Problems after evisceration surgery with porous orbital implants: experience with 86 patients.
OBJECTIVE
To assess the problems associated with the use of 4 types of porous orbital implant (Bio-Eye coralline hydroxyapatite, FCI3 synthetic hydroxyapatite, aluminium oxide [Bioceramic], and porous polyethylene [Medpor]) after evisceration surgery.


METHODS
A retrospective analysis was made of all cases of evisceration with placement of one of four types of porous orbital implants performed between 1991 and 2002 by one surgeon (n = 86). Patient age, implant type and size, surgery type (standard evisceration or evisceration with posterior sclerotomies), peg system used, follow-up duration, time of pegging, problems before and after pegging, and treatment were recorded.


RESULTS
Eight patients had less than 6 months of follow-up. The other 78 patients were followed for 6 to 107 months (average, 31 months). The following problems were noted before peg placement: discharge, 8 patients (10.2%); implant exposure, 6 patients (7.7%); implant fracture at the time of surgery, 1 patient (1.3%); persistent pain, 1 patient (1.3%). Of the 29 patients who had pegging, problems including discharge, exposure, pyogenic granuloma, infection, and peg sleeve problems occurred in 23 (79.3%). Sixteen (55.2%) of the 29 patients required at least 1 additional surgical procedure, 4 required 3 additional procedures, and 2 required 5 additional procedures, including implant removal.


CONCLUSIONS
Although primary evisceration with posterior sclerotomies and placement of a porous orbital implant is an accepted technique for treating a variety of end-stage eye diseases, patients should be cautioned about an increased likelihood of problems and potential need for additional surgeries if pegging is considered.
Jordan
David R
DR
University of Ottawa Eye Institute, Ottawa, Ontario, Canada. Drjordan@magma.ca
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005137:Eye, Artificial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D017233:Orbit Evisceration / Q000009:adverse effects*; D020273:Orbital Implants / Q000009:adverse effects*; D016062:Porosity; D011183:Postoperative Complications; D012189:Retrospective Studies