Related Experiment Video
Updated: Aug 13, 2026
Rapid Mix Preparation of Bioinspired Nanoscale Hydroxyapatite for Biomedical Applications
Published on: February 23, 2017
Use of the hydroxyapatite ocular implant in the pediatric population
P De Potter1, C L Shields, J A Shields
1Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa.
Insights
Hydroxyapatite ocular implants are well-tolerated in children, offering good prosthesis motility with few complications. Proper prosthesis fitting by an ocularist is crucial for optimal outcomes in pediatric enucleation cases.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Biomaterials Science
Background:
- Hesitancy exists regarding ocular implant use post-enucleation in children, particularly after retinoblastoma treatment.
- Hydroxyapatite implants offer a potential solution for restoring ocular volume and function.
Purpose of the Study:
- To evaluate the safety and efficacy of hydroxyapatite ocular implants in children under 10 years old.
- To assess prosthesis motility and complication rates following enucleation and hydroxyapatite implant placement.
Main Methods:
- Prospective study of 60 consecutive pediatric patients (<10 years) undergoing enucleation and hydroxyapatite implant placement.
- Histopathologic analysis of enucleated eyes to determine primary diagnoses.
- Mean follow-up of 19 months to record complications and assess prosthesis motility.
Main Results:
- Retinoblastoma was the most common diagnosis (51/60 patients).
- Low complication rates: 2 conjunctival erosions and 5 conjunctival thinning cases, all linked to a flat prosthesis vault.
- No implant extrusion, migration, or orbital cellulitis observed. Good prosthesis motility achieved in all patients, with enhanced motility in one case with peg placement.
Conclusions:
- Hydroxyapatite ocular implants are well-tolerated in pediatric patients, yielding good prosthesis motility and minimal complications.
- Comfortable prosthesis fitting with a high posterior vault by an ocularist is essential for successful outcomes.
- Delayed drilling and peg placement until patient cooperation improves is a viable strategy.
Objectives:
There is always a hesitancy to use an ocular implant after enucleation in children, especially in cases of eyes enucleated for retinoblastoma.
Design And Setting:
In this prospective study, we report our experience of 60 consecutive cases in which we used the hydroxyapatite ocular implant after enucleation in children younger than age 10 years.
Results:
The mean age at the time of enucleation and hydroxyapatite placement was 27 months (range, 1 to 108 months). The histopathologic diagnoses after enucleation included retinoblastoma in 51 patients, endophthalmitis in two patients, persistent hyperplastic primary vitreous in two patients, neovascular glaucoma resulting from Coats' disease in one patient, uveal melanoma in two patients, undifferentiated intraocular neoplasm in one patient, and blind painful traumatized eye in one patient. After a mean follow-up of 19 months (range, 6 to 36 months), two cases of conjunctival erosion and five cases of conjunctival thinning were recorded. These problems were associated with a flat posterior prosthesis vault in all seven cases. There were no cases of orbital cellulitis, implant extrusion, or implant migration. All children showed good small-degree prosthesis motility despite the lack of peg placement. Only one older child underwent drilling and peg placement and she had excellent small- and large-degree prosthesis motility. We generally postpone the drilling and peg placement stage and tedious prosthesis revision in children until they are able to fully cooperate with the ocularist.
Conclusions:
The hydroxyapatite ocular implant is well tolerated and provides good prosthesis motility in children with few complications. It is critical for the ocularist to fit the prosthesis comfortably with a high posterior vault.
