Socket Contracture Research Articles

The current alternative for ocular surface and anophthalmic socket reconstruction, cryopreserved umbilical amniotic membrane (cUAM).

This report presents the results of using cryopreserved umbilical amniotic membrane (cUAM) as an alternative mucosal graft for ocular surface reconstruction in cases of anophthalmic socket contracture (ASC), cicatricial entropion (CE), and conjunctival-scleral defects. The study included patients who underwent non-commercial implantation of cUAM grafts (prepared by corneal banking methods) for ASC, CE, conjunctival defect, and scleral melting. The main success criteria for this study were the comfortable fitting of the ocular prosthesis in ASC patients, the natural eyelid position in CE patients, and the degree of conjunctivalisation in melting patients. cUAM transplantation was performed in 2 patients who could not use a prosthetic eye due to conjunctival contracture, 2 patients with CE, and 1 patient with conjunctival defect and 1 patient with conjunctival-scleral melting. The primary outcome was achieved in 83.3% (5/6) of patients. In one patient with CE, partial healing was achieved due to the persistence of CE in the medial upper eyelid. cUAM is a viable alternative to mucosal grafting for reconstructing the bulbar and palpebral conjunctival surface, fornix, and orbit, with reduced donor morbidity and shorter surgical time. Its regenerative ability allows for tissue defect healing and improves cosmetic appearance through epithelialization within weeks.

Factors affecting anophthalmic socket reconstruction outcomes using autologous oral mucosal graft

BackgroundLimited studies have reported surgical outcomes that are defined by strict criteria following grade 2 or 3 socket reconstruction using an oral mucosal graft (OMG). We aimed to determine factors influencing surgical outcomes of anophthalmic socket reconstruction using OMG in patients with grade 2 or 3 socket contractures.MethodsThirty-seven patients who underwent socket reconstruction with autologous OMG between January 2007 and December 2017 were retrospectively analyzed. The successful outcome was defined as an eye prosthesis wearing without experiencing displacement and the absence of any re-operations or additional surgeries following socket reconstruction. Factors affecting surgical outcomes were identified using multivariate analysis.ResultsA total of 15 male and 22 female patients (mean age: 40.2 ± 17.2 years) were included. The median duration of socket contracture was 21.5 years. Grade 2 and 3 socket contractures, based on Tawfik’s classification, were reported in 20 and 17 patients, respectively. Twenty-eight and eight patients underwent socket reconstruction using OMG alone and OMG combined with a hard palate graft, respectively. The success rates of grades 2 and 3 socket contracture reconstruction were 80.0% and 52.9%, respectively. Multivariate analysis demonstrated that only grade 3 contractures were predictive of worse outcomes. At the final visit (mean follow-up: 6.3 years), 34 patients (91.9%) could wear their eye prostheses.ConclusionsSocket reconstruction using autologous OMG can provide acceptable results in grade 2 and 3 contractures; however, satisfactory results were more significantly reported in grade 2 than in grade 3 contractures.

THE EXPRESSION OF ALPHA-SMOOTH MUSCLE ACTIN IN CONTRACTED SOCKET

Abstract
 Introduction & Objectives : A contracted socket is considered a common complication in anophthalmic patients, with the resulting poor fitting of an ocular prosthesis. In severe cases where patients have had multiple previous reconstructive attempts, further socket contraction may result from fibrosis, leading to eventual surgical failure. Alpha-smooth muscle actin (alpha-SMA) is often used to identify pathologic fibroblasts. It may serve as a reliable marker for myofibroblast cells. The aim of the study was to find alpha-SMA protein expression in myofibroblasts derived from orbital socket contracture.
 Methods : In this study, we observed five patients with contracted sockets who underwent fornicoplasty and buccal graft surgery from October 2022 to February 2023. Tissue samples were taken from the conjunctival fornix area during the surgery and then examined for alpha-SMA expression.
 Results : In this study, there were 2 out of 5 (40%) positive alpha-SMA expressions with history of recurrent contraction, 2 (40%) negative expressions with no history of recurrent contraction, and 1 result that could not be assessed due to the limited number of samples containing fibroblasts in patient with history of recurrent contraction.
 Conclusion : Alpha-SMA levels can be detected in patients with contracted sockets. Patients with a history of recurrently contracted sockets have a tendency to express positive alpha-SMA. This may allow for the need for the administration of antimetabolites in patients with recurrent contracted sockets to avoid recurrence of this contracted socket.

