Department of Oculoplastics, Envision Squint and Oculoplastics Centre, Lahore, Pakistan
*Corresponding Author: Sameera Irfan, Department of Oculoplastics, Envision Squint and Oculoplastics Centre, Lahore, Pakistan.
Received: January 27, 2022; Published: April 20, 2022
Purpose: To study the effectiveness of a Cone-shaped orbital implant either as a primary or a secondary procedure.
Primary Surgical Outcome: To achieve satisfactory cosmetic appearance with a reasonable symmetry between the two eyes, good implant motility, and prosthesis worn comfortably.
Methods: A prospective, interventional study of 261 consecutive cases who had orbital implant surgery at a tertiary care centre, from Jan 2009 to Jan 2021. There were 146 males and 115 females between the age 17-62 years (median age 23 years). 218 cases had an enucleation with a primary orbital implant. 43 cases had a secondary implant for an empty socket (26 cases), exposed, or posteriorly migrated implant (17 cases) that was removed and replaced by a secondary orbital implant.
The indications, surgical technique, post-operative complications, and longterm aesthetic outcome are discussed in detail. The limitations and risks of the procedure were fully explained to the patients. Patients and their attendants were counselled regarding the fitting of final prosthesis, its care and the need for regular follow-up visits. All cases were followed up for a minimum period of 12 months while 50% cases visited had an average follow-up of 7 ± 3 years.
Results: The most serious complication was post-operative infection; despite a meticulous surgical technique, it occurred in 14 cases (6.42%) in the primary implant group and 6 cases (13.95%) of the secondary group. It was managed conservatively in all cases. However, recurrent purulent discharge, wound dehiscence, and implant exposure necessitated the removal of implant in 2 primary cases (0.91%). Conjunctival scarring due to previous surgeries resulted in 3 mm wound dehiscence and implant exposure in 3 cases
(6.97%) of the secondary group. A mucus membrane graft was needed to cover the defect. A lid tightening procedure was needed in 12 cases (27.90%) in the secondary implant group who had worn prosthesis in an empty socket prior to the secondary implant surgery. Good implant motility was noted in all primary cases due to the fully-integrated nature of the implant. It was good in only 11 cases (25.59%) where all rectus muscles were attached to the implant and fair in 14 cases (44.18%) where a few muscles could be salvaged. Motility was absent in 13 secondary cases (30.23%) where no muscles could be found. All primary cases had a good cosmesis and 100 % patient satisfaction.
Conclusion: The technique described here is simple, with a short learning curve. It is an inexpensive option amongst a vast array of costly fully-integrated orbital implants that are commercially available. It offers good cosmetic results with minimal post-operative complications.
Keywords: Enucleation; Evisceration; Orbital Implant; Post-enucleation Socket Syndrome; Implant Wrappings; Integrated Orbital Implant
Citation: Sameera Irfan. “Sam's Technique of Cone-shaped Orbital Implant".Acta Scientific Ophthalmology 5.5 (2022): 46-56.
Copyright: © 2022 Sameera Irfan. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.