Wrapping of Porous Orbital Implant Using Acellular Dermal Allograft

Hee Ok Jeong; Tae Yoon La

doi:10.3341/jkos.2008.49.9.1371

Journal List > J Korean Ophthalmol Soc > v.49(9) > 1008065

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Jeong and La: Wrapping of Porous Orbital Implant Using Acellular Dermal Allograft

Original Article

J Korean Ophthalmol Soc 2008;49(9):1371-1378.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.9.1371

Wrapping of Porous Orbital Implant Using Acellular Dermal Allograft

Hee Ok Jeong, M.D., Tae Yoon La, M.D.

Department of Ophthalmology, St. Vincent's Hospital, College of Medicine The Catholic University of Korea, Gyeonggi-do, Korea

Address reprint requests to Tae Yoon La, M.D. Department of Ophthalmology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea #93-6 Ji-dong, Paldal-gu, Suwon-si, Gyeonggi-do 442-723, Korea Tel: 82-31-249-7340, Fax: 82-31-251-6225, E-mail: laty@catholic.ac.kr

Received 11 June 2008 Accepted 20 February 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the results when using the acellular dermal allograft (SureDerm^Ⓡ, Hans Biomed Co., Korea) as a new wrapping material for porous orbital implants.

Methods

The charts of 11 patients who underwent either primary or secondary insertion of Medpor^Ⓡ orbital implants after enucleation or a new insertion after removal of previous orbital implants were reviewed. Medpor^Ⓡ orbital implants either 18 or 20 mm were wrapped with SureDerm^Ⓡ in 4×4 cm sections that were 1-mm-thick. Four rectus muscles were fixed to the SureDerm^Ⓡ wrapped implant, and a conjunctival suture was made with 6-0 Vicryl. All patients had follow-up periods longer than 10 months and were evaluated to determine the success of wrapping and to identify any complications.

Results

The average age of the patients was 48.3 years. The patients wore artificial eyes for 9 weeks after the operation, and the follow-up periods were 22.4 months on average. There was no case of implant or SureDerm^Ⓡ exposure, inflammation, and other significant complications except in one case that required fornix reconstruction to allow the subject to wear an artificial eye.

Conclusions

Acellular dermal allograft appears to be a good substitute material if preserved sclera is not available when inserting orbital implants with wrapping.

Keywords: Acellular dermal allograft, Wrapping material of porous orbital implant

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Figure 1.

(A) An orbital implant is wrapped around with SureDerm^Ⓡ of 4×4 cm size using 6-0 Vicryl suture. (B) Four rectangular windows are made at the posterior part of wrapped implant. (C) Deep tunnels into the center of the implant are made by 18-gauge needle to facilitate vascularization. (D) Four rectus muscles fixation sites are marked at the anterior surface of SureDerm^Ⓡ-wrapped implant with gentian violet. (E) After making four windows at SureDerm^Ⓡ, deep tunnels into the center of the implant are made in the same manner. (F, G) The wrapped implant is inserted into the orbit by using disposable inserter aid.(H) Isolated four rectus muscles are fixed at windows of SureDerm^Ⓡ-wrapped implant by 6-0 Vicryl suture. (I) Closure of Tenon’s layer and conjunctiva are done by 6-0 Vicryl suture.

Figure 2.

Photograph of successfully sustained SureDerm^Ⓡ-wrapped orbital implants and well-healed conjunctiva at postoperative 14 months (A, B), 22 months (C).

Table 1.

Patients characteristics and clinical results of SureDerm^Ⓡ wrapping of porous orbital implant

No.	Sex	Age	Preoperative Dx	Type of surgery	Size of Iimplant	Prosthesis wearing	State of SureDerm^Ⓡ wrapped implant	Complications	Additional Tx. for complications	Post op F/U
1	F	66	Phthisis bulbi	1’insertion	20 mm	6 wks	Well sustained	None	None	22 mo
2	F	64	Phthisis bulbi	1’insertion	20 mm	4 wks	Well sustained	None	None	25 mo
3∗	F	60	Anophthalmos, enophthalmos	2’insertion	20 mm	6 wks	Well sustained	None	None	30 mo
4	F	49	Anophthalmos,LL sag^§	2’insertion	20 mm	9 wks	Well sustained	IFS^∏	CFW c TT^#	15 mo
5	F	39	Anophthalmos, enophthalmos	2’insertion	20 mm	4 wks	Well sustained	None	None	28 mo
6	M	56	Anophthalmos,DSSD^‡	2’insertion	20 mm	6 wks	Well sustained	None	None	34 mo
7∗	F	44	Implant exposure	Remo+Ne w	20 mm	34 wks	Well sustained	IFS, CWD††	Fornix reconstruction	14 mo
8	M	43	Implant	Remo+New^†	20 mm	10 wks	Well sustained	IFS, CWD	CFW c TT	17 mo
9	M	34	Implant infection	Remo+Ne w^†	20 mm	6 wks	Well sustained	None	None	38 mo
10	F	75	Implant infection	Remo+Ne w^†	20 mm	8 wks	Well sustained	None	None	10 mo
11	M	1	Retinoblastoma	1’insertion	18 mm	6 wks	Well sustained	None	None	13 mo
µ		48.3				9 wks				22.4 mo

^∗ Only 3 rectus muscle except medial rectus were fixed at SureDerm^Ⓡ

^† Remo+New=removal of previous implant and insertion

^# CFW

^§ LL sag=lower lid sagging;

^∏ IFS=inferior fornix shortening; of new implant;

^‡ DSSD=deep superior sulcus deformity; c TT=conformer wearing with temporary tarsorrhaphy;

^†† CWD=conjunctival wound dehiscence

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