Hydroxyapatite orbital implants. Experience with 100 cases.

Published on May 1, 1995in Australian and New Zealand Journal of Ophthalmology
· DOI :10.1111/J.1442-9071.1995.TB00139.X
Alan A. McNab42
Estimated H-index: 42
(Royal Children's Hospital)
Sources
Abstract
Background: The hydroxyapatite (HA) intraorbital implant is a relatively new implant made from the porous skeleton of a coral species which allows fibrovascular ingrowth and therefore tissue integration. After fibrovascular ingrowth, a hole can be drilled in the implant and a motility peg inserted to increase movements of the prosthesis by coupling the implant to the prosthesis. Method: The records of the first 100 cases of HA intraorbital implants inserted by the one surgeon were analysed for complications, pain and nausea postoperatively, length of hospital stay, and further surgical procedures required. A series of acrylic implants inserted by the same surgeon was used for comparison. Results: Twenty-five primary and 75 secondary HA implants were performed in patients ranging from six to 74 years of age. All were covered in donor sclera. Follow-up was three to 34 months (mean 16.9, median 17.0). Complications occurred in 15 patients and included too large an implant (seven cases) requiring surgical reduction, scleral exposure in three (repair required in one), an early small exposure of the coral in one case, late thinning of the conjunctiva and later exposure of the implant in one, and shallowing of the inferior fornix requiring mucous membrane grafting in three. No implants migrated, extruded or became infected. Of 80 patients beyond six months follow-up, 28 (35%) had insertion of motility pegs, and six (7.5%) of these suffered minor complications related to the peg. Compared to patients having acrylic implants, the postoperative analgesic requirements and length of hospital stay were significantly greater for the HA patients. Conclusions: Hydroxyapatite intraorbital implants represent a significant advance over other implants and offer a more stable, safe alternative. They also offer the possibility of improved prosthesis motility. The additional cost of the implant, prolonged hospital stay and postoperative pain, should be considered in recommending such implants to patients either as primary or secondary implants.
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Background: Porous coralline hydroxyapatite orbital implants have gained significant popularity for use in anophthalmic sockets. Several reports have noted increased rates of early implant exposure. Methods: Six patients with exposure complications of primary hydroxyapatite implants after enucleation or evisceration were studied. Results: The hydroxyapatite implant exposures occurred 2 to 8 weeks after implantation. Magnetic resonance imaging scans with gadolinium enhancement obtained in two pat...
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The coral derived hydroxyapatite sphere is a popular, integrated orbital implant designed to provide improved motility of the ocular prosthesis following enucleation. Although the implant has rapidly become widely used by ophthalmologists, little information is available regarding the problems of this technique in a large series of cases. Experience with 250 consecutive cases of hydroxyapatite orbital implant use was reviewed and the problems of the implants and their management investigated spe...
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: Two porous orbital implants available for clinical use in the anophthalmic socket are hydroxyapatite (HA) and porous polyethylene (PP). We examined the rate and the extent of fibrovascular ingrowth into these implants using histopathologic criteria in a rabbit model. Thirty-two New Zealand white rabbits underwent a unilateral enucleation with placement of a 14-mm spherical orbital implant. Twelve rabbits received HA, 12 small-pore PP, and 8 large-pore PP. The implants inserted were wrapped eit...
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Tissue breakdown and exposure of a hydroxyapatite implant were observed in eight patients: in four of six patients after evisceration and in four of 31 after enucleation. The reasons for evisceration were a blind, painful eye and endophthalmitis in two patients each. The reasons for enucleation were a choroidal melanoma in two patients and endophthalmitis and irreparable traumatic damage in one patient each. The patients with endophthalmitis received the implant in a second surgical procedure af...
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Six patients with complications of primary or secondary hydroxyapatite implants were studied. Complications included socket infection and/or conjunctival dehiscence. Complications were detected during regular follow-up examinations, and various treatment approaches were used. The hydroxyapatite implant exposure occurred 4 to 6 weeks (mean, 4.5 weeks) after implantation. Three of the six implants were wrapped in preserved donor sclera before implantation. One of the implants showed wide exposure ...
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Abstract To gain a deeper insight into the cause of the postenucleation socket syndrome, high-resolution computed tomography (CT) was performed in 22 anophthalmic patients before insertion of an intraorbital implant. The anatomy of the normal and the anophthalmic orbits was compared. Computed tomographic scans were made either in the sagittal and the coronal plane or in the sagittal and transverse plane. The authors discovered a sagging and retraction of the superior muscle complex and a downwar...
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