title: Anterior filler displacement following injection of calcium hydroxylapatite gel (Radiesse) for anophthalmic orbital volume augmentation.
abstract: OBJECTIVE
  To describe the complication of anterior filler displacement following injection of calcium hydroxylapatite gel (Radiesse) for anophthalmic enophthalmos correction.
  
  
  METHODS
  Retrospective case series of patients who experienced anterior filler displacement following orbital injection of calcium hydroxylapatite. Data includes patient demographics, indication for injection, route and volume of injection, description of postinjection complications, and final outcome.
  
  
  RESULTS
  Four cases of anterior filler displacement and expansion following injection of calcium hydroxylapatite were identified. The patients' ages ranged from 33 to 64 years old. All 4 patients underwent multiple prior orbital surgeries and suffered from anophthalmic enophthalmos. Injectable calcium hydroxylapatite was delivered transcutaneously, to the deep extraconal orbital space, via 27-gauge, 1.25-inch retrobulbar needles. Each patient received an initial 1.3 ml of filler, with 1 patient receiving an additional 0.8 ml. Within 1 week, all patients experienced prominent, edematous lower eyelids. A CT scan of 1 patient radiographically documented anterior migration of the filler material. Two patients required transconjunctival excision of the filler and infiltrated orbital fat. Histopathologic examination of 1 specimen revealed chronic foreign body granulomatous inflammation. Two patients were treated medically, with resolution of clinical findings over 6 to 9 months.
  
  
  CONCLUSIONS
  Anterior filler displacement is a potential complication of orbital volume augmentation with injectable calcium hydroxylapatite. Patients should be counseled regarding this possibility when considering options for the treatment of anophthalmic enophthalmos. A history of multiple prior orbital surgeries, with associated tissue disruption and scarring, may be a risk factor for filler displacement.
authors.affiliation: Department of Ophthalmology and Otolaryngology/Head and Neck Surgery, Saint Louis University, St Louis, Missouri, USA. agb111@hotmail.com
authors.forename: Adam G
authors.initials: AG
authors.lastname: Buchanan
authors.forename: John B
authors.initials: JB
authors.lastname: Holds
authors.forename: M Reza
authors.initials: MR
authors.lastname: Vagefi
authors.forename: Maziar
authors.initials: M
authors.lastname: Bidar
authors.forename: John D
authors.initials: JD
authors.lastname: McCann
authors.forename: Richard L
authors.initials: RL
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000853:Anophthalmos / Q000628:therapy*; D000869:Anterior Eye Segment / Q000000981:diagnostic imaging / Q000473:pathology*; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000009:adverse effects*; D017886:Durapatite / Q000008:administration & dosage / Q000009:adverse effects*; D015841:Enophthalmos / Q000628:therapy; D005128:Eye Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D015353:Eye Enucleation; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology*; D005782:Gels; D006801:Humans; D056965:Injections, Intraocular; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000187:drug effects*; D009929:Organ Size; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D001672:Biocompatible Materials; D005782:Gels; D017886:Durapatite