Orbital Implants Research Articles

Integrated miRNA sequencing and experimental validation Unveil that low-level laser enhances vascular endothelial cell proliferation, migration, and lumen formation via miR-90/VEGFA

The hydroxyapatite orbital implantation is widely used to treat orbital malformation, but delayed postoperative angiogenesis can hinder conjunctival wound healing, potentially leading to implant exposure and prolapse. Low-intensity laser therapy (LLLT) is recognized for its ability to promote tissue regeneration, reduce inflammation, and alleviate pain. This study aims to explore the specific mechanism of miRNAs-VEGFA pathway regulation in early vascularization after orbital implant placement induced by LLLT. A hydroxyapatite orbital implant model was established and treated with LLLT. Vascular tissues surrounding the ocular prosthesis were extracted for high-throughput sequencing to identify differentially expressed miRNAs. miRNAs predicted to bind with VEGFA were selected for validation. GO and KEGG analyses were performed to reveal the functional enrichment of target genes regulated by these miRNAs. Dual luciferase assay, qRT-PCR, and Western blotting were used to verify the targeting relationship between miR-90 and VEGFA. The effects of miR-90 on rabbit microvascular endothelial cell function were assessed through CCK-8 assay, scratch test, and tube formation assay. High-throughput sequencing revealed 32 differentially expressed miRNAs, with 8 upregulated and 24 downregulated. miR-90 was predicted to have a high binding score and expression abundance with VEGFA and was confirmed to regulate VEGFA expression. In vitro functional tests showed that miR-90 inhibited rabbit microvascular endothelial cell proliferation, migration, and tube formation. This study is the first to demonstrate that LLLT regulates ocular prosthesis angiogenesis via the miR-90/VEGFA pathway, providing a new target for treating vascular-dependent diseases.

Exploring 3D Printed Implants With Anti-Dropout Function to Overcome Time Constraints in Acute Orbital Fractures for Patient-Specific Implants.

Orbital wall reconstruction and implant insertion are crucial procedures for temporarily replacing the orbital walls in cases of significant fractures. Traditional methods using planar orbital implants have faced challenges owing to their flat shape, which increases the risk of dislocation from improper cuts and necessitates the use of screws in the orbital rim. This study aims to improve outcomes by employing customized 3-dimensional implants, thereby reducing complications and risk of dislocation resulting from external shock or implant weight postinsertion. This prospective study included 12 Korean individuals diagnosed with facial fractures (orbital wall injuries). Surgeries were performed on 12 patients, and follow-up CT scans were conducted on 10 of them. Therefore, the authors could only address the results for the 10 patients. The authors used bioactive glass ceramics and medical-grade poly-e-caprolactone to 3D print personalized implants, completing the manufacturing process in an average of 4.6 days. Computed tomography scans guided measurements of orbital volumes and exophthalmos. After surgery, we found that the difference values for bone orbital volumes (<0.1mL) and exophthalmos (<1mm except one) decreased compared with presurgery values. Independent t tests and Pearson correlation analysis revealed no significant changes between normal and affected sides in both phases. However, R-values increased in the postsurgery phase. Patients monitored postsurgery at 2 weeks, 3 months, and 6 months showed no complications. The 3D-printed patient-specific implants, customized to individual fracture shapes and featuring distinct implants and locking parts with notches, effectively restore bony orbital volumes and reduce exophthalmos. They have been proven feasible and applicable for reconstructing acute orbital wall fractures.

Risk Factors Associated with Reoperation for Exposed Hydroxyapatite Orbital Implants

Purpose: We evaluated risk factors associated with reoperation following exposed hydroxyapatite orbital implant placement.Methods: We retrospectively analyzed 34 patients (34 eyes) diagnosed with exposed hydroxyapatite orbital implants at our institution between 2008 and 2022; all patients had a minimum follow-up of 12 months. All patients initially received conservative management. However, if symptoms, such as pain, discharge, or progressive exposure persisted, surgery was undertaken. We analyzed several variables, including age, sex, diabetic status, preoperative diagnosis, surgical approach, implant type and size, and exposed implant surface area. Regression analysis was performed to identify variables associated with reoperation.Results: Of the 34 patients (34 eyes), 17 (50.0%) were managed conservatively, whereas 17 (50.0%) required surgical intervention. Regression analysis revealed a significant association between the size of the exposed area and the need for reoperation (p = 0.018); however, other factors did not significantly impact reoperation rates. Receiver operating characteristic curve analysis identified a threshold of 4.5 mm for exposed area size, with an area under the curve of 0.934, sensitivity of 0.882, and specificity of 0.824. Patients categorized into small and large groups based on the 4.5 mm threshold revealed a statistically significant difference in reoperation rates (&lt;i&gt;p&lt;/i&gt; &lt; 0.001).Conclusions: Our study demonstrates that the size of the exposed area is the single most significant predictor of revision surgery in patients with exposed hydroxyapatite orbital implants. Notably, an exposed area &gt; 4.5 mm was associated with a significantly increased risk of reoperation.

