title: [Results of natural hydroxyapatite implants covered with Vicryl® mesh in a series of 704 enucleations].
abstract: OBJECTIVE
  Retrospective study of local tolerability of a natural hydroxyapatite orbital implant wrapped with Vicryl(®) (polyglactin) mesh in patients undergoing enucleation.
  
  
  METHODS
  Complications were classified into four types according to their management: type 1 if no reoperation was required, type 2 if additional surgery without grafting was required, type 3 if an oral mucosal graft was performed (major dehiscence) and type 4 if the complication required removal of the implant.
  
  
  RESULTS
  Seven hundred and four patients with a median follow-up of 44 months. Five hundred and three patients were enucleated as a primary procedure and 201 after failure of conservative management. The overall complication rate was 12.07% (85 patients) with 68 type 1 complications, nine type 2 complications, three type 3 complications and five type 4 complications (0.71%). A total of 17 patients (2.42%) required additional surgery. The use of chemotherapy or radiotherapy before or after surgery did not influence the results. In univariate analysis, the tolerability was better in children than in adults. With multivariate analysis, only the diameter of the implant was an independent risk factor for complications (P=0.001).
  
  
  CONCLUSIONS
  Use of a Vicryl(®) mesh-wrapped natural hydroxyapatite orbital implant after enucleation is particularly well tolerated including the pediatric population. A compromise should be sought with an implant large enough for good cosmetic results but small enough to avoid complications.
authors.affiliation: Service d'ophtalmologie 3, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Service d'oncologie ophtalmologie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: X
authors.initials: X
authors.lastname: Ricaud
authors.affiliation: Service d'oncologie ophtalmologie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Levy-Gabriel
authors.affiliation: Service d'oncologie ophtalmologie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Lumbroso-Le Rouic
authors.affiliation: Service d'oncologie ophtalmologie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Cassoux
authors.affiliation: Service d'oncologie ophtalmologie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Esteve
authors.affiliation: Service de biostatistiques, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Plancher
authors.affiliation: Service de biostatistiques, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Asselain
authors.affiliation: Service d'oncologie ophtalmologie, institut Curie, 26, rue d'Ulm, 75005 Paris, France. Electronic address: laurence.desjardins@curie.net.
authors.forename: L
authors.initials: L
authors.lastname: Desjardins
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017886:Durapatite / Q000009:adverse effects / Q000737:chemistry*; D015353:Eye Enucleation / Q000706:statistics & numerical data; D005134:Eye Neoplasms / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D020273:Orbital Implants / Q000009:adverse effects; D011098:Polyglactin 910 / Q000009:adverse effects / Q000737:chemistry*; D011183:Postoperative Complications / Q000453:epidemiology; D019919:Prosthesis Implantation / Q000009:adverse effects; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000209:etiology
chemical_list: D011098:Polyglactin 910; D017886:Durapatite
keywords: Conjunctiva; Enucleation; Hydroxyapatite; Implant orbitaire; Mélanome uvéal; Orbital implant; Retinoblastoma; Rétinoblastome; Uveal melanoma; Énucléation conjonctive