title: Scleral wrap increases the long-term complication risk of bone-derived hydroxyapatite orbital implants.
abstract: BACKGROUND
  This study was prompted by previous findings that suggested that scleral wrapping increased the rate of complications following insertion of bone-derived hydroxyapatite orbital implants and compared the long-term results of implants inserted with and without scleral wraps.
  
  
  METHODS
  This retrospective case series reviewed the long-term outcomes of 159 patients who had undergone enucleation with insertion of a bone-derived hydroxyapatite orbital implant at Dunedin Hospital between 1977 and 2006. Implants were inserted with and without scleral wraps in 85 and 74 cases, respectively. Follow up was 0.5-27.5 years (mean 8.2 years) for the whole series and 9.7 years for the sclera group and 6.7 years for the group without sclera. Patient details were obtained from theatre records, case note review, patient interview and examination, interview of patient relatives and family general practitioner records. The main outcome measures were the rates of minor or major complications and their treatments and outcomes.
  
  
  RESULTS
  Twenty-seven cases (17%) suffered minor complications of limited implant exposure that either healed spontaneously, with implant drilling or wound resuturing and 11 cases (7%) suffered major complications requiring explantation. Of 38 patients with postoperative complications, 31 (82%) had scleral wraps compared with 7 (18%) without sclera (P < 0.001; OR 5.14, 95% CI 2.00-14.78).
  
  
  CONCLUSIONS
  Bone-derived hydroxyapatite orbital implants inserted without scleral wrap were associated with better clinical outcomes and a lower rate of long-term complications. It is therefore recommended that these implants be inserted without a scleral wrap.
authors.affiliation: Eye Department, Dunedin Hospital, Dunedin, New Zealand.
authors.forename: Tze'Yo
authors.initials: T
authors.lastname: Toh
authors.forename: Tui H
authors.initials: TH
authors.lastname: Bevin
authors.forename: Anthony C B
authors.initials: AC
authors.lastname: Molteno
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001842:Bone and Bones; D002648:Child; D002675:Child, Preschool; D020099:Coated Materials, Biocompatible; D017886:Durapatite / Q000009:adverse effects*; D015353:Eye Enucleation; D005137:Eye, Artificial; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D020273:Orbital Implants / Q000009:adverse effects*; D016062:Porosity; D011183:Postoperative Complications; D012189:Retrospective Studies; D012590:Sclera; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D020099:Coated Materials, Biocompatible; D017886:Durapatite