title: Implant and prosthesis movement after enucleation: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate implant and prosthesis movement after myoconjunctival enucleation and subsequent polymethyl methacrylate (PMMA) implantation, compared with the traditional enucleation with muscle imbrication using a PMMA implant and with enucleation accompanied by porous polyethylene implantation.
  
  
  METHODS
  Randomized, controlled, observer-masked, interventional study.
  
  
  METHODS
  One hundred fifty patients, equally and randomly allocated to the 3 groups.
  
  
  METHODS
  Group 1 consisted of patients in whom a PMMA implant was used after enucleation with muscle imbrication (traditional PMMA group). Group 2 consisted of patients in whom a PMMA implant was used after enucleation with a myoconjunctival technique (myoconjunctival PMMA group). Group 3 consisted of patients in whom a porous polyethylene implant was used after enucleation by the scleral cap technique (porous polyethylene group). Fifty patients were included in each group. Patients were allocated to 1 of the 3 groups using stratified randomization. Informed consent was obtained. Acrylic prostheses custom made by a trained ocularist were fitted 6 weeks after surgery in all patients. A masked observer measured implant and prosthesis movement 6 weeks after surgery using a slit-lamp device with real-time video and still photographic documentation. Analysis of implant and prosthesis movement was carried out using the Mann-Whitney U test, and a P value of < or =0.03 was considered significant. Complications including implant displacement and exposure also were noted.
  
  
  METHODS
  Implant and prosthesis movement.
  
  
  RESULTS
  Myoconjunctival PMMA implant movement was better than the traditional PMMA implant (P = 0.001), but was similar to that of the porous polyethylene implant. Prosthesis movement with the myoconjunctival PMMA implant was better than that of either the traditional PMMA (P = 0.001) or porous polyethylene (P = 0.002) implants.
  
  
  CONCLUSIONS
  Myoconjunctival enucleation technique with a PMMA implant provides statistically and clinically significantly better implant and prosthesis movement than the traditional PMMA implant and better prosthesis movement than the porous polyethylene implant.
authors.affiliation: Department of Facial Plastic Surgery, Apollo Hospitals, Apollo Health City, Hyderabad, India.
authors.forename: Debraj
authors.initials: D
authors.lastname: Shome
authors.forename: Santosh G
authors.initials: SG
authors.lastname: Honavar
authors.forename: Kuldeep
authors.initials: K
authors.lastname: Raizada
authors.forename: Deepa
authors.initials: D
authors.lastname: Raizada
mesh_terms: D015353:Eye Enucleation; D005133:Eye Movements / Q000502:physiology*; D005137:Eye, Artificial; D005500:Follow-Up Studies; D006801:Humans; D009801:Oculomotor Muscles / Q000502:physiology*; D020273:Orbital Implants; D020959:Polyethylene; D019904:Polymethyl Methacrylate; D017755:Prosthesis Fitting; D019919:Prosthesis Implantation; D013536:Suture Techniques; D013997:Time Factors
chemical_list: D020959:Polyethylene; D019904:Polymethyl Methacrylate