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Results for “Orbital Implants”

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At least 19 recordsLinked to original sources
PubMed1996

Late migration of an orbital implant causing orbital hemorrhage with sudden proptosis and diplopia.

A 31-year-old woman complained of sudden diplopia and proptosis associated with a headache. Approximately 10 years earlier, she had sustained a right orbital blowout fracture during a snow machine accident that was repaired using a Supramid implant. She presented with 4 mm of right-sided proptosis by Hertel exophthalmometry, with limitation of up and down gaze. She manifested a right gaze preference with a left head turn to achieve fusion. Visual acuity was 20/20 on both sides; however, there was 20% red desaturation and a subtle afferent pupillary defect on the right side. Goldmann visual fields were full and the retinal examination was normal. A computed tomography (CT) scan of the orbits with and without contrast demonstrated a large right posterior inferior orbital mass. Once the periorbita was breached during orbitotomy, a burgundy serosanguinous material emerged. Gram staining revealed red cells without organisms. The implant had not been fixed by wires or screws. Upon removal, the implant appeared oversized, encompassing the orbital floor, medial and lateral walls. Postoperatively, the proptosis, gaze preference with face turn, afferent pupillary defect, desaturation abnormality, and diplopia resolved.

Adult↗
PubMed1995

Vicryl-mesh wrap for the implantation of hydroxyapatite orbital implants: an animal model.

OBJECTIVE: To evaluate host fibrovascularization of hydroxyapatite orbital implants wrapped in sclera or in Vicryl (polyglactin 910) mesh in a rabbit model. NUMBERS: Eight adult New Zealand white rabbits that received hydroxyapatite orbital implants wrapped in homologous donor sclera (four animals) or Vicryl mesh (four animals). INTERVENTIONS: The rabbits had one eye enucleated and then received a 12-mm hydroxyapatite implant wrapped in sclera or Vicryl mesh. Magnetic resonance imaging (MRI) and bone scintigraphy were done to assess host fibrovascularization of the implant 4, 8, 12 and 20 weeks after implantation. Two animals (one in each group) were killed at each of these times, and the implant was removed for histopathological examination. MAIN OUTCOME MEASURES: Enhancement on MRI, uptake on bone scintigraphy, fibrovascularization seen on histopathological examination. RESULTS: The degree of fibrovascularization was substantial in all the specimens but appeared greater in the Vicryl-mesh-wrapped implants in the first 12 weeks after implantation on both histopathological and MRI studies. At 20 weeks these findings were similar in the two groups. A granulomatous foreign-body giant-cell reaction to both the Vicryl mesh and the implant itself was present up to 8 weeks after implantation. Bone scans showed only grade 1+ activity in all the implants. CONCLUSIONS: Host fibrovascularization in the rabbit appears to occur to a greater degree in Vicryl-mesh-wrapped hydroxyapatite implants than in those wrapped in donor sclera during the first 12 weeks after implantation. Vicryl mesh appears to be an acceptable alternative wrap for the hydroxyapatite implant, eliminating the need for donor sclera and its potential risks of transmissible diseases.

Animals↗
PubMed2003

[Functional and cosmetic relevance of primary orbital implants].

BACKGROUND: Orbital implants are used to prevent post-enucleation-syndromes and to improve prosthesis motility. PATIENTS AND METHOD: 20 patients without and 32 patients with orbital implants were examined 6 to 14 years after enucleation. Maximum prosthesis motility in 4 directions, width of the palpebral fissure and vertical difference of the eye axis were measured using Kestenbaum glasses. The apex of the prosthesis was measured with a Hertel exophthalmometer. The post-enucleation-syndrome was assessed by a 4 point scale by the investigators. RESULTS: Post-enucleation-syndromes are significantly (p < 0.01) less pronounced in patients with orbital implants, also prosthesis motility is significantly (p < 0.05) larger. The width of the palpebral fissure and the vertical difference of the eye axis is not significantly (p > 0.05) altered. CONCLUSION: Primary orbital implants allow for prevention of a post-enucleation-syndrome and a better functional and cosmetic outcome.

Adult↗
PubMed1998

[Biocompatibility of a porous alumina orbital implant. Preliminary results of an animal experiment].

PURPOSE: Evaluation of clinical tolerance and scanning electron microscopy study of the bio-colonisation of a porous ceramical alumina implant after evisceration of the rabbit. Preliminary results. METHODS: Sixteen white New Zealand rabbits were eviscerated. A porous hydroxyde alumina ball was implanted in the opened sclera and explanted 15, 30, and 90 days after implantation. Clinical tolerance was assessed and implant tissular ingrowth was analyzed by scanning electron microscopy. RESULTS: One infection was observed and there was no conjunctival breakdown. Fibrovascular ingrowth occurred as soon as 15 days after implantation, and was full at one month. CONCLUSION: Porous alumina implant orbital tissue tolerance and fast fibrovascular ingrowth in the rabbit socket suggest promising result in the human anophthalmic socket.

