Exposure Rates of Wrapped and Unwrapped Orbital Implants Following Enucleation

Abstract

The exposure rate of porous polyethylene implants in this study (9%) was found to be comparable to published rates for hydroxyapatite implants. There were no exposures of unwrapped solid acrylic spheres. Unwrapped porous implants in pediatric patients or following trauma-related enucleation may represent an increased risk for postoperative implant exposure. Absorbable wrapping of porous implants may carry the same risk for exposure as no wrapping. Porous implants wrapped in durable material appear to be as safe as solid acrylic spheres.

Conjunctival Melting Syndrome Associated with the Use of Bovine Pericardium Wrapping Material

“…3,[15][16][17][18][19] Similarly, the previously reported incidence of implant exposure using PP varies from zero to 21.6%. 4,14 In most series, exposure of porous implants did not result in extrusion or infection and did not necessitate removal of the implant, which reflects the authors' experience as well. 3,[17][18][19] The authors, therefore, have abandoned the use of bovine pericardium implant wrapping material and do not recommend routine use of this product for this purpose until further studies are performed.…”

“…The use of wrapping material for porous implants has been advocated to reduce the risk of exposure and to facilitate reattachment of the extraocular muscles. [1][2][3][4] Other alternatives include processed human pericardium, processed human fascia lata, processed human sclera, polyglactin 910 mesh (Vicryl), polyglycolic acid mesh (Dexon), expanded polytetrafluoroethylene (e-PTFA), and autologous temporalis fascia, fascia lata, or pericranium. 1 An animal study comparing bovine pericardium and homologous sclera as wrapping materials for hydroxyapatite (HA) implants concluded that the two tissues are clinically comparable.…”

The Use of Autogenous Sclera as Wrapping Material in Hydroxyapatite Implantation

“…However, debates over the complications including implant exposure continue. Li et al [21] reported that exposure was observed in 1 of 3 eyes using Vicryl mesh and in 1 of 12 eyes using Gelfoam for wrapping porous polyethylene spheres, while no exposures were observed in 8 eyes using cadaver dura mater (n = 6), autogenous fascia lata (n = 1) and banked sclera (n = 1). According to Kao [22], who used polytetrafluoroethylene (Gore-Tex®) as the wrapping material of hydroxyapatite, the implant exposure occurred in 1 of 5 eyes, and severe implant infection occurred in 1 eye, leading to implant removal.…”

Anophthalmic socket: choice of orbital implants for reconstruction

“…Acrylic and silicone implants have the lowest rate of complications, particularly when used as the primary implant (35,36) . In conclusion, despite progress in studies of new implants to correct anophthalmic sockets, it is possible to assume that porous polyethylene-coated implants are just as effective as non-porous implants (21) .…”

“…The follow-up of patients was decisive for identifying problems that may occur with the integrated implants, which were at least as common as those with the non-integrated implants. Dehiscence of the conjunctiva and sclera were increasingly frequent, and the exposure rates ranged from 2.9% to 62%, which were influenced by many factors such as the surgical technique employed (enucleation or evisceration), removal of the cornea or not (20) , the use of wraps or not, the length of follow-up, and systemic diseases in the anophthalmic socket (2,4,21,22) . Ultimately, it is impossible to state whether extrusion or the need to remove implants will not occur when using integrated implants.…”