Search

Purpose: To evaluate complications and risk factors associated with the placement of wrapped and unwrapped porous polyethylene (PP) spherical implants after evisceration, enucleation, or secondary implantation., Methods: A retrospective, interventional, noncomparative case series of consecutive cases of PP implant placement after anophthalmic socket surgery performed by three surgeons over a 5-year period. A PP spherical implant was placed in 133 patients, 61 women (2 bilaterally) and 72 men (1 bilaterally). There were 91 enucleations, 30 eviscerations, and 15 secondary implant placements. Sixty-six (48.5%) implants were wrapped prior to placement. Parameters evaluated included: age, sex, prior ocular surgery or radiation treatment, indications for surgery, procedure performed, size of PP sphere, material used to wrap the implant, and complications., Results: A total of 17 of 136 (12.5%) cases had documented postoperative complications, with implant exposure being the most common. In 5 patients (3.7%), implant exposure developed: 1 after evisceration and 4 after primary enucleation. Three of the five exposures were small and resolved with either observation alone or in one case with surgical revision of the socket. In two cases, the exposures were large enough that removal of the implant was indicated, one after evisceration and the other after enucleation with placement of a wrapped PP sphere., Conclusions: Our series revealed no significant difference in exposure rate between wrapped and unwrapped PP sphere implants, nor was the exposure rate affected by whether an eye was eviscerated or enucleated.

The transconjunctival inferior fornix incision provides access to the floor, rim, lateral, and inferior medial walls of the orbit. Complications of this surgical approach to the orbit are known to be rare but heretofore have not been clearly defined. Over an 8-year period, in an estimated 1200 cases, the authors have encountered cicatricial entropion, lower eyelid retraction, canthal dehiscence, lower eyelid avulsion, canalicular laceration, buttonhole laceration of the lower eyelid, conjunctival chemosis, and lacrimal sac laceration. Attention to anatomic landmarks and sound surgical execution will prevent these complications in most patients.

Lower eyelid and lateral canthal angle malposition or frank ectropion are the most common complications of lower eyelid blepharoplasty. Although these complications may result from excessive skin excision, from surgical imbrication of the orbital septum or lower eyelid retractors, or from scar formation within the eyelid, failure to correct preexisting lower eyelid laxity is the most common cause. Recently published data have established laxity at the lateral canthus as the primary cause of involutional lower eyelid laxity. We review the pathophysiology of lower eyelid laxity and present an anatomic approach for the correction of lower eyelid laxity during blepharoplasty.

A 38-year-old man presented with hyperophthalmia, enophthalmos, and upper eyelid retraction 18 months following an osteoplastic flap and frontal sinus obliteration for mucocele. Computerized tomography confirmed the presence of frontal bone absorption in the roof of the orbit with traction and elevation of the orbital contents into the obliterated frontal sinus. A fracture of the orbital roof with penetration of periorbita at the time of original surgery was the suspected precipitating cause of the complication. Surgical management included lysis of the cicatrix between the orbit and frontal sinus and interposition of a silicone sheet between the orbit and sinus, which restored the appropriate anatomic relationships and prevented recurrence.

We used delayed primary wound closure in three cases of bacterial endophthalmitis to minimize the risk of implant extrusion following evisceration. In a fourth case, the wound was closed primarily, but wound dehiscence and implant extrusion occurred six weeks postoperatively, and reoperation was required. The advantages of delayed primary wound closure following evisceration of the globe for endophthalmitis include rapid removal of the intraocular abscess, continued drainage and mechanical débridement of the infected scleral pouch, and the development of granulation tissue resistant to bacterial growth at the wound margins prior to wound closure. These factors are important in reducing the risk of implant extrusion following evisceration of the globe for endophthalmitis.