Problems associated with porous orbital implants

Abstract

Purpose. To assess the problems and complications associated with the use of 120 synthetic hydroxyapatite (HA) implants and contrast them to other currently available porous orbital implants (Bio-Eye®, Molteno® M-Sphere TM, Brazilian HA, Chinese HA, Medpore TM – porous polyethylene and Bioceramic implants). Methods. The authors analyzed all of the problems and/or complications associated with the use of a synthetic hydroxyapatite implant (FCI 3) in 120 patients by one surgeon over 4 years. The following data were recorded: age, type of surgery performed, size of implant used, peg system used, follow-up duration, time of pegging, problems and/or complications encountered, and treatment. Results. Thirteen patients were lost to follow up after 3 months, leaving 107 patients who were followed from 4 to 48 months (average 29 months). Discharge occurred in 21 (19.6%) patients, implant exposure in 3 (2.8%), socket discomfort in 2 (1.9%), trochleitis in 2 (1.9%), conjunctival thinning in 1 (0.93%), pyogenic granuloma in 1 (0.93%). Peg problems occurred in 24 out of 68 patients pegged (35.2%). Problems encountered with the peg were discharge in 10 (14.7%) patients, pyogenic granuloma in 9 (13.2%), conjunctiva overgrowing peg in 4 (5.8%), HA exposure around the sleeve in 3 (4.4%), loose sleeve in 3 (4.4%), peg drilled at an angle in 1 (1.5%), implant infection in 1 (1.5%) and peg falling out in 1 (1.5%). Conclusion. The FCI 3 synthetic HA is a less costly alternative form of hydroxyapatite currently in use in many parts of the world. Problems and complications encountered with its use are similar to those seen in other porous orbital implants such as the Bio-Eye®. The incidence of exposure associated with the synthetic HA implant is lower than several other reports on the Bio-Eye®. The synthetic HA implant is slightly softer than the Bio-Eye® and in one case it fractured under extreme pressure.