The scleral filet technique for secondary orbital implantation surgery

Objective: To describe a simple procedure, the scleral filet technique, to place a secondary implant and take advantage of the scleral remnant. Setting: Oculoplastic service at a university-affiliate hospital in Ottawa. Patients: Three patients from Middle Eastern countries who had undergone evisceration following trauma without placement of an orbital implant. All three had a scleral remnant, enophthalmos and poor prosthetic motility, Interventions: The scleral remnant was incised (fileted) in a crisscross fashion, allowing access to the retrobulbar space. A hydroxyapatite implant was placed, and the scleral remnants were closed without disrupting the muscle attachments, leaving the socket motility intact. Results: All three patients had an uneventful postoperative course and were fitted with a prosthesis between 6 to 8 weeks. There was no implant exposure during the follow-up period of 8 to 15 months. Implant drilling and peg placement was carried out 6 to IO months postoperatively. One of the patients had excellent motility, and two had good or fair motility. All were very satisfied with the results. Conclusions: Advantages of the scleral filet technique include simplicity, ability to use the patient's own vascularized scleral remnant to act as a protective cap over the implant and avoidance of donor material. We advocate the use of this procedure when a scleral remnant is present in a patient presenting for consideration of secondary implantation.