THE EXPRESSION OF ALPHA-SMOOTH MUSCLE ACTIN IN CONTRACTED SOCKET

Purpose: A contracted socket is considered a common complication in anophthalmic patients, with the resulting poor fitting of an ocular prosthesis. In severe cases where patients have had multiple previous reconstructive attempts, further socket contraction may result from fibrosis, leading to eventual surgical failure. Alpha-smooth muscle actin (?-SMA) is often used to identify pathologic fibroblasts. It may serve as a reliable marker for myofibroblast cells. The aim of the study was to find ?-SMA protein expression in myofibroblasts derived from orbital socket contracture. Methods: In this study, we observed five patients with contracted sockets who underwent fornicoplasty and buccal graft surgery from October 2022 to February 2023. Tissue samples were taken from the conjunctival fornix area during the surgery and then examined for ?-SMA expression. Result: In this study, there were 2 out of 5 (40%) positive ?-SMA expressions with history of recurrent contraction, 2 (40%) negative expressions with no history of recurrent contraction, and 1 result that could not be assessed due to the limited number of samples containing fibroblasts. Conclusion: ?-SMA levels can be detected in patients with contracted sockets. Patients with a history of recurrently contracted sockets have a tendency to express positive ?-SMA. This may allow for the need for the administration of antimetabolites in patients with recurrent contracted sockets to avoid recurrence of this contracted socket.

Clinical use of cryopreserved ultra-thick human amniotic membrane for anophthalmic socket contracture.

To study the use of ultra-thick human amniotic membrane for management anophthalmic socket contracture. A prospective study done at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Thirty-six patients (45 eyelids) were involved. Contracted socket caused by trauma, previous surgery or radiotherapy, delay in use of prosthesis, Congenital Anophthalmia/Microphthalmia, and Anophthalmia secondary to Enucleation/Evisceration were included in the study. Thirty-three patients (42 eyelids) underwent fornix reconstruction with cryopreserved ultra-thick human amniotic membrane. Mean ± SD age at surgery was (40.90 ± 17.32) years. Mean follow up was 10.5 months. Grade II fornix contracture was the most common type in 23 (54.8%) eyelids. The most common involved primary diagnosis was Anophthalmia secondary to Enucleation/Evisceration (n = 13). The incidence of pyogenic granuloma (PG) after surgery was seen in 8 eyelids (19.0%). Anophthalmic contracted socket secondary to significant history of multiple PG excision (> 5 times) and secondary to enucleation/evisceration were associated with good surgical outcome. Cryopreserved ultra-thick human amniotic membrane is an ideal material for the management of anophthalmic socket contracture.

Reconstruction of Anophthalmic Sockets With Pedicled Nasoseptal Flap.

Patients who undergo eye removal often present with orbital soft-tissue insufficiency and contraction of the eye sockets. The most commonly used reconstruction strategy is grafting the orbit with free grafts, which is associated with the drawback of harvesting tissue from an unconnected site. This study describes the use of the vascularized nasoseptal flap in the reconstruction and enlargement of the contracted anophthalmic cavity in patients with severe or recurrent contracted eye sockets and evaluates its efficacy. A sphenopalatine-pedicled flap from the nasal septum was harvested and mobilized into the anophthalmic orbit for the reconstruction, coverage, and enlargement of the socket in 17 patients with anophthalmic socket syndrome. Data regarding the demographics, preoperative status, postoperative findings, follow-up, outcomes, dates of mutilant and reconstructive surgery, and relevant clinical or imaging were collected. Krishna´s classification was used to assess the postoperative outcomes. The final rating improved in all patients at a median follow-up duration of 35 months. A greater impact was observed in patients who underwent reconstructive surgery before nasoseptal flap creation. Two minor complications occurred; however, major surgical intervention was not required. Implant extrusion was observed in 2 patients. The novel strategy of applying nasoseptal flaps in the reconstruction of anophthalmic sockets results in improved socket grading and a low rate of recurrence (socket contracture or implant extrusion), and complications. The vascular nature of the flap makes it suitable for use in complex cases.

