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Implant and prosthesis movement after enucleation: a randomized controlled trial
Debraj Shome1, Santosh G Honavar, Kuldeep Raizada
1Department of Facial Plastic Surgery, Apollo Hospitals, Apollo Health City, Hyderabad, India.
Ophthalmology
|April 27, 2010
Summary
The myoconjunctival enucleation technique with a polymethyl methacrylate (PMMA) implant offers superior implant and prosthesis movement compared to traditional PMMA implantation. This method also shows better prosthesis movement than porous polyethylene implants.
Area of Science:
- Ophthalmology
- Ocularistry
- Biomaterials Science
Background:
- Enucleation, the removal of the eyeball, requires orbital implant placement to maintain orbital volume and support prosthesis.
- Traditional enucleation with muscle imbrication and polymethyl methacrylate (PMMA) implants is a common procedure, but outcomes can be limited by implant motility.
- Alternative techniques, such as myoconjunctival enucleation with PMMA or scleral cap enucleation with porous polyethylene implants, aim to improve motility and aesthetic results.
Purpose of the Study:
- To compare implant and prosthesis movement following myoconjunctival enucleation with PMMA implantation versus traditional PMMA implantation and porous polyethylene implantation.
- To evaluate the efficacy of different enucleation and implant techniques in achieving optimal ocular prosthesis function.
Main Methods:
- A randomized, controlled, observer-masked, interventional study involving 150 patients undergoing enucleation.
- Patients were allocated to three groups: traditional PMMA implant, myoconjunctival PMMA implant, or porous polyethylene implant.
- Implant and prosthesis movement were objectively measured six weeks post-surgery using specialized slit-lamp equipment.
Main Results:
- Myoconjunctival PMMA implants demonstrated significantly better movement than traditional PMMA implants (P=0.001).
- Prosthesis movement was superior with the myoconjunctival PMMA implant compared to both traditional PMMA (P=0.001) and porous polyethylene (P=0.002) implants.
- Implant movement with myoconjunctival PMMA was comparable to porous polyethylene implants.
Conclusions:
- The myoconjunctival enucleation technique combined with a PMMA implant offers statistically and clinically significant improvements in implant and prosthesis movement over the traditional PMMA method.
- This technique also provides superior prosthesis movement compared to porous polyethylene implants, suggesting a favorable option for achieving better functional and aesthetic outcomes post-enucleation.