Aluminum Oxide↗
PubMedDate not supplied

Implant infection in porous orbital implants.

PURPOSE: To analyze implant infection in patients with porous orbital implants. METHODS: A retrospective analysis of 212 patients with one of five types of porous orbital implants (bone-derived hydroxyapatite [HA], coralline HA, synthetic HA, porous polyethylene, and aluminium oxide) was conducted. Reasons for surgery, type of surgery, type of implant, peg system used, time of pegging, problems before and after pegging, treatment, and follow-up duration were recorded for all patients, along with additional data including time of onset of infection, microorganism cultured, antibiotics used, patient response to antibiotic therapy, additional interventions, and final status for patients with infection. RESULTS: Of the 212 patients with porous orbital implants, 116 (54.72%) were pegged. Implant infection was observed in 11 of 116 patients (9.48%) with pegs, whereas 0% of unpegged implants was infected (p = 0.001). The interval between pegging and the onset of infection was 3 to 83 months (average, 36.27 +/- 29.12 months). Implant exposure was noted in 5 of the 11 patients with infection. Symptoms resolved completely with antibiotic treatment in 7 patients. One patient required implant removal as the result of frequent exacerbations. The remaining 3 patients presented with hemorrhagic, purulent discharge and/or pyogenic granuloma on their last visits after being free of symptoms for 5 to 6 months. CONCLUSIONS: Implant infection is a serious problem that requires additional patient visits, intensive antibiotic therapy, surgery, or some combination of these. Existence of a peg system appears to play a role in implant infection. Infection may develop as late as 6 to 7 years after pegging, and the patient should be cautioned about potential late-onset problems. It is possible to control the infection with appropriate antibiotic therapy; removal should be reserved for refractory cases.

Adolescent↗
PubMed1997

Osteogenin-enhanced bone-specific differentiation in hydroxyapatite orbital implants.

Hydroxyapatite orbital implants undergo early ingrowth of fibrovascular tissue after enucleation. This animal study determined whether control and osteogenin-impregnated hydroxyapatite orbital implants vary in their osteogenic response at 6 and 52 weeks. Rabbits underwent enucleation with implantation of control or osteogenin-impregnated hydroxyapatite spheres. Light microscopy determined fibrovascular ingrowth, and histomorphometry quantitated the amount of bone produced. Osteogenin implants vascularized at a faster rate and contained bony foci by 6 weeks that became confluent at 1 year. Spontaneous osteogenesis was not seen in control animals at 6 weeks. After 1 year they contained bone, although less than in the osteogenin implants. Mixed cell inflammation was observed at the hydroxyapatite-tissue interface in both groups. No inflammation was noted at the interface of hydroxyapatite and bone. These are the first controlled observations that bone-specific differentiation occurs in the pores of spherical hydroxyapatite implants within the soft tissues of the socket. This vascularized process can be enhanced with osteogenin to occur earlier and more uniformly in the implants at one year.

Animals↗
PubMedDate not supplied

Retroscleral implantation technique for porous polyethylene orbital implant after evisceration.

The authors developed a technique for the retroscleral implantation of a porous polyethylene orbital implant after evisceration for the placement of an adequately large orbital implant without wound tension. The surgical results of the technique in 27 patients are reported. The technique involves the severance of the optic nerve after standard evisceration and the insertion of the orbital implant into the retroscleral and intraconal space through the side of the scleral shell. All patients received a 20-mm orbital implant. No complications such as infection, implant exposure, or worsened implant motility were observed during the average follow-up period of 22.4 months. Retroscleral implantation of the orbital implant after evisceration may be an appropriate procedure that allows placement of a large orbital implant without exposure or decreased implant motility.

Adolescent↗
PubMed1990

[Long-term results after implantation of silicone orbital implants].

In 1980-1988 at the Second Ophthalmological Clinic 78 enucleations of the bulbs with a orbital silicon implant were performed. The tolerance of the implant and the cosmetic result of the operation was evaluated in 53 adults and 5 children. The observation period varied between 6 months and 7 years. From the total number of 53 adults a very good cosmetic effect was achieved in 9 (17.1%), a good effect in 25 (47.1%), a satisfactory effect in 12 (22.6%) a poor effect in 2 (1.8%) patients. The implant was rejected in 5 (9.4%) of the cases, 4 implants within one month and one two years after enucleation. A very good cosmetic effect was observed in one (20%) child and a good effect also in one (20%). The implant was rejected in 3 (60%) children, 1, 4 and 20 months after operation. Rejection after 20 months was preceded by an inflammatory reaction in the area of the implant. Rejection of orbital silicon implants in adults was as a rule due to surgical complications or incorrect surgical technique. In the rejection of implants in young children the increased biological reaction of the child organism may be involved.

