title: Hydroxyapatite orbital implant in children following enucleation: analysis of 531 sockets.
abstract: OBJECTIVE
  To evaluate the features and long-term outcomes of hydroxyapatite (HA) orbital implant following enucleation in pediatric patients.
  
  
  METHODS
  A retrospective review was performed on clinical records of patients ≤18 years of age , managed with enucleation and HA implant placement. Recorded outcomes included implant-related complications, implant and prosthesis motility, and patient cosmetic satisfaction.
  
  
  RESULTS
  There were 525 children (531 sockets) with HA implant following enucleation. The mean age at HA implant placement was 3 years (median, 2 years; range, 4 days to 17 years). Indications for enucleation included retinoblastoma (n = 457, 86%), uveal melanoma (n = 17, 3%), medulloepithelioma (n = 8, 2%), and others (n = 49, 9%). The HA implant was uncoated (n = 370, 70%) or polymer coated (n = 161, 30%). For the 370 uncoated implants, wrapping was provided with scleral (n = 346, 94%) or bovine pericardium (n = 1, <1%), and 23 patients (6%) had no wrapping. The extraocular muscles were attached to the implant/polymer coat/wrap (n = 531, 100%), by suturing 4 rectus muscles (n = 349, 66%) or all 6 muscles (n = 182, 34%). Over mean follow up of 60 months, in 477 orbital implants, complications included conjunctival thinning (n = 10, 2%), implant infection (n = 6, 1%), implant exposure (n = 13, 3%), and implant migration/extrusion (n = 0, 0%). Motility for implant was judged as excellent (n = 245, 78%) and small-angle prosthesis motility was excellent (n = 196, 59%). Patient/family satisfaction with cosmetic outcome was rated as excellent in 471 implants (99%).
  
  
  CONCLUSIONS
  Following enucleation in children, long-term outcomes of the HA orbital implant are excellent with favorable patient cosmetic satisfaction and rare complication.
authors.affiliation: Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Sanket U
authors.initials: SU
authors.lastname: Shah
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.forename: Sara E
authors.initials: SE
authors.lastname: Lally
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D000293:Adolescent; D001672:Biocompatible Materials; D002648:Child; D002675:Child, Preschool; D017886:Durapatite; D015353:Eye Enucleation; D005134:Eye Neoplasms / Q000601:surgery; D005137:Eye, Artificial; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009915:Orbit / Q000601:surgery*; D020273:Orbital Implants; D017060:Patient Satisfaction; D011183:Postoperative Complications; D019919:Prosthesis Implantation; D012189:Retrospective Studies
chemical_list: D001672:Biocompatible Materials; D017886:Durapatite