Using the inferior oblique muscle to augment implant coverage in enucleation surgery.
OBJECTIVE
We present a technique modification for enucleation surgery that may decrease implant exposure or extrusion by using native tissue to reinforce the implant at the most susceptible area, specifically the anterior-most aspect.


METHODS
An enucleation procedure is performed, and an implant is placed into the orbit. The horizontal rectus muscles are attached to the implant, and the vertical rectus muscles are attached directly to the horizontal muscles. The inferior oblique muscle is then spread over the anterior implant surface and sutured to the superior rectus and lateral rectus muscles.


RESULTS
15 patients underwent this procedure, with implantation of an SST porous polyethylene implant. The mean follow-up interval was 18 months with a range of 4-33 months. One patient suffered an implant exposure, and one experienced a post-operative orbital hemorrhage. Two patients required blepharoptosis surgery to achieve eyelid symmetry.


CONCLUSIONS
This retrospective series demonstrates the potential usefulness of the inferior oblique muscle to augment coverage of the orbital implant. Reinforcement of the anterior surface of the implant with vascularized tissue may improve the integrity and strength of the tissues anterior to the implant, and thereby reduce the likelihood of implant exposure.
McInnes
Alan W
AW
Eyesthetica Oculofacial and Cosmetic Surgical Associates, University of Southern California, Keck School of Medicine, Santa Monica, California, USA. awmcinnes@gmail.com
Dresner
Steven C
SC
D001672:Biocompatible Materials; D015353:Eye Enucleation / Q000379:methods*; D005137:Eye, Artificial; D005500:Follow-Up Studies; D006801:Humans; D009801:Oculomotor Muscles / Q000601:surgery*; D020273:Orbital Implants; D011095:Polyethylenes; D011183:Postoperative Complications / Q000517:prevention & control*; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D013536:Suture Techniques
D001672:Biocompatible Materials; C084562:Medpor; D011095:Polyethylenes