Adolescent↗
PubMed2002

The wayward implant: orbital silicone plate extrusion associated with squamous epithelial downgrowth and infection.

We report an unusual case of orbital implant migration in which the silicone plates were found to be enveloped in a pseudocapsule surprisingly infected and lined by squamous epithelium of probable conjunctival origin. An epithelial 'plug' found in the inferior fornix portion of the pseudocapsule might have been responsible for bacterial entry into the cavity. We discuss the literature regarding pseudocapsule formation around silicone implants and the phenomenon of capsular contracture. Both the infection and the epithelial downgrowth may have facilitated the implant migration.

Adult↗
PubMedDate not supplied

Infected aluminum oxide orbital implant.

Porous orbital implant infection is rare. The diagnosis may be delayed as the initial symptoms and signs are not always indicative of implant infection. It is often only with time, a persistence of symptoms and signs, and additional symptoms and signs that implant infection is suspected.

Aluminum Oxide↗
PubMed2001

Proliferation of human fibroblasts in vitro after exposure to orbital implants.

BACKGROUND: Porous orbital implants allow fibrovascular ingrowth and integration with the extraocular muscles. The available implants have different structural characteristics, which may influence orbital response. We studied the proliferation of orbital fibroblasts in vitro after exposure to four different orbital implants. METHODS: Four orbital implant biomaterials were studied: hydroxyapatite (Bio-Eye), synthetic hydroxyapatite, porous polyethylene (Medpor) (pore sizes 150 microm and 400 microm) and aluminium oxide (Bioceramic implant). Human fibroblasts obtained from orbital fat at the time of elective blepharoplasty were cultured and then exposed to the individual implants. Cell growth was assessed with immunocytochemical analysis using bromodeoxyuridine, a thymidine analogue. After DNA denaturation, the cells were washed, incubated with secondary antibody and visualized. RESULTS: The fibroblasts growing on the Bio-Eye, synthetic hydroxyapatite, and 150-microm and 400-microm Medpor implants all had debris associated with them. The Bioceramic implant was free of this debris. The Bioceramic implant and the 150-microm Medpor implant had the greatest number of fibroblasts on the coverslips. INTERPRETATION: The proliferation of fibroblasts, as determined by visualization of actively dividing cells with bromodeoxyuridine, differed on the various implants studied. The lack of debris associated with the Bioceramic implant may be related to the crystalline structure of the implant.

Aluminum Oxide↗
PubMed1995

The use of Vicryl mesh (polyglactin 910) for implantation of hydroxyapatite orbital implants.

Hydroxyapatite (HA) implants currently are most commonly wrapped in donor sclera before implantation to facilitate placement within the orbit and allow attachment of the extraocular muscles. Although the risk of acquiring a transmittable disease through donor sclera is extremely low, some individuals remain concerned about receiving nonautologous material. As an alternative to sclera, autologous temporalis fascia, or autologous fascia lata, we have been wrapping HA in "Vicryl mesh" before insertion into the orbit. The Vicryl mesh-wrapped implant goes into the socket readily, allows one to easily attach the extraocular muscles, and has no risk of transmittable disease. In addition, the Vicryl mesh is readily available at most hospitals and is dissolvable.

Durapatite↗
PubMed1999

[Long-term results of secondary orbital implants].

BACKGROUND: Secondary orbital implants are used for the correction of the post-enucleation socket syndrome (PESS). This study evaluates retrospectively the post-operative course, complications, additional surgery, long-term cosmetic and functional results, and patient's satisfaction after secondary orbital implants. PATIENTS: Nineteen out of 24 patients who underwent secondary baseball implant insertion between 1986 and 1989 for the correction of PESS were re-examined. RESULTS: Five patients had complications, 11 patients (58%) further surgery. After a mean follow-up of 8.6 years, 17 patients (89%) showed findings better than preoperatively. Two patients were unchanged. The static overall impression, assessing particularly volume deficit and symmetry, using a scale of 1 to 5, was improved from 4.5 preoperatively to 2.5. CONCLUSIONS: Secondary orbital implants improve symptoms of PESS and patient's satisfaction in a high proportion of cases also in the long term. Complications are not rare, and frequently more than one operation is necessary. There is no significant risk of long-term side effects and no reduction of the positive effect with time.

Adult↗
PubMedDate not supplied

A clinical study of the hydroxyapatite orbital implant.

