Malpositioned orbital implants: indications for implant removal and secondary reconstructive techniques

Area of Science:

• Ophthalmology
• Plastic Surgery
• Medical Imaging

Background:

• Malpositioned orbital implants frequently cause significant postoperative morbidity, often requiring revision surgery.
• Standardized frameworks for managing these cases are lacking, presenting challenges in clinical decision-making.

Purpose of the Study:

• To analyze clinical presentations, radiographic failure patterns, and surgical strategies for revision surgery in patients with malpositioned orbital implants.
• To evaluate the outcomes of multidisciplinary surgical management for these complex cases.

Main Methods:

• A retrospective case series of patients undergoing revision surgery for malpositioned orbital implants was conducted.
• Data collected included demographics, symptoms, radiographic findings, surgical approaches, and outcomes.
• Co-management by plastic/reconstructive and oculoplastic surgeons was common.

Main Results:

• Diplopia, pain, and swelling were the most common presenting symptoms.
• Radiographic findings included implant protrusion and peri-implant inflammatory collections.
• Revision surgery, including explantation or reconstruction with custom implants, led to improvement in symptoms for most patients.

Conclusions:

• Malpositioned orbital implants have diverse failure modes necessitating individualized surgical plans.
• A multidisciplinary strategy aids in decision-making for implant removal versus reconstruction, achieving favorable outcomes.
• Virtual surgical planning and intraoperative navigation enhance the safety and precision of revision orbital surgery.