Fibrin glue as a novel therapy for contracted socket in comparison to mitomycin-c and triamcinolone acetonide at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Background: Contracted socket is still a major problem for patients with anophthalmia. The main factor for this condition is inflammation and fibrosis, which result in conjunctival shortening. Myofibroblasts that express α-SMA are the primary mediators of anophthalmic socket contraction. Methods: One healthy eye of a New Zealand white rabbit were randomly selected for evisceration and divided into four treatment groups, each with five rabbits. Each rabbit in the group received a single subconjunctival injection of a different agent. Group, I was the control group that received no injection, Group II received MMC 0.4 mg/ml, Group III received TCA 40 mg/ml, and Group 4 received fibrin glue. After 14 days, the animals were euthanized, and conjunctival samples were submitted for histopathological analysis. A monoclonal α-SMA antibody was applied, and pathologists provided the IRS score for each sample. The differences in α-SMA expression were statistically analyzed with a significant level of p <0.05 Result: All groups displayed a statistically significant decrease in α-SMA expression compared to the control group (p<0.05) as sorting as MMC group with p=0.007, TCA group with p=0.007, and fibrin glue with p= 0.009. MMC was the most effective at reducing α-SMA (p=0.004). Surprisingly, there were no statistically significant differences between MMC, TCA, and fibrin glue when they were evaluated independently. Conclusion: A single subconjunctival injection of fibrin glue may be used as a novel treatment to prevent socket contracture in actively healing sockets.

Modified evisceration with posteriorly detached petals for management of deficient sclera

Aim The aim of this work was to evaluate the effectiveness of modified evisceration technique compared with standard technique in cases associated with deficient sclera. Patients and methods A prospective interventional study was conducted that included 34 eyes of 31 patients with deficient sclera scheduled for modified evisceration technique with intraconal placement of nonporous acrylic implants. Outcome was assessed in terms of implant extrusion, exposure, as well as other early or late postoperative complications. Results Adequate volume replacement was achieved in 32 (94.12%) of 34 eyes. Overall, two (5.88%) eyes had mild upper sulcus deficit, and three (8.8%) eyes had mild to moderate prominence of the prosthesis compared with the fellow eye, but no true exposure, extrusion, migration, socket contracture, or sympathetic ophthalmia was encountered. All of the patients were satisfied with the cosmetic and functional outcomes of the procedure, except for the two (5.88%) cases with upper sulcus deficit. Conclusion A modified evisceration technique for deficient sclera provides superior cosmetic and functional results compared with the standard technique. It has the advantage of allowing placement of relatively large orbital implants in cases associated with insufficient sclera with very low rates of implant extrusion, exposure, migration, or socket contracture.

Clinical Manifestations in Patients Wearing Ocular Prostheses.

This study aimed to assess upper and lower eyelid shapes and changes in patients wearing ocular prostheses. The authors retrospectively reviewed the clinical records of patients wearing ocular prostheses. Clinical manifestations, including superior sulcus deepening, ptosis, upper and lower eyelid entropion, upper and lower eyelid ectropion, upper and lower eyelid retraction, and upper and lower eyelid socket contracture were investigated. For those patients who underwent evisceration, the most common clinical manifestations of the eyelid were superior sulcus deepening and ptosis (35%, respectively), whereas lower eyelid entropion and lower eyelid retraction were the second most common manifestations (25%, respectively). Among those patients who underwent enucleation, the most common eyelid changes were lower eyelid entropion (45.5%), and ptosis and lower eyelid socket contracture were the second most common alterations (36.4%, respectively). Finally, superior sulcus deepening, upper eyelid entropion, and lower eyelid retraction occurred in 27.3% of patients, respectively. Upper eyelid ptosis, superior sulcus deepening, and lower eyelid entropion and retraction were the most common clinical manifestations in patients wearing ocular prostheses. When following up with patients with ocular prostheses, it is important to check these eyelid changes and consider making appropriate corrections.

The Role of TGF‐□1 on RHO GTPase, GSK3, JNK, MMP‐2, ‐Catenin and ‐SMA expression in myofibroblast cell culture orbital soket contracture

AbstractPurposeTo study the role of TGF‐□1 on the expression of RHO GTPase, GSK3, JNK, MMP‐2, □‐catenin and □‐SMA in the myofibroblast cell culture of orbital socket contracture.MethodsThis research is an experimental research with invitro model of the myofibroblast cell culture of orbital socket contracture. □‐Sma expression examine with immunohistochemistry and confocal microscopy. Examination of the RHO GTPase, GSK3, JNK, MMP‐2, and □‐catenin expression using ELISA KIT, while the morphology of fibroblasts or myofibroblasts was examined by 100× magnification with an inverted Olympus IX 71 microscope and 400× magnification with CLSM FV1000ResultsIncreased dose of TGF‐□1 in passages 3 decreased the expression of a‐SMA and no morphological changes in myofibroblast cells. The morphology of myofibroblasts cells can not turn back into fibroblasts. Increased doses of TGF‐□1 increase JNK expression, slightly increase RHO GTPase expression, decrease GSK3 and a‐SMA expression, and doesn’t change MMP‐2 and □‐cathenine expression.ConclusionsTGF‐□1 increase JNK expression and slightly RHO GTPase, but decrease the expression GSK3 and a‐SMA, and has no effect on MMP‐2 and □‐cathenine expression in Myofibroblast Cell Culture Orbital Soket Contracture.

