Two-stage procedure for management of large exposure defects of hydroxyapatite orbital implant.
OBJECTIVE
To report the results of a newly devised two-stage surgical technique for management of large hydroxyapatite exposure defects.


METHODS
Eight patients with exposed hydroxyapatite orbital implant were treated in two stages. The exposed hydroxyapatite anterior surface was burred down and the defect was directly closed 3 to 13 months after the primary procedure. Then a mucous membrane or dermis-fat graft was added for socket reconstruction.


RESULTS
Trauma was the primary cause of enucleation in all patients. Hydroxyapatite exposures occurred 1 to 2 weeks after implantation. Mean defect size was 15 mm in the greatest dimension (range 10-21 mm). Socket reconstruction was done in seven patients with mucous membrane graft and in one patient with dermis fat graft 3 to 13 months after direct repair of the defects. All eight patients maintained closure of the defects during a mean follow-up of 13 months (range 9-19 months).


CONCLUSIONS
Management of hydroxyapatite exposures, especially those with large defects, can be difficult. Based on our experience, optimal results can be obtained after direct closure of the defect under minimal tension at the expense of foreshortening the fornices after which the socket can be reconstructed with a mucous membrane or dermis fat graft as a secondary procedure.
Salour
H
H
Department of Ophthalmology, Oculoplastic Service, Labbafinejad Medical Center, Teheran, Iran. hosalour@hotmail.com
Owji
N
N
Farahi
A
A
D000273:Adipose Tissue / Q000637:transplantation; D000328:Adult; D001672:Biocompatible Materials; D002648:Child; D017886:Durapatite / Q000009:adverse effects*; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000637:transplantation; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D009916:Orbital Diseases / Q000209:etiology / Q000601:surgery*; D020273:Orbital Implants / Q000009:adverse effects*
D001672:Biocompatible Materials; D017886:Durapatite