[Orbital implants of coralline hydroxyapatite as eye replacement after enucleation]

BACKGROUND During the last two decades, hydroxyapatite has become popular as alloplastic material for bone replacement in orthopedic and dental surgery. We investigated prospectively the feasibility of hydroxyapatite spheres as replacement of enucleated eyes. PATIENTS AND METHODS Thirty-three consecutive patients entered a prospective study designed to evaluate the results obtained after either primary (n = 26) or secondary (n = 7) implantation of a hydroxyapatite sphere as replacement of the enucleated eyeball. Each patient was examined preoperatively, 1, 2, and 4 months after surgery, as well as every 6 months thereafter. At each examination time the motility of both coralline sphere and overlying cosmetic prosthesis was evaluated and the conjunctival sac was carefully examined at the slit-lamp. RESULTS The postoperative follow-up averaged 10.5 months for the primary implantations and 7.2 months for the secondary implantations. Two implants had to be removed because of infection unresponsive to antibiotic treatment. Defects in the conjunctiva overlying the implant necessitated wound revision in two cases. A buccal mucosal graft was performed in two additional ones. A temporary cosmetic prosthesis could be fitted in all but two of the remaining patients as early as 3 weeks after surgery. Motility of at least 3 mm in all directions could be obtained in 31 cases. CONCLUSION Our study demonstrated that satisfactory motility and good biocompatibility can be achieved, at least in the medium term, with implantation of coralline hydroxyapatite spheres.