The Use of Umbilical Amnion for Conjunctival Socket, Fornix, and Eyelid Margin Reconstruction.

To describe outcomes using umbilical amnion for conjunctival fornix, socket, and eyelid margin reconstruction. A medical record review was performed to identify patients who had received umbilical amnion over a 2-year period in their department. Patient demographics, disease etiology, and data regarding surgical outcomes were collected. The primary outcome was the success rate of the surgical intervention. Twenty-one patients received umbilical amnion for anophthalmic socket contracture (n = 16), orbital implant exposure (n = 3), ocular surface burn (n = 1), and cicatricial entropion repair (n = 1). The primary outcome was met in 76% of patients overall. In anophthalmic socket contracture, the primary outcome was met in 86% and 0% of patients with acquired and congenital anophthalmia, respectively. The primary outcome was met in all cases of orbital implant exposure and cicatricial entropion. The primary outcome was not met in a Roper-Hall grade IV ocular surface burn. Umbilical amnion is an ideal substrate graft for reconstruction of the conjunctival fornix, socket, and eyelid margin. Umbilical amnion appears to be efficacious for the management of socket contracture in acquired anophthalmia, orbital implant exposure, and cicatricial entropion. Further experience is needed to determine the efficacy of umbilical amnion in ocular surface burns.

Novel Use of Cryopreserved Ultra-thick Human Amniotic Membrane for Management of Anophthalmic Socket Contracture.

To describe the use of cryopreserved ultra-thick human amniotic membrane for management of anophthalmic socket contracture. A chart review was performed to identify patients undergoing fornix reconstruction with cryopreserved ultra-thick human amniotic membrane for management of anophthalmic socket contracture. Patient demographics, disease etiology, and data regarding postoperative prosthesis fit and complications were collected. The technique is described in 3 female patients with anophthalmic socket contracture who underwent fornix reconstruction using cryopreserved ultra-thick human amniotic membrane. All patients had excellent prosthesis fit at final follow up (range, 10-14 months). There were no clinically significant complications and no reoperations were performed. One pyogenic granuloma developed and was excised without affecting ocular prosthesis fit. Cryopreserved ultra-thick human amniotic membrane is easy to use, well tolerated, and produces good outcomes for management of anophthalmic socket contracture.

Split-Skin-Graft Wrapped Conformer to Treat Severe Contracted Sockets.

This case series present the surgical management of cases with severe contracted sockets using a split-skin-graft wrapped conformer. Eight patients with severely contracted anophthalmic sockets underwent surgery. The surgical technique is described and a chart review was performed to collect patient data pre- and postoperatively. Preoperatively, all patients had grade 3 or 4 contracted sockets with shallow or obliterated fornices and patients were unable to retain an external prosthesis in place. Donor material was harvested from the supraclavicular area. The split-skin-graft was successfully performed in all cases without fornix-deepening sutures. All patients underwent a significant improvement of socket contracture enabling retention of the prosthesis and were satisfied with the outcomes. The split-skin-graft wrapped conformer is a rapid and less surgically challenging option to correct severe contracted anophthalmic sockets.

α-SMA Expression Increased Over Cell Passages and Decreased by Exogenous TGF-β1, In Vitro Studies on Myofibroblast Derived from Orbital Socket Contracture

α-smooth muscle actin (α-SMA), a marker of myofibroblast, induces cytoskeleton reorganization, increases contractility and stimulates cell migration in TGF-β1 induced stress fibers. The aims of the present study were to determine the level of α-SMA expression and morphological cell changes in different passages of myofi-broblasts with varied TGF-β1 concentrations. Myofibroblast cell cultures were derived from fibrotic tissues of fourth degree socket contracture. The α-SMA expression level was measured in myofibroblast cultures pas-sage I, II, and III with and without 10 ng/mL TGF-β1, and in passage III with 2.5; 5; 10; and 20 ng/mL TGF-β1. Results: The levels of α-SMA expression level in passage I to III were I 31.42 ± 3.4; 40.34 ± 8.14 and 56.37 ± 7.57, respectively. Addition of 10 ng/mL TGF-β1 into passage I-III myofibroblast cultures resulted in α-SMA expression level of 31.24 ± 2.93; 36.81 ± 6.09; and 14.29 ± 2.72, respectively. Myoblasts passage III showed the lowest α-SMA expression level following exposure to TGF-β1 10 ng/mL (22.37 ± 12.86) and highest without TGF-β1 (48.34 ± 13.36), however no morphological changes detected. α-SMA expression level increased with cell passages, decreases with addition of TGF-β1 while not affecting morphology of myofibroblast derived from the orbital socket contracture.

