Evisceration with Hydroxyapatite Implant: Surgical Technique and Review of 31 Case Reports

Abstract

To evaluate the use of hydroxyapatite (HA) as an orbital implant with evisceration. Although several reports have documented good success with HA orbital implants and their use with enucleation, only a few reports mention HA with evisceration. These few reports are less favorable, with exposure rates as high as 67%. In contrast, the authors have had good success with evisceration and HA implants with no major complications and a low exposure rate. A retrospective analysis of all eviscerations with HA implant performed between January 1989 and July 1993 was completed (n = 31). Patients underwent evisceration with scleral modification, including anterior relaxing incisions and posterior sclerotomies to accommodate a large sphere without tension on the wound. Patient records were reviewed for demographic data, surgical indication, sphere size, clinical outcome, complications, and follow-up interval. The surgical technique is described. All 31 patients underwent successful surgery with complications limited to exposure (6%), mild superior sulcus deficit (6%), and a conjunctival cyst (3%). No patient required further socket reconstruction, and no patient required peg placement to enhance motility. The average follow-up interval was 13.3 months. The authors have had good success using HA orbital implants for evisceration without major complications. Primary evisceration with HA implantation after posterior sclerotomies is a safe and effective method for treating patients with a blind, painful eye.