Long-Term Mental Health after High-Density Polyethylene-Based Porous Orbital Implant in Enucleated and Eviscerated Patients

Objectives: To assess the overall mental health of enucleated or eviscerated patients after high-density porous polyethylene OCULFIT implantation and external prosthesis over a 1-year follow-up. Methods: Patients with an indication of enucleation or evisceration with OCULFIT implantation were included in a prospective study. The patients completed four questionnaires regarding mental health at three different visits (baseline, 3–6 months, and 9–12 months post-surgery). The questionnaires used were the following: SF-12 for multidimensional health-related quality of life (scale 0–100); Rosemberg self-esteem scale (scale 0–40); Patients Health Questionnaire-4 (PHQ-4) (scale 0–6); and a Lifetime Major Depression and Anhedonia questionnaire (categorised in groups with/without symptoms). Results: A total of 33 patients (16 enucleations and 17 eviscerations) were included in the study. The physical domain of the SF-12 questionnaire did not change between visits, but the mental domain significantly improved from the baseline to the last visit (41.71 ± 12.72 vs. 46.80 ± 10.68, p = 0.04). The number of patients with high, moderate, and low self-esteem (Rosemberg scale) was similar between the baseline and the last visit. The depression and anxiety scores of the PHQ-4 were not significantly different among visits. The number of patients with no symptoms (depression or anhedonia) improved from the baseline (42.2%) throughout the follow-up (66.7% at the last visit). Conclusions: OCULFIT orbital implant and external prosthesis placement maintained and/or improved the quality of life related to mental health in eviscerated and enucleated eyes. The number of patients with no symptoms improved from the baseline throughout the follow-up. The patients’ self-esteem was already high before implantation and remained stable over the follow-up.

Re-establishing Facial Aesthetics - Patient-specific Orbital Implant for Post-traumatic Deformity

Abstract Rationale: Complex fractures of the maxillofacial region can require staged interventions to achieve optimal outcomes. A significant example of this are complex fractures of the orbital floor, which may be difficult to restore during primary treatment. The secondary correction is often required which can be using stock- or customised implants. Patient Concerns: A previously operated case of panfacial trauma presented with an aesthetic concern regarding the asymmetrical appearance of his eyes. Diagnosis: On clinical and radiological evaluation, the patient was diagnosed with enophthalmos of the left eye secondary to orbital floor fracture. Treatment: A patient-specific implant (PSI) was fabricated and placed for orbital floor reconstruction. Outcomes: Postoperatively, aesthetic and functional outcomes were satisfactory. Take-away Lessons: This case report highlights the use of PSIs in orbital floor reconstruction, made possible due to the advent of virtual surgical planning and three-dimensional printing in the field of oral and maxillofacial surgery.

Clinical characterization and long-term postoperative outcomes of retinoblastoma patients receiving enucleation and primary orbital implantation in early infancy: an observational study

ObjectivesTo retrospectively investigate clinical characterization and the long-term postoperative outcomes of retinoblastoma (RB) patients receiving enucleation with primary orbital implantation in early infancy (0–6 months old).MethodsThe clinical and follow-up data of 42 RB patients receiving enucleation with primary orbital implantation in early infancy at Beijing Tongren Hospital from December 2009 to January 2020 were analysed. The average follow-up time was 83 months. The patient group included 24 males and 18 females, 30 unilateral and 12 bilateral cases. A total of 44 eyes with 10 in stage D and 34 in stage E underwent 40 unilateral and 2 bilateral surgeries. 17 RB eyes received hydrogel and 27 RB eyes received hydroxyapatite implants. This study was performed by following the guideline of STROBE.ResultsEnucleation combined with primary orbital implantation promoted survival and was safe with few and minor complications such as increased secretion, upper eyelid ptosis, and sunken eye sockets which were not affected by stages, lateralities, or implant materials. 55-80% RB patients exhibited satisfactory appearance and obvious or moderate motility of orbital implants according to the evaluation by doctors and family members. Family members were likely more optimistic about the appearance and more pessimistic about motility of the orbital implantation than doctors did.The quality of life was high as indicated by PedsQL3.0 or PedsQL4.0 scores ( ≧ 90 for > 75% patients). It was not affected by the stages, laterality, and implant materials, nor affected by the appearance and motility of the implants.ConclusionsThe outcomes of the combination of enucleation and primary orbital implantation for pertinent RB patients in early infancy are generally satisfactory with few and minor complications, high safety, appearance, and overall quality of life. Enucleation combined with primary orbital implantation in early infancy benefits pertinent RB patients in appearance, survival, and quality of life.

