Anterior surface breakdown and implant extrusion following secondary alloplastic orbital implantation surgery

BackgroundSecondary orbital implantation surgery can be complex due to scarring of the orbital tissues and can be complicated by implant exposure and extrusion. PurposeTo evaluate the incidence and risk factors of implant exposure and extrusion following secondary alloplastic orbital implantation surgery in anophthalmic patients. MethodsRetrospective analysis of a consecutive series of patients who underwent secondary placement of an alloplastic orbital implant by one surgeon between 2001 and 2016 in the Rotterdam Eye Hospital. Outcome parameters: implant exposure or extrusion. Other complications. ResultsSixty-three patients underwent secondary orbital placement of scleral-wrapped acrylic (60) or silicone (three) spherical implants. A subset of 25 patients had undergone earlier secondary orbital implant placement (by other surgeons) with exposure/extrusion necessitating additional implant surgery. Two patients were excluded due to lack of follow-up (<3months). Mean age was 49years (range: 1-84.5years). The mean follow-up was 4.1years (range: 0.25-13, 6years). Implant exposure or extrusion occurred in six of 18 (33%) patients in whom no muscle had been reattached during secondary orbital implantation and in five of 43 (12%) patients in whom the extraocular recti muscles had been attached, but the follow-up time was shorter for the latter group. Surgical treatment for implant exposure/extrusion was required in eleven of 61 patients (18%). Other complications included postoperative volume deficiency despite optimal prosthesis (five of 61, 8%), inclusion cysts (four of 61, 7%) and conjunctivitis sicca (two of 61, 3%). Seven of 61 (11%) patients required fornix deepening and seven (11%) blepharoptosis correction. ConclusionSecondary orbital implantation of sclera-wrapped alloplastic implants was complicated by implant extrusion or exposure in 12% of cases in which the extraocular muscles were attached to the implant.