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Related Experiment Videos

Management of exposed hydroxyapatite orbital implants

Y D Kim1, R A Goldberg, N Shorr

  • 1Jules Stein Eye Institute, University of California, School of Medicine, Los Angeles 90024-7006.

Ophthalmology
|October 1, 1994
PubMed
Summary

Porous hydroxyapatite orbital implants can expose early after surgery. Optimal management for larger exposures involves autogenous tissue grafts and implant surface modification to prevent further complications.

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Area of Science:

  • Ophthalmology
  • Biomaterials Science
  • Surgical Reconstruction

Background:

  • Porous coralline hydroxyapatite orbital implants are widely used in anophthalmic sockets.
  • Increased rates of early implant exposure have been reported, necessitating further investigation.

Observation:

  • Hydroxyapatite implant exposures occurred 2-8 weeks post-implantation.
  • MRI revealed a "cold" zone anteriorly, indicating failed fibrovascular ingrowth in exposed areas.
  • Surgical interventions included defect edge freshening, implant burring, and autogenous tissue grafts (palate mucosa, dermis-fat).

Findings:

  • Spontaneous closure was observed for small exposures (<3mm), but larger defects required active management.
  • Repeated exposure occurred even after free grafting in some patients.

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  • Three patients had intact surfaces with thin conjunctiva over hydroxyapatite spicules.

    • Implications:

    • Active management is crucial for larger hydroxyapatite implant exposure defects.
    • Free autogenous tissue grafts combined with implant surface burring yield optimal results.
    • Minimizing implant exposure at primary surgery through appropriate implant sizing and tension-free, vascularized tissue coverage is essential.