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Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
Porous orbital implants, wraps, and PEG placement in the pediatric population after enucleation
Jia-Kang Wang1, Shu Lang Liao, Luke L K Lin
1Department of Ophthalmology, Far Eastern Memorial Hospital, Taipei, Taiwan.
Insights
This study found that wrapping porous orbital implants with Lyodura or a modified Vicryl mesh technique significantly reduced exposure complications in pediatric patients after enucleation.
Area of Science:
- Ophthalmology
- Biomaterials Science
- Pediatric Surgery
Background:
- Enucleation is a common procedure in pediatric ophthalmology.
- Porous orbital implants are used to restore orbital volume and support prosthetic eyes.
- Complications such as implant exposure can negatively impact outcomes.
Purpose of the Study:
- To compare the complication rates, specifically implant exposure, of various porous orbital implants and wrapping materials in pediatric patients.
- To evaluate the efficacy of different wrapping techniques in preventing exposure.
Main Methods:
- A retrospective, comparative, nonrandomized study of pediatric patients (<15 years) undergoing enucleation with porous orbital implants.
- Implants included hydroxyapatite (HA), Medpor, and Bioceramic.
- HA implants were wrapped with donor sclera, Lyodura, porcine sclera, or Vicryl mesh; Medpor implants were unwrapped; Bioceramic implants were wrapped with Vicryl mesh and scleral grafts.
Main Results:
- Exposure rates varied significantly by implant and wrapping material.
- Porcine sclera-wrapped HA implants had a 100% exposure rate.
- Lyodura-wrapped HA implants and modified Vicryl mesh-wrapped HA/Bioceramic implants showed no exposure.
- The modified wrapping technique and Lyodura significantly reduced exposure rates (P < .001).
- 42.5% of patients were fitted with peg-coupled prostheses with good subjective movement.
Conclusions:
- The choice of porous orbital implant and wrapping material significantly influences exposure rates in pediatric enucleation patients.
- A modified wrapping technique, particularly with Lyodura or Vicryl mesh with scleral grafts, appears effective in preventing implant exposure in children.
- Optimizing implant wrapping is crucial for successful prosthetic rehabilitation in pediatric orbital reconstruction.
Purpose:
To investigate complications of various porous orbital implants and wrapping materials in the pediatric population after enucleation.
Design:
A retrospective, comparative, nonrandomized study.
Methods:
Between November 1992 and November 2006, patients younger than 15 years old were collected for study participation. They underwent enucleation with porous orbital implants primarily or secondarily at National Taiwan University Hospital. The authors used the hydroxyapatite (HA), Medpor, and Bioceramic orbital implant. The HA implant was wrapped with four different materials: donor sclera, Lyodura, porcine sclera, and Vicryl mesh. A part of HA implants and all bioceramic implants were wrapped with Vicryl mesh, added anteriorly with scleral patch grafts. All Medpor implants were unwrapped.
Results:
Forty-seven cases had more than a two-year follow-up. The exposure rates according to implants and wraps were: donor sclera-wrapped HA (two of nine, 22%), porcine sclera-wrapped HA (three of three, 100%), Vicryl mesh-wrapped HA (one of five, 20%), and unwrapped Medpor (one of four, 25%). No exposure was found in four Lyodura-wrapped HA implants, and 22 Vicryl mesh-wrapped HA and Bioceramic implants with anteriorly scleral coating. The exposure rate was lower in cases with implants wrapped by our method and Lyodura than in those with implants wrapped by other materials (P < .001). Of 47 patients, 20 (42.5%) were fitted with peg-coupled prostheses and all had good prosthetic movements subjectively.
Conclusions:
Different types of implants and wraps resulted in various exposure rates in the pediatric population. The modified wrapping technique may prevent porous implants from exposure in children.
