title: Improved prosthetic motility with placement of a second coupling PEG.
abstract: OBJECTIVE
  Integrated coupled orbital implants have been shown to improve prosthetic motility over noncoupled orbital implants. Some patients are limited in prosthetic motility despite this coupling for various mechanical and physiological reasons. A common limitation of motility in anophthalmic rehabilitation is forniceal constriction or scarring. Anophthalmic patients with coupled integrated implants who were noted to have limited prosthetic motility because of conjunctival scarring, improperly placed coupling pegs, rotation of the prosthesis, or contracture in the fornices underwent placement of a second coupling peg with the aim of improving prosthetic motility.
  
  
  METHODS
  Six patients were selected who fit the criteria of poor prosthetic motility despite excellent implant motility. All patients had previously placed hydroxyapatite implants followed by motility peg placement several months later. Titanium motility peg placement was only placed after gadolinium-enhanced magnetic resonance imaging neuroimaging studies were performed to assess proper vascularization of the integrated implant. After determining the direction of motility limitation caused by conjunctival dysfunction, a second titanium motility peg was placed in the standard fashion to improve prosthetic motility.
  
  
  RESULTS
  All six patients had improvement of prosthesis motility, as noted by both the patient and surgeon, after second motility coupling peg placement. No complications were encountered.
  
  
  CONCLUSIONS
  In select patients with poor translation of implant motility to prosthesis motility, placement of a second motility coupling peg may improve prosthetic motility.
authors.affiliation: Department of Ophthalmology, Baylor University Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.
authors.forename: Grant D
authors.initials: GD
authors.lastname: Gilliland
authors.forename: Randy
authors.initials: R
authors.lastname: Trawnik
authors.forename: John N
authors.initials: JN
authors.lastname: Harrington
mesh_terms: D001672:Biocompatible Materials; D017886:Durapatite; D015353:Eye Enucleation; D005133:Eye Movements / Q000502:physiology*; D005137:Eye, Artificial; D006801:Humans; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D009915:Orbit / Q000601:surgery*; D020273:Orbital Implants; D019919:Prosthesis Implantation / Q000379:methods*
chemical_list: D001672:Biocompatible Materials; D017886:Durapatite