Postoperative outcomes of anophthalmic socket reconstruction using an autologous buccal mucosa graft.

Socket contracture is one of the most common and difficult problems in anophthalmic patients. This study intended to evaluate postoperative outcomes of anophthalmic socket reconstruction using an autologous buccal mucosa graft in patients with socket contracture. Medical records and photographs of 44 anophthalmic patients who underwent socket reconstruction surgery using an autologous buccal mucosa graft were reviewed retrospectively. The time necessary for the graft surface to be completely vascularized was assessed, and fornix depth was measured before and 6 months after surgery. Postoperative cosmetic and functional outcomes were evaluated, and the factors that influence postoperative outcomes were investigated. The surgery was performed without any significant complications, and the patients only complained of oral discomfort within 1 week. The graft surface was fully vascularized about 1.1 months after surgery. Mean fornix depth after surgery was significantly deeper than that before surgery (9.1 mm, about 68.2% of the vertical size of the implanted graft). Preoperatively, 50.0% of the patient had cosmetic grades 1 and 2; however, 63.6% of the patients achieved grade 4, and 93.2% had higher than grade 3 after surgery. In functional outcomes, 86.4% of the patients presented functional success. Graft recontracture occurred in only 2 patients. Preoperative severe socket contracture was a factor associated with worse cosmetic outcome (P = 0.001). An autologous buccal mucosa can be a safe and effective graft material for the reconstruction of a contracted socket.

Clinical and impression cytology findings of amniotic membrane and oral mucosal membrane transplantation for the management of socket contracture.

To investigate and compare the cytopathological and clinical effects of amniotic membrane transplantation (AMT) and oral mucosal membrane transplantation (OMMT) in socket contraction. Twelve patients who could not be fitted with ocular prosthesis due to socket contracture were included in this study. Seven patients underwent AMT and 5 patients underwent OMMT. Thirteen patients who had healthy sockets were included as control group. Depth of inferior fornix, degree of inflammation, extent of the socket contracture and socket volume were measured in the preoperative period and at sixth and twelfth weeks postoperatively. Impression cytology of conjunctival fornices and tear transforming growth factor beta-1 (TGFβ1) levels were determined. In the AMT group, socket volume and lower fornix depth values were significantly higher (P=0.030 and P=0.004 respectively) and inflammation levels and impression cytology stages (P=0.037 and P=0.022 respectively) were significantly lower in postoperative period compared to preoperative period. In the OMMT group, no statistical differences were found in terms of clinical parameters, inflammation levels and impression cytology stages of preoperative versus postoperative values. Preoperative tear TGFβ1 levels were higher in AMT and OMMT groups compared to the control group (25.5 ng/mL, 26.3 ng/mL and 21.7 ng/mL respectively). Decreased tear TGFβ1 levels were observed in both the AMT and OMMT groups postoperatively (median decrease value=2.1 ng/mL and 2.7 ng/mL respectively). AMT is associated with postoperative improvement in inferior fornix depth, socket volume, inflammation and impression cytology levels and may be a more proper alternative method than OMMT in the management of socket contracture.

The reconstruction of a contracted eye socket using a post-auricular full-thickness skin graft

To report the efficacy of a full-thickness skin graft (FTSG) for the reconstruction of a contracted eye socket. A retrospective, non-comparative, interventional case series. This was a retrospective review of patients with a contracted eye socket who underwent socket reconstruction using a post-auricular FTSG from 2001 to 2011 at the National Taiwan University Hospital. The postoperative results including prosthetic fitting, the cosmetic result, and eyelid function were assessed. There were 11 male and 15 female patients, with a mean age of 52.3 ± 15.6 years (range 21 to 76). The duration of the socket contracture varied from three months to three years (average 7.4 ± 8.1 months). The severity of the socket contracture ranged from grade 2 to grade 4, based on Tawfik's classification. The mean follow-up time was 35.7 ± 9.6 months. After socket reconstruction, using a post-auricular FTSG, 96% of the cases (25 of 26) demonstrated a successful prosthetic fitting and a satisfactory cosmetic outcome. Both good eyelid function and a stable fornix depth were maintained during the follow-up time. One case received a second socket reconstruction three months after the first operation, using a FTSG, because of an inadequate lateral fornix. The final result was satisfactory. There were no serious complications, but a granuloma formed in one case, and there was prolonged discharge in one case. The reconstruction of a contracted eye socket using a post-auricular FTSG is an effective method with a high success rate, which causes less discomfort to donor sites and results in few complications.

