Chronic Orbital Inflammation Associated to Hydroxyapatite Implants in Anophthalmic Sockets

Abstract

Purpose: We report 6 patients who received a hydroxyapatite (HA) orbital implant in the socket and developed chronic orbital inflammation unresponsive to conventional medical therapy. Case Reports: We assisted 6 cases (4 males, 2 females) who received an HA orbital implant in the socket between 2015 and 2016 at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, and developed chronic orbital inflammation with chronic discharge, redness, and pain (onset from weeks to over 2 decades after surgery). Computed tomography evaluation indicated inflammation in the orbital tissues, and histological examination showed a foreign body granulomatous reaction mainly localized around and blanching the HA implant. The condition was unresponsive to usual medical treatment and was resolved immediately after implant removal. Conclusions: Chronic inflammation can occur decades after placement of an HA implant in the orbit and can be successfully treated with implant removal.

Extensive orbital inflammation in an anophthalmic socket: is the Bioceramic implant a bystander or a participant?

“…Examination features consistent with chronic inflammation included forniceal shortening, fibrosis, symblepharon and socket contraction. 3 , 4 Our patient's clinical presentation of pain, ill-fitting prosthesis and conjunctival inflammation mirror the inflammatory changes previously reported. Similar to the histological features in our case, Chee et al and Galindo-Ferreiro et al’s cases of hydroxyapatite-induced inflammation had microscopic features of chronic inflammatory infiltrate, giant cells, multiple small foreign bodies, eosinophils and dense fibrosis.…”

“…A review of the literature found only five previous cases of spherical orbital implant-associated inflammation with radiological findings reported, all of which had occurred with hydroxyapatite implants. 3 , 4 Presenting symptoms included inflammation, discharge, pain and prosthesis intolerance. The delay from implantation to onset of symptoms ranged from 3 weeks to 24 years.…”

“…Similar to the histological features in our case, Chee et al and Galindo-Ferreiro et al’s cases of hydroxyapatite-induced inflammation had microscopic features of chronic inflammatory infiltrate, giant cells, multiple small foreign bodies, eosinophils and dense fibrosis. 3 , 4 It is unlikely that these peri-implant histological findings represented idiopathic sclerosing orbital inflammation given the complete quiescence achieved following implant removal. Four patients showed some improvement with topical antibiotics and steroids, however their symptoms recurred upon cessation of treatment.…”

“…In Galindo-Ferreiro et al’s case series, computed tomography scan and histopathological studies were conducted in all except one case, and none had an MRI performed. 4 The radiological features varied between patients, with two cases describing inflammation surrounding the implant whilst two others found only preseptal inflammation. Our case was further complicated by the patient's recent history of choroidal melanoma, which, together with an ambiguous radiological appearance, raised the possibility of tumour recurrence.…”

“… 1 Implant-associated inflammation is a particularly rare complication and only a few cases have been reported in patients with hydroxyapatite implants. 3 , 4 Furthermore, details of the radiological findings associated with this rare complication are scarce.…”