Enucleations, eviscerations and orbital implants in German eye hospitals

Evaluation of the number of enucleations and eviscerations performed in Germany and the orbital implants used. Analysis of the quality reports of German ophthalmological clinics for the years 2012-2021 provided by the Federal Joint Committee (Gemeinsamer Bundesausschuss, G‑BA). Almost 10 times as many enucleations (8368) as eviscerations (975) are performed in Germany. After enucleation, alloplastic implants are used most frequently (44.6% alloplastic, no further specification, 30.0% alloplastic coated, no further specification; 14.1% microporous implants) and autologous dermis-fat grafts in 6.1% of the cases. In Germany, significantly more enucleations than eviscerations are performed. Alloplastic orbital implants are preferred for primary reconstruction following enucleation.

Delayed-Onset Orbital Abscess After Orbital Blowout Fracture Repair Using Porous Polyethylene Implant.

This study aims at documenting a rare case of delayed-onset orbital abscess following the use of a nonabsorbable porous polyethylene implant in orbital fracture repair, highlighting the potential long-term risks associated with non-biodegradable orbital implants. A 44-year-old man presented with diplopia on down gaze, proptosis, and eyelid edema for 2 weeks. He had undergone repair of an inferior orbital wall fracture with a porous polyethylene implant 5 years ago. Computed tomography (CT) evaluation revealed a significant intraorbital abscess related to implant infection. Surgical interventions included abscess drainage and implant replacement, which led to patient recovery. Nonabsorbable implants, which are beneficial for orbital reconstruction, may pose a risk of occurrence of delayed infections several years following surgery. This report highlights the importance of long-term monitoring to mitigate the risks of potential late complications, which necessitate early diagnosis, appropriate intervention, and management strategies.

Multidisciplinary approach to severe intracranial, intraorbital allergic fungal sinusitis

BackgroundAllergic fungal sinusitis (AFS) is a form of paranasal mycosis that often involves bone destruction and can extend into the orbit and anterior skull base. Intracranial and intraorbital involvement are published but not both in each included patient of a series. The purpose of the present study was to review cases of extensive AFS with orbital or/and skull base erosion, including the presenting symptoms, patient socioeconomic background, imaging features, surgical technique, and post-operative outcomes. MethodsThe records of 30 patients with the histological diagnosis of AFS and both intracranial and intraorbital involvement were reviewed. ResultsThe average age of the patients was 25.2 years. 83 % of patients were male. 70 % were African American. 66 % of patients had Medicaid or were uninsured. Presenting symptoms were headaches (80 %), nasal obstruction (33 %), proptosis (40 %), vision change (23 %), facial pressure (10 %), and decreased sense of smell (7 %). 100 % of patients had bone erosion observed on computerized tomography scans with disease extending intracranially through the anterior skull base or posterior wall of the frontal sinus along with disease that eroded through the lamina papyracea. All patients had failed medical management. All patients underwent surgery by Otolaryngology, Ophthalmology, and Neurosurgery with transnasal endoscopic approaches and orbitotomy. 80 % also underwent a bifrontal craniotomy for removal of intracranial extradural disease with cranialization. 53 % of patients had orbital implants remaining after surgery; 23 % had nasal stents. There were no postoperative cerebrospinal fluid leaks. Average hospital stay was 4.8 days. Preoperatively, 13 % of patients underwent allergy testing. 94 % saw an Allergist postoperatively. 21 % required follow up surgery. ConclusionsA team approach of Otolaryngologists, Ophthalmologists, and Neurosurgeons is recommended for this slowly growing but locally destructive disease. Most patients with AFS will present with headaches and nasal obstruction. While most cases of AFS can be successfully managed with transnasal endoscopic techniques, orbitotomy and craniotomy represents an effective treatment for severe AFS cases with extensive intracranial and intraorbital involvement. This disease is found most commonly in young African American males and in the underinsured.

