Orbital implants in retinoblastoma patients: 23 years of experience and a review of the literature

Abstract

ABSTRACT.Purpose: To evaluate complications of different types of orbital implants following enucleation for retinoblastoma. Methods: We performed a retrospective chart study of all patients that underwent enucleation as treatment of retinoblastoma between April 1991 and June 2013. Events of implant exposure, extrusion (defined as a complete loss of the implant, or a major exposure that could not be closed) and socket abnormalities were analysed for association with implant type and influence of additional external beam radiation therapy (EBRT) and/or chemotherapy. Results: A total of 224 enucleations in 216 patients (eight bilateral) were identified. Mean age at surgery was 1.9 (median 1.5) years. Of the 219 included enucleated eyes, 20 were not replaced by a primary implant and 18 were replaced by an Allen implant. Scleral wrapped hydroxyapatite (HA) and acrylic implants (polymethylmethacrylate) were inserted in, respectively, 79 and 102 cases. In the total population, 29 treatment or implant-specific events (13.2%) were registered. Main complications were implant exposure n = 10 (4.6%) and extrusion n = 6 (2.7%). The acrylic/sclera group had less exposures or extrusions (5 of 102, 4.9%) compared to the HA/sclera group (10 of 79, 12.7%), although this difference did not quite reach statistical significance (p = 0.06). Additional treatment (chemotherapy and/or EBRT for the fellow eye) was administered in 78 cases (35.8%). The overall complication rate in the entire study population was significantly higher (16.7% versus 5.7%) in the group exposed to additional therapy (OR 3.3; 95% CI 1.30-8.36 p = 0.008). This negative effect of additional therapy was also significant in the combined acrylic/HA group (OR 2.9; 95% CI 0.97-8.46 p = 0.048). Conclusion: Our results suggest a favourable outcome for acrylic implants compared to the HA implant. Additional treatment with chemotherapy and/or EBRT is associated with an increased risk of complications.

Orbital Implants in Enucleation Surgery

“…Mourits et al 11 (level III) reviewed their experience with the use of hydroxyapatite (n ¼ 79) and PMMA (n ¼ 102) implants in 181 eyes that were enucleated for retinoblastoma. This study did not assess motility after enucleation.…”

Persistent socket pain postenucleation and post evisceration: a systematic review

“…Other implant-related causes for PSP are implant exposure (Shah-Desai et al 2000; n = 1) and the use of tantalum mesh-covered implants (Przybyla & La Piana 1982). Implant exposure is a major complication after enucleation and evisceration (Su & Yen 2004;Viswanathan et al 2007;Jongman et al 2016;Mourits et al 2016)), but is normally not associated with persistent pain. In small exposures (<3 mm), the conjunctiva may close spontaneously or may be resutured or patched.…”

Bioactive glass and glass‐ceramic orbital implants

“…A special mention should be dedicated to the "quasiintegrated" implant, which was introduced in the 1970s and was characterized by a "lock-and-key" coupling system to better support the external ocular prosthesis and expand its range of movements. 22,23 Exposure in porous implants can be treated with conservative management using pharmacological treatment or salvage strategies (anterior apposition of scleral or polymeric patches), without the need for implant removal and replacement with a new one. 20 The mounds created two perpendicular channels so that the stumps of horizontal and vertical extraocular muscles could be sutured together before being covered by the conjunctiva.…”

“…For example, the exposure rate of porous implants can be favored by a rough and stiff surface. 22,23 Exposure in porous implants can be treated with conservative management using pharmacological treatment or salvage strategies (anterior apposition of scleral or polymeric patches), without the need for implant removal and replacement with a new one. 24,25 Furthermore, there are other factors not directly related to the implants which can lead to postoperative complications, such as bad surgical technique or patient's systemic diseases.…”