An Innovative Modified Orbital Implant in Enucleated Eyes for Postoperative Functionality and Cosmesis

Abstract

Orbital implants replace the volume lost by enucleated eye, impart motility to the prosthesis, and maintain cosmetic symmetry with the fellow eye. They include nonintegrated, synthetic semi-integrated, integrated, bio-integrated, and biogenic varieties. The much favored hydroxyapatite (bio-integrated) implant, due to its rough surface, needs to be wrapped in donor sclera or other wrapping materials (like polyglactin-910 mesh, polytetrafluoroethylene sheet, etc.) to which the muscles could be directly sutured. Cost factor of such wrappings is often prohibitive that add to the expense of such implants.Purpose: To highlight monofilament polypropylene surgical mesh commonly used for herniorrhaphy as an alternative implant wrapping for achieving augmented implant volume and enabling easier extraocular muscle attachment in postenucleation reconstruction of artificial eye. Materials and methods:Following enucleation of a nonfunctional eye in a patient who met with a road traffic accident, a 14 mm hydroxyapatite ball was used to replace the globe. The ball was wrapped with a monofilament polypropylene surgical mesh used in herniorrhaphy and sutured. The patient achieved a satisfactory cosmesis and movements of the implant for different gazes. No ocular discomfort or implant extrusion was reported following 6 months of follow-up. Conclusion:Monofilament polypropylene mesh can be used safely as an orbital implant wrapping, economizing the implant cost.