Clinical application of biomaterials in orbital implants: a systematic review

Clinical application of biomaterials in orbital implants: a systematic review

Long-Term Outcomes of Enucleation and Secondary Orbital Implantation Surgeries Using Polyester Mesh-Wrapped Acrylic Orbital Implants.

To reveal the long-term outcomes of enucleation and secondary orbital implantation surgeries employing nonabsorbable surgical mesh-wrapped acrylic orbital implants for various reasons. A retrospective interventional study of 48 eyes that underwent primary or late primary enucleation and secondary orbital implantation using polyester mesh-wrapped acrylic orbital implants, between 2012 and 2021. Patient demographics, diagnosis, prior ophthalmic surgery, implant size, follow-up periods, and implant-associated complications were evaluated. The records of 36 patients who underwent primary or late primary enucleation and 12 who underwent secondary orbital implantation due to sphere extrusion were evaluated. Patients' mean age was 38.7 (range: 2-75) and the mean follow-up period was 48.3 months (range: 24-72mo). Major causes for surgeries were trauma and malignancies (54.1% and 33.3%, respectively). No complications, such as conjunctival dehiscence, implant exposure or extrusion, contracted socket, or fornix insufficiency were observed in any patient during the long-term follow-up period postsurgeries. Using polyester mesh-wrapped acrylic orbital implants in enucleation and secondary orbital implantation surgeries proves to be a successful, safe, and cost-effective option.

A New Approach in Management of Orbital Adherence Syndrome.

Orbital walls are one of the most common sites of midface fractures and account for ~40% of traumatic injuries in this region. These fractures are often associated with changes in the anatomy of the orbital cavity and frequently affect the orbital inferior wall, infraorbital groove and canal, and medial orbital wall, which leads to changes in its pattern and volume as well. Generally, the forces required for brake superior and lateral walls are greater than those required for thin medial and inferior walls. Disruption of any of these structures leads to the expansion of orbital volume that brings to the appearance of enophthalmos, diplopia, and impaired ocular mobility. The gold standard in the treatment of orbital wall fractures is surgical reconstruction, that includes fracture site exposure, freeing tissue prolapsed into the fracture site, and re-approximating the orbital wall support, usually with an orbital implant. It usually could be achieved by the usage of such as transconjunctival, subciliary, and coronal approaches and implementation of graft and reconstructive materials, including bones, cartilage, titanium, and resorbable mesh. Today, the gold standard in orbital floor reconstruction is the application of titanium mesh orbital plates. However, their implementation could be associated with a number of postoperative complications, such as mispositioning and orbital adherence syndrome. Orbital adherence syndrome is a poorly described and understood phenomenon and appears to occur after the use of large-pored titanium mesh for orbital reconstruction. It usually appears as limited eye movement that appears 1 to 2 weeks after reconstructive procedure. Prevention is possible through careful patient selection and the placement of a smooth interface medium in the initial surgery. The aim of the current study is to present the outcomes of orbital reconstruction done by both orbital mesh and customized ​​smooth-surfaced titanium orbital implants.

An Effective Technique for the Correction of Orbital Hypertelorism to Prevent Recurrence.

To investigate the efficacy and safety of medial orbital wall osteotomy with medial displacement combined with lateral orbital wall Medpor artificial material implantation in the treatment of orbital hypertelorism. A retrospective analysis was performed on patients who underwent the above surgical procedures from 2010 to 2019, and long-term follow-up was conducted to record surgery-related complications and evaluate postoperative outcomes. Four patients (3 males and 1 female) were followed up for 24 months. All patients were satisfied with the postoperative results. There was no diplopia, vision loss, eye movement disorder or other vision-related complications. There was no implant rejection, infection or exposure. This operation is a modification of the traditional surgical method of medial orbital wall osteotomy. It is safe and effective for the treatment of orbital hypertelorism.

