Hydroxyapatite orbital implant in children following enucleation: analysis of 531 sockets.

Abstract

To evaluate the features and long-term outcomes of hydroxyapatite (HA) orbital implant following enucleation in pediatric patients. A retrospective review was performed on clinical records of patients ≤18 years of age , managed with enucleation and HA implant placement. Recorded outcomes included implant-related complications, implant and prosthesis motility, and patient cosmetic satisfaction. There were 525 children (531 sockets) with HA implant following enucleation. The mean age at HA implant placement was 3 years (median, 2 years; range, 4 days to 17 years). Indications for enucleation included retinoblastoma (n = 457, 86%), uveal melanoma (n = 17, 3%), medulloepithelioma (n = 8, 2%), and others (n = 49, 9%). The HA implant was uncoated (n = 370, 70%) or polymer coated (n = 161, 30%). For the 370 uncoated implants, wrapping was provided with scleral (n = 346, 94%) or bovine pericardium (n = 1, <1%), and 23 patients (6%) had no wrapping. The extraocular muscles were attached to the implant/polymer coat/wrap (n = 531, 100%), by suturing 4 rectus muscles (n = 349, 66%) or all 6 muscles (n = 182, 34%). Over mean follow up of 60 months, in 477 orbital implants, complications included conjunctival thinning (n = 10, 2%), implant infection (n = 6, 1%), implant exposure (n = 13, 3%), and implant migration/extrusion (n = 0, 0%). Motility for implant was judged as excellent (n = 245, 78%) and small-angle prosthesis motility was excellent (n = 196, 59%). Patient/family satisfaction with cosmetic outcome was rated as excellent in 471 implants (99%). Following enucleation in children, long-term outcomes of the HA orbital implant are excellent with favorable patient cosmetic satisfaction and rare complication.