The autogenous dermis-fat orbital implant in children

The autogenous dermis-fat graft orbital implant is one alternative for volume augmentation in the adult anophthalmic socket. We have reviewed our experience with dermis-fat grafts after primary enucleation in the pediatric population.

We reviewed the clinic charts of all patients under 8 years of age who underwent primary enucleation combined with dermis-fat graft implantation. We assessed subsequent orbital growth by measuring lid and fissure symmetry, superficial soft tissue socket volume, prosthetic fit, and periorbital symmetry. All measurements were obtained by 2 of the authors.

Eight children had primary enucleations combined with a dermis-fat implant (Table 1). Age at the time of surgery ranged from 1 week to 8 years. Indications for enucleation were retinoblastoma (4), malignant teratoid medulloepithelioma (1), blind, painful eye secondary to trauma (2), or phthisis secondary to end-stage retinopathy of prematurity (1). Two patients were lost to follow up at 3 months and 6 months post enucleation. The remaining 6 patients had between 1 year and 6 years of follow up. All implants maintained appropriate volume allowing proper prosthetic fit and facial symmetry. Two children experienced excessive growth of their implants, managed by surgical debulking. Two children developed a central graft ulcer, managed by superficial revision and reclosure.

We have observed that dermis-fat grafts in pediatric primary enucleations demonstrate good maintenance of orbital soft tissue volume and periorbital symmetry. The complications of excessive dermis-fat growth or central ulceration were easily corrected. We feel this is a promising implant for the pediatric anophthalmic socket.