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Hydroxyapatite orbital implant in children following enucleation: analysis of 531 sockets
Sanket U Shah1, Carol L Shields, Sara E Lally
1Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
Insights
Hydroxyapatite (HA) orbital implants show excellent long-term outcomes and high patient satisfaction following pediatric enucleation. Complications associated with HA implants are rare, making them a safe and effective choice for children.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Biomaterials
Background:
- Enucleation is a common procedure for pediatric eye loss.
- Hydroxyapatite (HA) implants are widely used for orbital reconstruction.
- Evaluating long-term outcomes in pediatric patients is crucial for surgical success.
Purpose of the Study:
- To assess the features and long-term results of hydroxyapatite (HA) orbital implants after enucleation in children.
- To analyze implant-related complications, motility, and cosmetic satisfaction.
Main Methods:
- Retrospective review of pediatric patients (≤18 years) who underwent enucleation and HA implant placement.
- Data collected included implant type, surgical technique, complications, implant/prosthesis motility, and patient/family satisfaction.
- Mean follow-up duration was 60 months.
Main Results:
- 531 HA implants were placed in 525 pediatric patients, with a mean age of 3 years at placement.
- Complications were rare: conjunctival thinning (2%), infection (1%), exposure (3%), with no migration/extrusion.
- Excellent implant motility (78%) and prosthesis motility (59%) were observed.
- Patient/family cosmetic satisfaction was rated as excellent in 99% of cases.
Conclusions:
- Hydroxyapatite (HA) orbital implants demonstrate excellent long-term outcomes in pediatric enucleation.
- High patient cosmetic satisfaction and a low complication rate support the use of HA implants.
- HA implants are a safe and effective option for orbital reconstruction in children.
Purpose:
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.
