Integrated versus non-integrated orbital implants for treating anophthalmic sockets

Area of Science:

• Ophthalmology
• Biomaterials Science
• Surgical Innovation

Background:

• Anophthalmia, the absence of one or both eyes, requires orbital implant reconstruction.
• Integrated implants (e.g., hydroxyapatite) integrate with host tissue, while non-integrated implants (e.g., PMMA) remain separate.
• Uncertainties persist regarding the comparative effectiveness of integrated versus non-integrated orbital implants in anophthalmic socket treatment.

Purpose of the Study:

• To systematically assess the effects of integrated versus non-integrated orbital implants in treating anophthalmic sockets.
• To evaluate implant success rates, motility, and adverse events associated with different orbital implant types.
• To identify gaps in current research for anophthalmic socket reconstruction.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (CENTRAL, MEDLINE, Embase, LILACS, ISRCTN, ClinicalTrials.gov, WHO ICTRP) up to August 2016.
• Included randomized controlled trials (RCTs) and quasi-RCTs comparing integrated and non-integrated orbital implants for anophthalmic sockets.
• Data on procedure success, implant motility, and adverse events were independently extracted and analyzed by two authors.

Main Results:

• Three heterogeneous RCTs with 284 participants were included; analysis focused on 250 participants.
• No significant difference in the proportion of successful procedures at one year was found between integrated (hydroxyapatite) and non-integrated (alloplastic) implants (low-certainty evidence).
• Evidence regarding implant motility showed mixed results, with some indications of slightly worse mobility with integrated implants, but differences in surgical techniques complicate attribution (very low-certainty evidence). Adverse events were inconsistently reported.

Conclusions:

• Current evidence from three small RCTs is insufficient to definitively assess the effects of integrated versus non-integrated orbital implants for anophthalmic sockets.
• The included studies were generally poorly reported, with an unclear risk of bias.
• Further well-designed randomized controlled trials are crucial to guide clinical decisions in anophthalmic socket treatment.