Clinical Outcomes Following Simultaneous Orbital Implant Insertion Operation and Dermo-Fat Graft for Anophthalmos Patients

Jae Yeong Park; Hee Young Choi

doi:10.3341/jkos.2015.56.2.155

Journal List > J Korean Ophthalmol Soc > v.56(2) > 1010108

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Park and Choi: Clinical Outcomes Following Simultaneous Orbital Implant Insertion Operation and Dermo-Fat Graft for Anophthalmos Patients

Original Article

J Korean Ophthalmol Soc 2015;56(2):155-161.

Published online: 6 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.2.155

Clinical Outcomes Following Simultaneous Orbital Implant Insertion Operation and Dermo-Fat Graft for Anophthalmos Patients

Jae Yeong Park, MD¹, Hee Young Choi, MD, PhD^1,^2,

¹Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea

²Biomedical Research Institute, Pusan National University Hospital, Busan, Korea

Address reprint requests to Hee Young Choi, MD, PhD, Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 602-739, Korea, Tel: 82-51-240-7324, Fax: 82-51-242-7341 E-mail: hychoi@pusan.ac.kr

Received 13 June 20144 August 2014 Accepted 7 January 2015

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 clinical results of patients who have undergone simultaneous dermofat graft and insertion of orbital implants in patients who are unable to put on an ocular prosthesis due to severe conjunctival sac contracture or large orbital implant exposure.

Methods

A retrospective analysis was performed of patients who underwent dermofat graft simultaneously with orbital implant insertion for replacement of the conjunctival sac from 2007 to 2012. Eight eyes were enrolled in this study and all patients were followed up for phthisis bulbi or implant exposure.

Results

Among the eight eyes, five eyes (62.5%) that were diagnosed with orbital implant exposure underwent orbital implant exchange and dermofat graft, and two eyes (25%) were anophthalmic enophthalmic patients and underwent secondary orbital implant insertion and dermofat graft. One patient (12.5%) underwent orbital implant insertion and dermofat graft simultaneously during the evisceration operation. We followed the progress for 46.3 months.

For seven out of eight eyes, the results of the wound healing process were successful. One patient underwent removal and reinsertion of the orbital implant with dermofat graft, and the wound in this case healed well. However, after five months, dermofat regraft was performed for orbital implant reexposure and it was not exposed thereafter. Overall cosmetic appearance was satisfactory in each patient, and all patients were able to comfortably retain a prosthesis.

Conclusions

We found that undergoing dermofat graft simultaneously when performing orbital implant insertion is effective for replacement of the conjunctival sac and orbital volume.

Keywords: Dermo-fat graft, Replacement of conjunctival sac, Replacement of orbital volume

References

1. Yoon KC, Ji YS, Park YG. Management of exposed hydroxyapatite implant with acellular dermal allograft. J Korean Ophthalmol Soc. 2005; 46:927–32.

2. Park MS, Kim KS, Baek SH, Lee TS. Management of exposed porous orbital implant with autogenous dermis graft. J Korean Ophthalmol Soc. 2001; 42:1127–32.

3. Sohn KS, Kim JW, Lee TS. Clinical observation on reconstruction of the anophthalmic contracted socket in 28 eyes. J Korean Ophthalmol Soc. 1986; 27:471–4.

4. Gougelmann HP. The evolution of the ocular motility implant. International Ophthalmology Clinics. 1970; 10:689–711.

5. Soll DB. The anophthalmic socket. Ophthalmology. 1982; 89:407–23.

6. Perry AC. Integrated orbital implants. Adv Ophthalmic Plast Reconstr Surg. 1990; 8:75–81.

7. Kostick DA, Linberg JV. Evisceration with hydroxyapatite implant. Surgical technique and review of 31 case reports. Ophthalmology. 1995; 102:1542–8. discussion 1548-9.

8. You YS, Kim HY, Lee SY. Incidence and clinical course of implant exposure after hydroxyapatite implantation in anophthalmic socket. J Korean Ophthalmol Soc. 1997; 38:1694–9.

9. Dutton JJ. Coralline hydroxyapatite as an ocular implant. Oph- thalmology. 1991; 98:370–7.

10. Li T, Shen J, Duffy MT. Exposure rates of wrapped and unwrapped orbital implants following enucleation. Ophthal Plast Reconstr Surg. 2001; 17:431–5.

11. McNab A. Hydroxyapatite orbital implants. Experience with 100 cases. Aust N Z J Ophthalmol. 1995; 23:117–23.

12. Oestreicher JH, Liu E, Berkowitz M. Complications of hydrox-yapatite orbital implants. A review of 100 consecutive cases and a comparison of Dexon mesh (polyglycolic acid) with scleral wrapping. Ophthalmology. 1997; 104:324–9.

