The Molteno M-Sphere

Jordan, David R.; Hwang, Ivan P.; Brownstein, Seymour; McEachren, Todd M; Gilberg, Steve; Grahovac, Steve Z.; Mawn, Louise A.

doi:10.1097/00002341-200009000-00009

Cited by 43 publications

(16 citation statements)

References 17 publications

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“…This model was repeated in 3 other studies with similar results. [4][5][6] In our patient, MR imaging showed progressively lower T2 signal intensity in the prosthesis during the follow-up period. Additionally, postcontrast images demonstrated centripetal growth of enhancing tissues during the same period, compatible with fibrovascularization and incorporation of the prosthesis (Fig 1).…”

Section: Discussionsupporting

confidence: 50%

“…This process has been documented in animal studies that correlated changes in postcontrast T1 MR imaging with histologic samples demonstrating fibrovascular ingrowth. [2][3][4][5][6] This report documents similar changes seen in a patient following right-sided enucleation and bioceramic prosthetic implantation. …”

mentioning

confidence: 57%

“…These studies uniformly describe central T1 postcontrast enhancement, which coincides with histopathologic evidence of fibrovascularization. [2][3][4][5][6] Jordan et al 2 evaluated the bioceramic implant on 6 adult male New Zealand albino rabbits. The rabbits were divided into 3 groups.…”

Section: Discussionmentioning

confidence: 99%

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MR Imaging of Progressive Enhancement of a Bioceramic Orbital Prosthesis: An Indicator of Fibrovascular Invasion: Fig 1.

Barnwell¹,

Castillo²

2010

AJNR Am J Neuroradiol

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SUMMARY:The physical properties of bioceramics have made them ideal for a variety of prosthetic devices. Their porous structure allows fibrovascular tissue to invade the implant and secure it and provides a surface for muscular attachment. This process has been well-documented in animal studies; however, this case report describes the periodic imaging changes seen in a 67-year-old man following placement of a bioceramic orbital prosthesis. Bioceramics have been used in orthopedic and dental prosthetics for decades 1 ; in 2000, they were adapted to orbital prosthetics. Their aluminum oxide components form a cobblestone-appearing microcrystal structure that produces a lightweight, strong, easy-to-use, simple-tomanufacture, and highly porous implant.2 The pores of the implant allow fibrovascular invasion, which secures it within the orbital socket and provides a scaffold for muscular attachment. This process has been documented in animal studies that correlated changes in postcontrast T1 MR imaging with histologic samples demonstrating fibrovascular ingrowth. [2][3][4][5][6] This report documents similar changes seen in a patient following right-sided enucleation and bioceramic prosthetic implantation. Case ReportA 67-year-old man presented with chronic decreased visual acuity. A pigmented lesion, suspicious for melanoma versus choroidal nevus, was identified in the right eye. The lesion was followed with serial sonography for 9 years until its growth rate precluded the diagnosis of choroidal nevus. He then underwent right enucleation and bioceramic prosthetic implantation. Pathologic specimens confirmed the diagnosis of malignant melanoma. Lumbar punctures and imaging studies failed to demonstrate metastatic disease. Serial MR imaging studies with T1 spin-echo (TR, 400 ms; TE, 15 ms; 3-mm axial sections), T2 turbo spin-echo with fat saturation (TR, 5410 ms; TE, 100 ms; echo train of 21; 3-mm axial sections), and postcontrast T1 spinecho with fat saturation (TR, 675 ms; TE, 15 ms; 3-mm axial sections following administration of gadobenate dimeglumines [MultiHance, 1 mL/5 kg; Bracco, Milan, Italy]) were performed on a 1.5T magnet to evaluate the implant and assess disease recurrence. At 20 months after implantation, he is complication-and disease-free, and the prosthesis is well-incorporated clinically and on follow-up MR imaging (Fig 1). DiscussionFibrovascularization of orbital prosthetics secures them within the orbit and provides a surface for muscular attachment. This integral process has been examined in numerous animal models. These studies uniformly describe central T1 postcontrast enhancement, which coincides with histopathologic evidence of fibrovascularization. [2][3][4][5][6]

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Section: Discussionsupporting

confidence: 50%

mentioning

confidence: 57%

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MR Imaging of Progressive Enhancement of a Bioceramic Orbital Prosthesis: An Indicator of Fibrovascular Invasion: Fig 1.

Barnwell¹,

Castillo²

2010

AJNR Am J Neuroradiol

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“…[1][2][3][4] Numerous porous implants made from a variety of other materials have been described over the past 15 years. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Some are available throughout North America, others are available only in certain parts of the world, and some are still at an investigational stage. The most commonly used porous implants in North America are (in no particular order) coralline HA (Bio-Eye), porous polyethylene (Medpor), FCI 3 synthetic HA (Canada only), and aluminum oxide (Bioceramic).…”

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confidence: 99%

Fibrovascularization of Porous Polyethylene (Medpor) Orbital Implant in a Rabbit Model

Jordan

Brownstein

Dorey

et al. 2004

Ophthalmic Plastic &Amp; Reconstructive Surgery

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The porous polyethylene orbital implant represents an alternative implant for use after enucleation or evisceration or for secondary implantation. In our rabbit model, the porous polyethylene implant was well tolerated without complication. Complete fibrovascularization was first seen at 12 weeks. Porous polyethylene orbital implants appear to vascularize more slowly than Bio-Eye coralline HA, FCI(3) synthetic HA, and aluminum oxide implants.

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“…Numerous porous implants made from a variety of other materials have been described over the last 15 years. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Complications reported with hydroxyapatite (HA) and other porous orbital implants include discharge, implant exposure, conjunctival thinning, pyogenic granuloma formation, implant infection, and persistent pain or discomfort. 3,5,7,8,20 -39 Although implant exposure is the most common problem, [22][23][24][25][26]30 implant infection is the most serious because removal of the implant is often required.…”

mentioning

confidence: 99%

Clinicopathologic Analysis of 15 Explanted Hydroxyapatite Implants

Jordan

Brownstein²,

Faraji³

2004

Ophthalmic Plastic &Amp; Reconstructive Surgery

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The clinical course of porous orbital implant infection may be prolonged, and the early symptom of recurrent discharge, a common problem for implant recipients, may delay diagnosis. Implant infection should be suspected when there is persistent conjunctival inflammation and discharge after implant placement despite antibiotic therapy, discomfort on implant palpation, and recurrent pyogenic granuloma (indicative of implant exposure). Implant removal is usually required in these cases. If orbital pain (not necessarily related to implant palpation) is the main complaint, without signs of conjunctival inflammation and with or without discharge, one should consider other reasons for the symptoms.

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The Molteno M-Sphere

Cited by 43 publications

References 17 publications

MR Imaging of Progressive Enhancement of a Bioceramic Orbital Prosthesis: An Indicator of Fibrovascular Invasion: Fig 1.

MR Imaging of Progressive Enhancement of a Bioceramic Orbital Prosthesis: An Indicator of Fibrovascular Invasion: Fig 1.

Fibrovascularization of Porous Polyethylene (Medpor) Orbital Implant in a Rabbit Model

Clinicopathologic Analysis of 15 Explanted Hydroxyapatite Implants

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