicryl) mesh (Ethicon Inc., Somerville, NJ, U.S.A.) Methods: We retrospectively reviewed the records of 200 consecutive patients from one author's practice who received a polyglactin 910 mesh-wrapped porous orbital implant after enucleation or as a secondary implant between October 1, 1996, and April 15, 2001. We recorded potential problems that might be attributed to polyglactin 910 mesh...
49 CitationsSource
Purpose: To compare the rate of fibrovascularization of wrapped versus unwrapped hydroxyapatite (HA) spheres in an animal model and to investigate how drilling small-diameter access holes at the time of implantation affects the rate of fibrovascular ingrowth in wrapped implants. Methods: The right eyes of 20 New Zealand White rabbits were removed and a 12-mm HA sphere was implanted in each socket. The spheres were left bare in 8 of the animals. In the other 12, the implant was wrapped in an auto...
47 CitationsSource
#1Sang Yeul Lee (Yonsei University)H-Index: 28
#2Jae Woo Jang (Ajou University)H-Index: 1
Last. Hye Young KimH-Index: 4
view all 5 authors...
Abstract Purpose: In a retrospective study, we evaluated the complications in using the motility peg system (nonsleeved and sleeved) for hydroxyapatite orbital implants in an anophthalmic socket. Methods: Drilling for motility peg placement was performed in 265 patients with hydroxyapatite implantation: nonsleeved peg system (n = 191), sleeved peg system (n = 74). A statistical analysis was performed using the chi-square test. Results: Extrusion rates were significantly lower in the sleeved peg ...
26 CitationsSource
#1K. HoshiH-Index: 1
#2H. YoshinoH-Index: 1
Last. Takeshi SatoH-Index: 17
view all 6 authors...
Article abstract A nationwide survey and recent information documented 57 patients with Creutzfeldt–Jakob disease (CJD) who had received dura mater grafts during the period between January 1979 and September 1999. At least 54 of these 57 patients received the same brand of dura mater graft from the same processor. Mean age at disease onset in the 57 patients with dural grafts was younger (51.9 years) than that in patients with sporadic CJD (63 years) ( p
58 CitationsSource
Purpose: To evaluate a new hydroxyapatite-coated titanium sleeve and titanium peg system for HA orbital implants. Methods: The authors followed 54 patients receiving an HA-coated titanium sleeve and peg system and analyzed the complications associated with this peg system. The following data were recorded: type of surgery performed, size of implant used, type of HA used, time of pegging, follow-up duration, problems encountered, and treatment. Results: Fifty-seven patients received the HA-coated...
39 CitationsSource
Cited By76
Newest
Source
#1Larissa A. Habib (Yale University)
#2Victoria S. North (NewYork–Presbyterian Hospital)
Last. Nahyoung Grace Lee (MEE: Massachusetts Eye and Ear Infirmary)H-Index: 5
view all 6 authors...
PURPOSE To investigate medical conditions and systemic therapies associated with orbital implant exposure in patients with anophthalmic sockets. METHODS Retrospective review of patients who underwent enucleation or evisceration at a single centre between January 1, 2008 and March 1, 2018. Medical comorbidities, including peripheral or coronary artery disease, rheumatologic conditions, diabetes, malignancy and history of smoking were recorded. Use of immunomodulatory and anticoagulation therapy a...
1 CitationsSource
#1Manvi M. Sobti (Gartnavel General Hospital)H-Index: 2
#2Fatemeh Shams (Gartnavel General Hospital)H-Index: 2
Last. Vikas Chadha (Gartnavel General Hospital)H-Index: 5
view all 5 authors...
To report the results of a large case series of enucleations with primary insertion of an unwrapped hydroxyapatite (HA) orbital implant. We retrospectively reviewed consecutive enucleations with primary orbital (HA) implant insertion performed at the Scottish Ocular Oncology Service, Glasgow between 1990 and 2014. The unwrapped hydroxyapatite orbital implant was placed in the posterior portion of the socket and recti muscles sutured end-to-end over the implant. Out of 347 consecutive enucleation...
2 CitationsSource
#1Maria BorrelliH-Index: 21
#2Gerd GeerlingH-Index: 47
Last. Joana Witt (HHU: University of Düsseldorf)H-Index: 4
view all 4 authors...
ABSTRACTPurpose: When an eye has become irreversibly blind or painful it is removed by enucleation or evisceration. The resulting anophthalmic socket usually receives a volume replacing implant and...
4 CitationsSource
#1Andrew J. Rong (Bascom Palmer Eye Institute)H-Index: 3
#2Thomas E. Johnson (UM: University of Miami)H-Index: 11
Following globe removal, the surgeon must determine the best orbital implant to place into the anophthalmic socket. A decision on appropriate implant size, whether to place a porous or nonporous implant, and a patient’s total clinical picture must be considered to prevent future complications. Other considerations, including whether to wrap an implant and place a motility peg, must also be made. The modern implant is built on the foundation of anophthalmic socket reconstruction—implant retention...
Source
#1Zhaoxin Jiang (SYSU: Sun Yat-sen University)H-Index: 9
#2Yao Yang (SYSU: Sun Yat-sen University)H-Index: 6
Last. Xiaofeng Lin (SYSU: Sun Yat-sen University)H-Index: 8
view all 6 authors...
Evisceration is the end therapeutic approach for the treatment of severe ocular trauma cases, and it is a tremendous loss for patients. In this study, we explored the changing trends in the number of surgeries performed, demographic data and ocular features, and risks for early evisceration, aiming to provide more data for the additional prevention and management strategies for this catastrophic problem. This was a retrospective study that included patients who underwent ocular evisceration at t...
1 CitationsSource
#1David S. CurraghH-Index: 4
Last. Saul Rajak (University of Sussex)H-Index: 5
view all 9 authors...
ABSTRACTPurpose: We present a series of primary orbital implant replacement for cases of implant exposure to describe our experience of this one-staged surgical approach.Methods: This study reports...
2 CitationsSource
#1David R. Jordan (U of O: University of Ottawa)H-Index: 30
#2Stephen R. Klapper (IU: Indiana University)H-Index: 1
Loss of an eye to tumor, trauma, or end-stage ocular disease can be devastating. The loss of binocular visual function with reduced peripheral visual field and loss of depth perception may result in difficulties with activities of daily living and have various vocational restrictions [1–6]. Individuals may experience a sense of facial disfigurement and poor self-esteem as a result of the “lost body part” [3–6]. Because eye contact is such an essential part of human interaction, it is extremely i...
1 CitationsSource
#1Sarah W. DeParis (Johns Hopkins University)H-Index: 2
#2Nicholas R. Mahoney (Johns Hopkins University)H-Index: 7
Orbital implants are placed during or after eye removal surgeries. Implants support the orbital tissues, add volume to the eye socket, and support movement of an ocular prosthetic. Modern implants are made of either porous or nonporous materials. There are a variety of pros and cons to each material type with the ultimate ideal implant being well-tolerated and affordable as well as resistant to infection, exposure, migration, and extrusion. Porous materials allow fibrovascular ingrowth and as su...
Source
#2Andrea Tongbram (SN: Sankara Nethralaya)H-Index: 3
Loss of an eye is a devastating event in an individual’s life. It is of utmost importance to rehabilitate these patients with a proper fitting artificial prosthetic eye. The field of socket surgery has evolved over the last decade with better surgical techniques now available for these patients. The required procedure depends on the grade of socket contracture, and the aim of this chapter is to elucidate in brief the various techniques available for the same.
Source