Exposure rate of unwrapped hydroxyapatite orbital implants in enucleation surgery.
To document the long-term exposure rate of unwrapped coralline hydroxyapatite (HA) orbital implants and explore possible risk factors.



This retrospective case series (May 2008-April 2013) reviewed the 234 patients with anophthalmia who underwent insertion of an unwrapped HA orbital implant by one of two different surgical closing techniques.



Of the 234 cases, 151 underwent a rectus end-to-end suturing closure technique and 83 underwent a rectus orthotopic suturing closure technique. The time of follow-up ranged from 25 months to 69 months (mean 41.9 months). Implant exposure developed in 11 cases. Three in the rectus end-to-end suturing closure group (2.0%) and eight in the rectus orthotopic suturing closure group (9.6%). In the rectus end-to-end suturing technique, a crosswise fixation of vascularised rectus muscle tissue is formed across the front of the implant; in this group the incidence of implant exposure was reduced (OR=8.11, p=0.013). Prior ocular surgery was found to be a factor increasing the incidence of HA exposure (OR=2.73, p=0.032).



The placement of an unwrapped HA orbital implant with rectus end-to-end suturing in enucleation surgery was associated with a low rate of exposure in most cases. The end-to-end suturing creates a joint-like structure over the HA sphere, protecting the Tenon's capsule and conjunctiva from its rough surface and reducing the risk of implant exposure. Prior ocular surgery may be another risk factor for HA exposure.
Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
Juan
J
Ye
Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
Qi
Q
Gao
Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
Jin-Jing
JJ
He
Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
Tao
T
Gao
Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
Qing-Yao
QY
Ning
Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
Jia-Jun
JJ
Xie
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018786:Bone Substitutes; D002516:Ceramics; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D020099:Coated Materials, Biocompatible; D005128:Eye Diseases / Q000601:surgery*; D015353:Eye Enucleation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006882:Hydroxyapatites; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D020273:Orbital Implants; D016062:Porosity; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D018786:Bone Substitutes; D020099:Coated Materials, Biocompatible; D006882:Hydroxyapatites; C119955:coralline hydroxyapatite
Cosmesis; Treatment Surgery