Remove, rotate, and reimplant: a novel technique for the management of exposed porous anophthalmic implants in eviscerated patients

Background: Evisceration and nucleation are commonly performed ophthalmic surgeries for painful blind eye, disfiguring blind eye, endophthalmitis etc. After both these surgeries it is important to replace the lost volume in the orbit with implant. Implant is associated with many complications such as major discharge, exposure with discharge and implant exposure. The main surgical management of implant exposures basically primary revision or patch grafting with or without removal of the implant. Case: A 60 years old man presented to ophthalmic OPD with complaint of foreign body sensation and irritation in left eye. There was history of evisceration with silicon ball implant in left eye done one month back for painful blind eye at another hospital. On ophthalmic examination, there was a 3 × 4 mm of implant exposure most probably dueto tight closure. As per records the size of implant was 22mm. The patient was planned for extra-ocular myoplasty with buccal mucosal graft under general anesthesia. Observation: After sterile prepping and draping, 360˚ degrees peritomy was performed and care was taken to dissect between tenons and orbital implant. Medialand lateral recti were isolated and dissected upto 10-12mm from insertion site. Both the recti were secured with 6-0 vicryl suture and were detached from their respective insertions, advanced and approximated over the site of implant exposure. Thus the exposed implant was covered with a vascularized base which was reinforced with amucosal graft harvested from the buccal mucosa and secured with absorbable sutures. After 1 year of follow up patient was asymptomatic. Conclusion: Extraocular myoplasty with buccal mucosal graft is a good surgical remedy for orbital implant exposure implant.

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“…The surgical management of this complication is primary revision or patch grafting with or without removal of implants (Kayanak et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…A new technique of remove, rotate and reimplant was proposed by Kayanak P et al, 2014. The sclera with the implant was removed en mass, the axis of the whole mass was rotated anteroposteriorly so that the fully covered implant with scleral tissue was oriented anteriorly and the exposed part was oriented in the posterior part of the globe.…”

Section: Discussionmentioning

confidence: 99%

Extraocular Myoplasty: Surgical Remedy For Intraocular Implant Exposure

Singh

Vathulya²,

Agrawal³

et al. 2020

Nep J Oph

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“…These complications are usually treated with drugs and secondary surgery (3)(4)(5). Orbital implant exposure is currently treated with various surgical techniques, including a dermal fat graft (6,7), acellular dermal graft (8), palate mucosal repair (9), oral mucosal repair (10), Enduragen ® graft repair (11), subconjunctival tissue flap repair (12) and fresh amniotic membrane repair (13). These surgical methods are unsatisfactory, however, as they cannot eliminate local inflammation or accelerate vascularization of the orbital implant.…”

Section: Introductionmentioning

confidence: 99%

Helium-neon laser therapy in the treatment of hydroxyapatite orbital implant exposure: A superior option

Zhao

Zhu

et al. 2015

Experimental and Therapeutic Medicine

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The aim of the present study was to evaluate the efficacy of helium-neon laser therapy in the treatment of hydroxyapatite orbital implant exposure and compare the results with those of a combined drugs and surgery regimen. A total of 70 patients with hydroxyapatite orbital implant exposure in 70 eyes were randomly divided into two groups: Helium-neon laser therapy (group A) and drugs plus surgery (group B). Each group contained 35 patients. The healing rates and times of the conjunctival wound were recorded and compared following helium-neon laser treatment or the drugs plus surgery regimen. Changes in the hydroxyapatite orbital implant prior to and following helium-neon laser irradiation were analyzed. A similar animal study was conducted using 24 New Zealand white rabbits, which received orbital implants and were then received drug treatment or helium-neon therapy. In the human experiment, the rates for conjunctival wound healing were 97.14% in group A and 74.29% in group B, with a significant difference between the groups (χ=5.71, P<0.05). Patients with mild exposure were healed after 7.22±2.11 days of helium-neon laser therapy and 14.33±3.20 days of drugs plus surgery. A statistically significant difference was found between the groups (t=8.97, P<0.05). Patients with moderate to severe exposure were healed after 18.19±2.12 days of helium-neon laser therapy and 31.25±4.21 days of drugs plus surgery. The difference between the groups was statistically significant (t=7.91, P<0.05). Enhanced magnetic resonance imaging showed that the helium-neon laser therapy significantly promoted vascularization of the hydroxyapatite orbital implant. These results, combined with pathological findings in animals, which showed that a helium-neon laser promoted vascularization and had anti-inflammatory effects, suggest that helium-neon laser irradiation is an effective method for treating hydroxyapatite orbital implant exposure, thereby avoiding secondary surgery.

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“…3–8 Single-stage explantation-implantation is an alternative that has the advantages of faster rehabilitation, earlier prosthetic use, and reduced psychological impact from interrupted prosthetic wear between procedures. 9–13 Although there are reports of small series of patients having single-stage surgery for exposed implants, these have only relatively short follow-up intervals. 10–13…”

mentioning

confidence: 99%

“…9–13 Although there are reports of small series of patients having single-stage surgery for exposed implants, these have only relatively short follow-up intervals. 10–13…”

mentioning

confidence: 99%

One-stage Intraconal Volume Modification for Exposed and Nonexposed Ball Implants

Vahdani,

Rose,

Marjanovic

et al. 2024

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To assess long-term outcomes and reinterventions for exposed and nonexposed intraconal orbital implants after single-stage socket revisional surgery. Methods: Retrospective case-note review of patients with exposed or nonexposed orbital ball implants, who underwent a single-stage ball exchange (Group I) or ball removal with dermis-fat graft (Group II); Group I was subdivided as having either exposed (A) or nonexposed (B) implants. Outcomes were compared with similar cohorts undergoing multistage surgery. Results: Of 172 patients (54% male), 153 (89%) underwent ball exchange (Group I) and 19 (11%) had dermis-fat graft (Group II). With a mean follow up of 7.8 years, Group I patients without ball exposure (Group IB) had a slightly higher rate of reintervention for persistent volume deficit (21% vs. 9%; p = 0.163) and implant migration (6% vs. 0%; p = 0.091), while Group IA patients—having surgery for exposed implants—had more reexposures (7% vs. 3%; p = 0.270). Single-stage and 2-stage surgery had similar reintervention rates, with the exception of a trend toward fewer volume enhancements for those with nonexposed implants (17% vs. 30%; p = 0.380), and a shorter time to (re)exposure for exposed implants after 2-stage procedures (mean 0.33 vs. 3.5 years; p = 0.571). Group II patients required further volume enhancement in 32% of 1-stage procedures, and one patient needed graft removal. Conclusion: Single-stage volume modification is effective and the results are comparable to staged surgery for either exposed or nonexposed implants. Most patients report a stable prosthesis and satisfactory cosmesis, after a faster rehabilitation.

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Remove, rotate, and reimplant: a novel technique for the management of exposed porous anophthalmic implants in eviscerated patients

Abstract: Purpose To describe and to evaluate a new and relatively easy technique for porous implant exposure repair.

Cited by 8 publications

References 29 publications

Extraocular Myoplasty: Surgical Remedy For Intraocular Implant Exposure

Extraocular Myoplasty: Surgical Remedy For Intraocular Implant Exposure

Helium-neon laser therapy in the treatment of hydroxyapatite orbital implant exposure: A superior option

One-stage Intraconal Volume Modification for Exposed and Nonexposed Ball Implants

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