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      Long-term surgical outcomes of porous polyethylene orbital implants: a review of 314 cases

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          Abstract

          Purpose

          This study reports on the long-term surgical outcomes after the insertion of porous Medpor orbital implants into anophthalmic sockets.

          Methods

          A retrospective chart review of 314 eyes from 314 patients who underwent evisceration, enucleation and secondary procedures using Medpor orbital implants was completed focusing on implant-associated complications and their corrective methods as surgical outcomes.

          Results

          The mean follow-up was 50 months (range 6–107 months). The most common complication was blepharoptosis (n=33, 10.5%). Other postoperative complications were exposure (n=14, 4.5%) and implant infection (n=3, 1%). The complications were successfully managed by surgical repair and/or conservative care.

          Conclusion

          Using Medpor resulted in similar surgical outcomes, in terms of the types and frequencies of complications, as other kinds of porous orbital implants.

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          An evaluation of bone growth into porous high density polyethylene.

          David B. Sauer, J Klawitter, J Bagwell … (1976)
          The purpose of this investigation was to study bone growth into porous polyethylene rods as a function of time and pore structure. Previous studies have indicated the biocompatibility of solid polyethylene materials which are currently being used clinically. Porous polyethylene rods were implanted in the femurs of mongrel dogs which are sacrificed four, eight, and 16 weeks postoperatively. The implants were then sectioned and examined histologically and microadiographically. Quantitative techniques were employed to determine the amount of bone ingrowth as a function of time and pore size. The pore structures of the materials were evaluated using optical microscopy and mercury intrusion porosimetry. The results of this investigation have demonstrated that porous polyethylene is capable of accepting bone growth into pores as small as 40 mum. The optimum rate of bone ingrowth was observed in pore sizes of approximately 100 to 135 mum, with no increase in the rate of bone ingrowth observed in samples possessing larger pore sizes. No adverse tissue response was found at implant times up to 16 weeks in pore sizes of 100 mum or larger.
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            Exposure rate of hydroxyapatite orbital implants a 15-year experience of 802 cases.

            Jin Yoon, Helen Lew, Sung Kim … (2008)
            To document the long-term experience with hydroxyapatite (HA) orbital implants (Bio-Eye) and analyze the factors influencing implant exposure, including surgical type, procedural modification, use of different wrapping materials and peg materials. Retrospective observational case series. Eight hundred two eyes from 802 patients who underwent anophthalmic socket surgery (eviscerations, enucleations, secondary implant placements) using HA implants, performed by one surgeon between May 1990 and December 2005. All patients' clinical records were reviewed. Baseline age, cause of anophthalmic surgery, surgical type, size of HA implant, wrapping material, and peg system were recorded. Postoperative complications, especially implant exposure, were recorded separately before and after pegging, and compared according to type of surgery, wrapping material, and peg system. The main cause of anophthalmic surgery was trauma (73%). A variety of wrapping materials have been used, including Tutoplast-dura, Vicryl mesh, autogenous sclera, and polyester-urethane. Implant exposure occurred in 17 patients (2.1%) before pegging and 14 (4.0%) after pegging. The exposure rate was significantly higher in eyes eviscerated without (7.2%) than with (1.1%) keratectomy (P = 0.018), but did not differ according to type of surgery (P = 0.710). When distributed according to 5-year periods, the exposure rate was higher from 1990 to 1994 (4.7%) than in later periods (P = 0.004). In patients who underwent enucleation or secondary implantation, there was no difference in exposure rate between Tutoplast-dura- and Vicryl mesh-wrapped implants (P = 0.235). Among the 353 patients (44.0%) who underwent pegging, those who received titanium-pegged implants had a significantly lower incidence of peg extrusion (5.2%), major discharge (5.2%), and pyogenic granuloma (9.1%) than those with nonsleeved polymethyl methacrylate and sleeved polycarbonate peg materials (P<0.05). Exposures associated with HA orbital implants decreased with the improvement of surgical technique over time and have been managed successfully, both before and after pegging. The incidence of peg-related complications have decreased since the introduction of the titanium peg system.
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              Complications of orbital implants: a review of 542 patients who have undergone orbital implantation and 275 subsequent PEG placements.

              James Oestreicher, N Pang, Ashkan Shoamanesh (2007)
              To inform patients and physicians of the complications associated with three commonly used orbital implants, as well as associated anophthalmic socket issues. A retrospective chart review of 542 patients who underwent eviscerations, enucleations and secondary procedures by one surgeon (Dr. James Oestreicher) was completed, paying special attention to complications in the follow-up period prior to pegging, as well as those that occurred post-pegging. Approximately 60% of patients experienced complications prior to implant drilling, with discharge being the most prevalent (15.9%). Secondary procedures were associated with significantly greater complication rates prior to implant drilling. Silicone implants had significantly less pre-pegging pyogenic granuloma (P = 0.011) and hypo-ophthalmos (P = 0.042) than the other implant types. Seven implants had to be removed due to exposure. Implant drilling and peg placement were performed in 275 patients. Implant drilling complications were experienced by 67.4% of pegged patients, with a change in discharge from prior to pegging (27.2%) being the most prevalent. Plastic peg systems had a significantly higher incidence of complications than titanium systems. The majority of orbital implantations involve complications, these being largely minor ones which resolve spontaneously or are easily treated. Secondary implant procedures involve a higher likelihood of complications. Silicone implants have the smallest amount of complications. Should patients decide to undergo pegging, evidence sides strongly for the use of a titanium peg and sleeve system over the other peg types. Implant removal is a rare event; occurring in 1.3% (n = 7) of the study population.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Br J Ophthalmol
                Journal ID (iso-abbrev): Br J Ophthalmol
                Journal ID (publisher-id): bjo
                Journal ID (hwp): bjophthalmol
                Title: The British Journal of Ophthalmology
                Publisher: BMJ Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Print): 0007-1161
                ISSN (Electronic): 1468-2079
                Publication date (Electronic): 17 November 2011
                Publication date (Print): April 2012
                Publication date PMC-release: 17 November 2011
                Volume: 96
                Issue: 4
                Pages: 494-498
                Affiliations
                Department of Ophthalmology and Visual Science, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
                Author notes
                Correspondence to Dr Suk-Woo Yang, Department of Ophthalmology and Visual Science, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea; yswoph@ 123456catholic.ac.kr
                Article
                Publisher ID: bjophthalmol-2011-300132
                DOI: 10.1136/bjophthalmol-2011-300132
                PMC ID: 3308469
                PubMed ID: 22096144
                SO-VID: e9682174-a46b-472e-ba94-0a89d514d562
                Copyright © © 2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

                History
                Date accepted : 14 September 2011
                Categories
                Subject: Clinical Science
                Subject: 1506
                Series title: Original article

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: anophthalmia,inflammation,lacrimal drainage,lacrimal gland,porous polyethylene (medpor) orbital implant,eye lids,implant complications,orbit
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: anophthalmia, inflammation, lacrimal drainage, lacrimal gland, porous polyethylene (medpor) orbital implant, eye lids, implant complications, orbit

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