Use of Extraocular Muscle Flaps in the Correction of Orbital Implant Exposure

Abstract

PurposesThe study is to describe a new surgical technique for correcting large orbital implant exposure with extraocular muscle flaps and to propose a treatment algorithm for orbital implant exposure.MethodsIn a retrospective study, seven patients with orbital implant exposure were treated with extraocular muscle flaps. All data were collected from patients in Chang Gung Memorial Hospital, Taiwan during 2007–2012. All surgeries were performed by one surgeon (Y.J.T). Patient demographics, the original etiology, details of surgical procedures, implant types, and follow-up interval were recorded. Small exposure, defined as exposure area smaller than 3 mm in diameter, was treated conservatively first with topical lubricant and prophylactic antibiotics. Larger defects were managed surgically.ResultsSeven patients consisting of two males and five females were successfully treated for orbital implant exposure with extraocular muscle flaps. The average age was 36.4 (range, 3–55) years old. Five patients were referred from other hospitals. One eye was enucleated for retinoblastoma. The other six eyes were eviscerated, including one for endophthalmitis and five for trauma. Mean follow-up time of all seven patients was 19.5 (range, 2–60) months. No patient developed recurrence of exposure during follow-up. All patients were fitted with an acceptable prosthesis and had satisfactory cosmetic and functional results.ConclusionsThe most common complication of orbital implant is exposure, caused by breakdown of the covering layers, leading to extrusion. Several methods were reported to manage the exposed implants. We report our experience of treating implant exposure with extraocular muscle flaps to establish a well-vascularized environment that supplies both the wrapping material and the overlying ocular surface tissue. We believe it can work as a good strategy to manage or to prevent orbital implant exposure.

Dermis-fat graft as treatment of early implant exposure in a postpenetrating keratoplasty patient with nontraumatic eyeball rupture

“…Some previous studies mentioned wrapping implants with the use of sclerotomy to act as an additional layer of barrier and to facilitate implant insertion. [ 1 3 ] We may adjust the surgical technique in future.…”

“…also published their experience that correcting orbital implant exposure using extraocular muscle flaps is a suitable strategy. [ 3 ] The vascularization between conjunctival flaps and autogenous or donor tissue grafts plays an important role in the management of exposed orbital implants. The dermis-fat grafts are easily obtained and induce less immunological reaction.…”

“…Management of implant exposure is thus a vital issue, including the use of retroauricular myoperiosteal grafts, hard palate, temporalis fascia, extraocular muscle flaps, and dermis-fat grafts. [ 1 3 4 5 ]…”

Orbital Implants Receiving Food and Drug Administration Premarket Notification

“…2 Porous implants offer the theoretic advantage of fibrovascular ingrowth to improve stability and decrease complications of migration or extrusion. 3,4 Regardless of implant type, infection and extrusion may occur years after surgery. 2…”

“…2 Porous implants offer the theoretic advantage of fibrovascular ingrowth to improve stability and decrease complications of migration or extrusion. 3,4 Regardless of implant type, infection and extrusion may occur years after surgery. 2 The Medical Device Amendment of 1976 to the Federal Food, Drug, and Cosmetic Act historically marks the beginning of modern device regulation by creating a classification system and 2 main avenues for medical device marketing.…”