13. Custer PL, Trinkaus KM. Porous implant exposure: Incidence, management, and morbidity. Ophthal Plast Reconstr Surg. 2007; 23:1–7.

14. Nunery WR, Heinz GW, Bonnin JM. . Exposure rate of hydroxyapatite spheres in the anophthalmic socket: histopathologic correlation and comparison with silicone sphere implants. Ophthal Plast Reconstr Surg. 1993; 9:96–104.

15. Remulla HD, Rubin PA, Shore JW. . Complications of porous spherical orbital implants. Ophthalmology. 1995; 102:586–93.

16. Yoon JS, Lew H, Kim SJ, Lee SY. Exposure rate of hydroxyapatite orbital implants a 15-year experience of 802 cases. Ophthalmology. 2008; 115:566–72.e2.

17. Baek SH. Clinical effect of porous polyethylene (Medpor(r)) orbital implant. J Korean Ophthalmol Soc. 2000; 41:1858–63.

18. Karcioglu ZA, al-Mesfer SA, Mullaney PB. Porous polyethylene orbital implant in patients with retinoblastoma. Ophthalmology. 1998; 105:1311–6.

19. Rosen HM, McFarland MM. The biologic behavior of hydrox-yapatite implanted into the maxillofacial skeleton. Plast Reconstr Surg. 1990; 85:718–23.

20. Goldberg RA, Holds JB, Ebrahimpour J. Exposed hydroxyapatite orbital implants. Report of six cases. Ophthalmology. 1992; 99:831–6.

21. Kim YD, Goldberg RA, Shorr N, Steinsapir KD. Management of exposed hydroxyapatite orbital implants. Ophthalmology. 1994; 101:1709–15.

22. Lee MJ, Khwarg SI, Choung HK. . Dermis-fat graft for treatment of exposed porous polyethylene implants in pediatric post-enucleation retinoblastoma patients. Am J Ophthalmol. 2011; 152:244–50.e2.

23. Lee BJ, Lewis CD, Perry JD. Exposed porous orbital implants treated with simultaneous secondary implant and dermis fat graft. Ophthal Plast Reconstr Surg. 2010; 26:273–6.

24. Smith B, Petrelli R. Dermis-fat graft as a movable implant within the muscle cone. Am J Ophthalmol. 1978; 85:62–6.

Figure 1.

(A) Preoperative photograph of an exposed orbital implant at a 31-year-old female. (B) Post-operative (6 weeks after dermis fat graft) photograph. (C) Post-operative (1 year after dermis fat graft) photograph. (D) At post-oper-ative 4 years after dermis fat graft, no evidence of reexposure is observed and wound was clear and well conjunctivalization (case 3).

Table 1.

Demographics and baseline characteristics of patients

Case	Age/ Sex	Etiology	Surgery	Implant	Implant size (mm)	Exposure size	Donor site	F/U period (months)	State of grafted dermo-fat	Donor site complications
Case	Age/ Sex	Etiology	Surgery	Implant	Implant size (mm)	Exposure size	Donor site	F/U period (months)	State of grafted dermo-fat	Donor site complications	1	M/72	Implant	Implant	HA	18	Large^∗	Abdomen	25	Well-grafted,	None
		exposure	exchange						no exposure
2	F/66	Anophthalmos,	Secondary	HA	18	-	Abdomen	32	Well-grafted,	None
		enophthalmos	implant						no exposure
			insertion
3	F/31	Implant	Implant	Silicone	20	Large	Abdomen	51	Well-grafted,	None
		exposure	exchange	ball					no exposure
4	F/73	Implant	Implant	HA	18	Large	Abdomen	55	Well-grafted,	None
		exposure	exchange						no exposure
5	F/51	Anophthalmos,	Secondary	HA	20	-	Abdomen	38	Well-grafted,	None
		enophthalmos	implant						no exposure
			insertion
6	M/61	Anophthalmos,	Evisceration	HA	20	-	Abdomen	57	Well-grafted,	None
		enophthalmos							no exposure
7	M/56	Implant	Implant	HA	18	Large	Abdomen	36	Well-grafted,	None
		exposure	exchange						no exposure
8	M/72	Implant	Implant	Medpore	16	Large	Abdomen	75	Exposed of graft	None
		exposure	exchange						site

F/U = follow up; HA = hydroxyapatite.

^∗ Exposure size > 10 mm².

TOOLS

Similar articles