The hydroxyapatite orbital implant has been used in the anophthalmic patient to give good motility of the artificial eye and a cosmetic result which matches that of the natural eye. It is thought to reduce the unacceptable complication rate that has been associated with other implants, as its buried, vascularized state deters extrusion and migration of the implant. Eighty consecutive patients were followed, 33 of whom had been referred for primary enucleation or evisceration, and 47 for secondary implant surgery. Thirteen of the secondary patients already had implants in situ. There were 44 males and 36 females in the study. The age range was 2.5 to 72 years with a mean of 36 years. The follow-up time was 2 to 30 months with a mean of 15 months. Twenty patients had been pegged at the time of review. A standardised operative and post-operative protocol was followed. The patients were assessed for the results of the motility of the artificial eye for both smooth pursuit and saccades, and for the cosmetic result. The amount of upper lid sulcus deformity was assessed to give an indication of volume replacement by the implant. The nature of any complications was noted as well as any further surgical procedures undertaken. The results show the hydroxyapatite orbital implant to give good cosmetic results with good motility of the artificial eye and to be associated with a low rate of complications. Drilling of the implant is simple to perform and also not associated with any significant complications. The hydroxyapatite orbital implant can be used successfully not only as a primary but also as a secondary or exchange implant with very few contraindications.

Adolescent↗
PubMed2000

Evaluation of efficacy and complications: primary pediatric orbital implants after enucleation.

BACKGROUND: Orbital implants are used routinely in pediatric patients at the time of enucleation. Complications, such as exposure, ptosis, and infection, may occur after implantation. Controversy continues regarding the rate of complications with newer implants in the pediatric population. OBJECTIVE: To examine the effects of orbital implants on children whose eyes have been enucleated. METHODS: Records of orbital implantation after enucleation performed by 5 surgeons on 120 pediatric patients (123 eyes) over a 10.5-year period were reviewed retrospectively. Demographic data, ocular diagnosis, prior ophthalmic surgery, implant characteristics, and postoperative complications were described using a standardized format for all patients, with a minimum of 6 months of follow-up (mean, 3 years). RESULTS: Complications were observed in 7 eyes (5.7%). Implant exposure (1 [0.8%]), implant extrusion (0 [0%), and implant migration (3 [2.4%) were rare. One hundred eighteen eyes (96%) had good cosmesis and 120 (98%) had good motility. CONCLUSIONS: Orbital implantation after enucleation is successful in the pediatric population. Complications are minimal. Hydroxyapatite implants were not associated with unacceptable complications in this pediatric population.

Adolescent↗
PubMed1986

Long-term stability of Teflon orbital implants.

Teflon orbital floor implants have become controversial owing to reports of implant-related complications. To determine the actual incidence of Teflon implant-related complications and factors associated with complications, we conducted a long-term follow-up study of 77 selected patients. We obtained data on 35 implants in 31 patients with a mean follow-up period of 16 years, representing an experience of 528 patient-implant years. The short-term complication rate (within 1 month of surgery) was 3.9 percent. The long-term complication rate was 2.8 percent. Concomitant antral packing and implantation of Teflon sheet were associated with a markedly higher risk of implant pocket infection. There was no case of implant migration with proper fixation. Facial growth was normal in three children in the series. We conclude that Teflon sheet is well-tolerated in the orbit in the long term. The low complication rate can be further reduced with proper fixation of the implant and avoidance of antral packing at the time of implantation.

Adult↗
PubMed1994

Comparison of fibrovascular ingrowth into hydroxyapatite and porous polyethylene orbital implants.

Two porous orbital implants available for clinical use in the anophthalmic socket are hydroxyapatite (HA) and porous polyethylene (PP). We examined the rate and the extent of fibrovascular ingrowth into these implants using histopathologic criteria in a rabbit model. Thirty-two New Zealand white rabbits underwent a unilateral enucleation with placement of a 14-mm spherical orbital implant. Twelve rabbits received HA, 12 small-pore PP, and 8 large-pore PP. The implants inserted were wrapped either in autologous sclera with and without anterior fenestrations or as unwrapped spheres. The implants were harvested at 6 and 12 weeks. The extent of fibrovascular ingrowth was assessed by determining the percentage of the cross-sectional area penetrated by fibrovascular tissue. On gross inspection, 12 implants (37.5%) were found to be exposed at harvesting; however, only two were grossly infected. The highest rate of exposure was found among the unwrapped implants. Wrapped versus unwrapped and fenestrated versus unfenestrated implants did not result in significant differences in the extent of vascularization. Hydroxyapatite implants were vascularized most rapidly. The small-pore PP implants did not become fully vascularized during the study, and yet complete vascularization was found in the large-pore PP at 12 weeks. The most intense areas of microscopic fibrovascular ingrowth were in the region where the extraocular muscles were in direct contact with the implant and at the posterior opening. Exposure of the implant was accompanied by chronic and acute inflammation. Both HA and large-pore PP spherical implants are capable of complete vascularization in this animal model.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