title: Pyogenic granuloma as a presenting sign of hydroxyapatite orbital implant exposure: a clinicopathologic study.
abstract: OBJECTIVE
  We report 5 unusual cases of exposed hydroxyapatite orbital implants that presented as pyogenic granulomas. We propose pathogenesis and histopathologic correlations.
  
  
  METHODS
  A clinicopathologic study of 5 patients with hydroxyapatite implants who presented with pyogenic granuloma.
  
  
  RESULTS
  Pyogenic granulomas were detected 1.5 to 30 months after implantation in 5 patients. The lesions were multiple but were not related to the wound margin at the exposed area and were not covered by the surface epithelium in most instances. Exposure defects were detected in all patients at the time of lesion excision. The mean exposure size in the greatest dimension was 16 mm (range, 9-20 mm). Three patients were treated successfully with simple excision of the granulomas, burring down of the anterior surface of the implants, and direct repair of the exposure defects. Explantation of the implant was performed in 2 cases. Histopathologic examination revealed chronic inflammation and microabscess formation in the explanted implants.
  
  
  CONCLUSIONS
  Five patients with pyogenic granulomas were found to have hydroxyapatite exposure. Pyogenic granuloma should not be considered a benign lesion on a hydroxyapatite orbital implant, especially in recurrent cases. Ophthalmologists must be aware of the possibility of conjunctival dehiscence with hydroxyapatite-implant exposure beneath the lesion.
authors.affiliation: Department of Ophthalmology, Khallili Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. owjin@sums.ac.ir
authors.forename: Naser
authors.initials: N
authors.lastname: Owji
authors.forename: Alireza
authors.initials: A
authors.lastname: Sadeghipour
authors.forename: Hosein
authors.initials: H
authors.lastname: Salour
authors.forename: Nima
authors.initials: N
authors.lastname: Sahraeyan
mesh_terms: D000293:Adolescent; D000328:Adult; D003937:Diagnosis, Differential; D017886:Durapatite; D005260:Female; D005500:Follow-Up Studies; D017789:Granuloma, Pyogenic / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D009916:Orbital Diseases / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D020273:Orbital Implants / Q000009:adverse effects*; D011475:Prosthesis Failure; D012086:Reoperation
chemical_list: D017886:Durapatite