Long-term Experience of Using of Polytetrafluoroethylene Orbital Implants

Purpose: to evaluate the long-term results of using polytetrafluoroethylene orbital implants in patients with anophthalmos.Patients and methods. The clinical group consisted of 1560 patients with blind and unpromising eyes or anophthalmos, who were divided into 3 groups (I, II, and III) depending on the method of surgical treatment used — evisceration of the eye with posterior pole resection and neurectomy, enucleation of the eye, and plastic orbital socket surgery, respectively.Results. All patients in the study groups showed a positive result according to the criteria: stump mobility averaged (130,1°), prosthesis mobility averaged (106,6°), prosthesis entrapment after evisceration was less common than in patients after eye enucleation by 14.5 %. And the average value of the prosthesis sinking (mm) was lower by 78.0 %. Occlusion of the upper eyelid was also 16.7 % less common, and the average occlusion of the upper eyelid (mm) was 37.3 % lower. PTFE orbital implants have proven to be affordable, biocompatible and easy to use implants. The effect of the operation remained stable with long-term follow-up up to 15 years. There were no complications directly related to the use of PTFE orbital implants.

Transconjunctival Approach with Lateral Skin Extension in Orbital Fracture Reconstruction

Introduction : Orbital fractures are commonly featured in various type of facial fracture, including zygomaticomaxillary, naso-orbito-ethmoid, frontal-sinus, Le Fort II, and III fracture patterns. Multidisciplinary surgery is required to restore physiological and aesthetic functions.&#x0D; Case Illustration : Three midfacial fracture operations with lower transconjunctival incision approach to 6, 18, and 25 years old patients were performed by maxillofacial team in Al Islam Hospital Bandung. The steps started with lateral canthotomy and continued with transconjunctival incision in a lateromedial direction. With dissection towards the infraorbital rim, lower eyelid is mobilized and can be retracted anteromedially. Two patients was given titanium orbital floor implants and plates, while the youngest patient received absorbable plates. This approach successfully gave wider access to orbital bone and less bleeding during surgery. No complication has been reported with good outcome.&#x0D; Discussion : Fracture of the orbital floor may be repaired through transcutaneous, transconjunctival or endoscopic approaches. Transconjunctival approach is the most effective surgical access to infraorbital rim and orbital floor or even to medial orbital wall. The ability to reach periosteum further allows access to great portion of the orbit. Lateral canthotomy allows periosteum to be elevated superiorly for repair of fracture frontozygomatic suture. This approach may decrease the risk of postoperative eyelid retraction than subciliary approach and is aesthetically superior to other approaches.&#x0D; Conclusion : Transconjunctival approach has provided wider intraoperative access during orbital fracture reconstruction with easier post operative care, also giving good functional and aesthetic outcome.

One-stage Intraconal Volume Modification for Exposed and Nonexposed Ball Implants.

To assess long-term outcomes and reinterventions for exposed and nonexposed intraconal orbital implants after single-stage socket revisional surgery. Retrospective case-note review of patients with exposed or nonexposed orbital ball implants, who underwent a single-stage ball exchange (Group I) or ball removal with dermis-fat graft (Group II); Group I was subdivided as having either exposed (A) or nonexposed (B) implants. Outcomes were compared with similar cohorts undergoing multistage surgery. Of 172 patients (54% male), 153 (89%) underwent ball exchange (Group I) and 19 (11%) had dermis-fat graft (Group II). With a mean follow up of 7.8 years, Group I patients without ball exposure (Group IB) had a slightly higher rate of reintervention for persistent volume deficit (21% vs. 9%; p = 0.163) and implant migration (6% vs. 0%; p = 0.091), while Group IA patients-having surgery for exposed implants-had more reexposures (7% vs. 3%; p = 0.270). Single-stage and 2-stage surgery had similar reintervention rates, with the exception of a trend toward fewer volume enhancements for those with nonexposed implants (17% vs. 30%; p = 0.380), and a shorter time to (re)exposure for exposed implants after 2-stage procedures (mean 0.33 vs. 3.5 years; p = 0.571). Group II patients required further volume enhancement in 32% of 1-stage procedures, and one patient needed graft removal. Single-stage volume modification is effective and the results are comparable to staged surgery for either exposed or nonexposed implants. Most patients report a stable prosthesis and satisfactory cosmesis, after a faster rehabilitation.

Neuronavigation and Endoscopy as Adjunctive Tools in Orbital Floor Implant Revision: Surgical Management of Infected, Misplaced Orbital Floor Implant with Chronic Eyelid Fistula and Sinusitis

Neuronavigation and Endoscopy as Adjunctive Tools in Orbital Floor Implant Revision: Surgical Management of Infected, Misplaced Orbital Floor Implant with Chronic Eyelid Fistula and Sinusitis

Long-Term Outcome of Staged Socket Surgery for Acquired Anophthalmos.

