title: Orbital augmentation with injectable calcium hydroxylapatite for correction of postenucleation/evisceration socket syndrome.
abstract: OBJECTIVE
  To demonstrate the utility of injectable calcium hydroxylapatite (Radiesse) for orbital volume augmentation to correct postenucleation/evisceration socket syndrome (PESS).
  
  
  METHODS
  A retrospective chart review of all consecutive patients in our practice who received injectable calcium hydroxylapatite placed in the extraconal space to augment orbital volume was conducted. Patients with at least 6 months follow-up were included in the study.
  
  
  RESULTS
  Among 26 patients with PESS who received injectable calcium hydroxylapatite for orbital volume augmentation, 15 individuals were identified with adequate follow-up. The mean amount of preoperative relative enophthalmos measured by Hertel exophthalmometry was 4 mm (range 0.5-7 mm). An average reduction of 2.4 mm of enophthalmos per syringe of filler was achieved. The mean follow-up obtained was 46 weeks (range 24-78 weeks). Most patients demonstrated clinical and aesthetic improvement that was observed to continue up to 1.5 years. Complications observed included anterior migration of filler, a peribulbar hemorrhage, and orbital discomfort. Two patients demonstrated little response to filler.
  
  
  CONCLUSIONS
  Injectable calcium hydroxylapatite provides a novel, safe, simple, cost-effective technique to treat volume deficiency in the anophthalmic orbit. Augmentation achieved with this semipermanent filler has demonstrated a lasting effect in the orbit with little volume loss. Volume replacement can be titrated to the socket requirements. Correction of PESS using this technique may be limited in orbits that demonstrate significant fibrosis as a result of multiple surgeries, severe trauma, or radiation treatment.
authors.affiliation: Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: M Reza
authors.initials: MR
authors.lastname: Vagefi
authors.forename: Tristan F W
authors.initials: TF
authors.lastname: McMullan
authors.forename: John R
authors.initials: JR
authors.lastname: Burroughs
authors.forename: Dan
authors.initials: D
authors.lastname: Georgescu
authors.forename: John D
authors.initials: JD
authors.lastname: McCann
authors.forename: Richard L
authors.initials: RL
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000008:administration & dosage*; D017886:Durapatite / Q000008:administration & dosage*; D015353:Eye Enucleation; D017234:Eye Evisceration; D005137:Eye, Artificial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000188:drug therapy* / Q000209:etiology; D020273:Orbital Implants; D011183:Postoperative Complications; D012189:Retrospective Studies; D013577:Syndrome; D015626:Tissue Expansion / Q000379:methods*; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials; D017886:Durapatite