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The scleral filet technique for secondary orbital implantation surgery
1University of Ottawa Eye Institute, Ont.
Objective:
To describe a simple procedure, the scleral filet technique, to place a secondary implant and take advantage of the scleral remnant.
Setting:
Oculoplastic service at a university-affiliated hospital in Ottawa.
Patients:
Three patients from Middle Eastern countries who had undergone evisceration following trauma without placement of an orbital implant. All three had a scleral remnant, enophthalmos and poor prosthetic motility.
Interventions:
The scleral remnant was incised (fileted) in a crisscross fashion, allowing access to the retrobulbar space. A hydroxyapatite implant was placed, and the scleral remnants were closed without disrupting the muscle attachments, leaving the socket motility intact.
Results:
All three patients had an uneventful postoperative course and were fitted with a prosthesis between 6 to 8 weeks. There was no implant exposure during the follow-up period of 8 to 15 months. Implant drilling and peg placement was carried out 6 to 10 months postoperatively. One of the patients had excellent motility, and two had good or fair motility. All were very satisfied with the results.
Conclusions:
Advantages of the scleral filet technique include simplicity, ability to use the patient's own vascularized scleral remnant to act as a protective cap over the implant and avoidance of donor material. We advocate the use of this procedure when a scleral remnant is present in a patient presenting for consideration of secondary implantation.