To evaluate long-term outcomes of staged volume rehabilitation for acquired anophthalmos. Case-note review of patients who had preceding i) eye removal without implant, ii) eye removal with an intraconal implant, but ball-related problems, or iii) removal of exposed implant. Secondary interventions were a) a first-time ball implant, b) dermis-fat graft, c) ball repositioning, d) ball replacement after prior removal, or e) orbital floor implantation. Secondary volume-augmenting surgery was performed in 175 sockets at a mean age of 42.7 years (range 2-91), with 62% secondary ball implants, 3% dermis-fat grafts, 6% ball repositioning, 19% ball replacement after prior removal for exposure, and 10% having orbital floor implantation. After this surgery, further volume enhancement was required in 21% of sockets, this being 40% for spheres ≤18 mm diameter, in contrast to 6% for those ≥20 mm ( p < 0.001). Exposure or malposition of the secondary implant occurred in 8% (12/151) and was unrelated to implant type, size, wrapping, or prior irradiation. Tertiary surgery addressed lining deficiency (18%) or eyelid malposition (25%). Overall, 92/175 (53%) had tertiary surgery to improve cosmesis and comfort, with 49% (36/92) being related to small implants. At a mean follow-up of 9.1 years, 82% of sockets had adequate volume, 79% had excellent lining, and 93% were comfortable. Prosthetic fit was satisfactory in 96% of cases, and 97% reported improved cosmesis. Over half of the sockets having planned 2-stage volume enhancement may need further procedures, especially after small-volume secondary implants, but, with meticulous surgery, reasonable long-term results can be achieved with few complications.

The posterior auricular muscle complex graft as a porous orbital implant wrap: long-term follow-up over a 31-year period

ABSTRACT Purpose Orbital implant exposures, infections, and extrusions can occur many years following enucleation or evisceration. This study analyzes complication rates following porous orbital implant wrapped with a posterior auricular muscle complex graft (PAMCG). Methods This is a retrospective study of patients who underwent orbital implantation following enucleation using this technique between 1992 and 2013. Only cases with a minimum of 18 months of follow-up were included. No patients underwent peg implantation. Patient’s demographics, follow-up time, type of implant, complications including wound dehiscence, exposure, postoperative infection, and extrusion were recorded. Results This study included 36 orbits of 36 patients with a mean age of 39.3 ± 23.2 years (range, 3–84 years). Thirty patients had hydroxyapatite implants and six had porous polyethylene. The average follow-up time was 12.6 ± 5.6 years (range, 1.5–31.0 years). There were no implant extrusions, and only one exposure resulting in orbital infection that necessitated implant removal (2.8%). Conclusion Wrapping porous orbital implants with PAMCG had favorable long-term outcomes over a thirty-one-year period.

Longitudinal Comparison of Orbital Volumes from Enucleated Eyes with Hydroxyapatite Orbital Implant in Unilateral Retinoblastoma Patients.

To compare the orbital volume between enucleated and contralateral, uninvolved orbits over a 5-year period in patients with unilateral retinoblastoma who underwent enucleation with hydroxyapatite (HA) implant placement by a single surgeon. A retrospective review was performed on the clinical records and radiographic images of unilateral retinoblastoma patients who underwent enucleation with primary HA implantation from 2003 to 2020 at a single institution. Bilateral orbital volume measurements were taken from the initial postoperative MRI scan and again at 1- and 5-years postenucleation. The main outcome measure was the longitudinal change in volume difference (∆𝑉). The implant size, age at enucleation, and sex were also evaluated. A linear mixed-effect model was used for analysis. A total of 124 patients (73 males) with HA implants following enucleation were included. Overall, the unaffected orbit trended toward having a greater volume compared with the enucleated orbit, but this was not statistically significant (β = 0.003; p = 0.122). The mean age at enucleation was 2.4 years. The median time between enucleation and the initial, 1-year, and 5-year postoperative MRIs was 6 months, 17 months, and 55 months, respectively. There was no statistical correlation between age at enucleation, gender, implant size, or orbital volume at any time points ( p > 0.05). Patients treated with enucleation and primary HA implant placement for unilateral retinoblastoma did not display significant asymmetry in orbital volume on 5-year postenucleation MRIs, suggesting that HA implants promote orbital growth comparable to a nonenucleated orbit in the pediatric population.