Use of Cyanoacrylate Glue for Temporary Tarsorrhaphy in Children

Congenital anophthalmia and postenucleation socket contracture are difficult conditions that require serial socket expansion with the use of hydrogel expanders and custom-made conformers along with temporary tarsorrhaphy. The authors undertook a part prospective case review of all children undergoing temporary tarsorrhaphy using cyanoacrylate glue over a 3-year period at a tertiary specialist children's hospital. They report a series of 7 children undergoing temporary tarsorrhaphy with cyanoacrylate glue instead of the conventional suturing technique. Indications were socket expansion (n = 4), fornix deepening (n = 2), prosthesis reposition, and prolapsed conjunctiva following enucleation (n = 1).The age range was 3 weeks to 14 years (mean, 2.7 years). The glue tarsorrhaphy lasted between 0.5 and 13 weeks (mean, 4.5 weeks). There were no adverse outcomes, and the glue tarsorrhaphy was tolerated well in all cases, with relative ease of reapplication of glue in clinic. Their study demonstrates that this technique allows quick and efficient temporary tarsorrhaphy with relative ease of reapplication in a clinic setting, avoiding the need for multiple general anesthetics.

Comparative analysis of use of porous orbital implant with mucus membrane graft and dermis fat graft as a primary procedure in reconstruction of severely contracted socket

Purpose:The purpose of our study is to present a surgical technique of primary porous orbital ball implantation with overlying mucus membrane graft (MMG) for reconstruction of severely contracted socket and to evaluate prosthesis retention and motility in comparison to dermis fat graft (DFG).Study Design:Prospective comparative study.Materials and Methods:A total of 24 patients of severe socket contracture (Grade 2-4 Krishna's classification) were subdivided into two groups, 12 patients in each group. In Group I, DFG have been used for reconstruction. In Group II, porous polyethylene implant with MMG has been used as a primary procedure for socket reconstruction. In Group I DFG was carried out in usual procedure. In case of Group II, vascularized scar tissues were separated 360° and were fashioned into four strips. A scleral capped porous polyethylene implant was placed in the intraconal space and four strips of scar tissue were secured to the scleral cap and extended part overlapped the implant to make a twofold barrier between the implant and MMG. Patients were followed-up as per prefixed proforma. Prosthesis motility and retention between the two groups were measured.Results:In Group I, four patients had recurrence of contracture with fall out of prosthesis. In Group II stable reconstruction was achieved in all the patients. In terms of prosthesis motility, maximum in Group I was 39.2% and Group II, was 59.3%. The difference in prosthesis retention (P = 0.001) and motility (P = 0.004) between the two groups was significant.Conclusion:Primary socket reconstruction with porous orbital implant and MMG for severe socket contracture is an effective method in terms of prosthesis motility and prosthesis retention.

Pediatric Anophthalmic Sockets and Orbital Implants: Outcomes with Polymer-Coated Implants

To compare wrapped and polymer-coated hydroxyapatite implants in children undergoing primary enucleation with no adjuvant therapies.Retrospective, interventional cohort study.All children undergoing primary enucleation without adjuvant therapies between 1999 and 2009 at a tertiary pediatric cancer hospital.Review and analysis of patient records.Implant exposure, extrusion and migration, socket contracture, and formation of pyogenic granuloma.Sixty consecutive patients undergoing primary enucleation with no adjuvant chemotherapy or radiation with follow-up of at least 12 months were included. Retinoblastoma was the diagnosis in 59 eyes (98.3%). Median follow-up was 3.6 years (range, 1.0-9.3 years). Two implant sizes were used: 20 mm in 47 patients (78.3%) and 18 mm in 13 patients (21.7%). Overall, 52 patients (86.7%) had an event-free recovery. Polymer-coated hydroxyapatite implants (43/60, 71.7%), when compared with wrapped ones (17/60, 28.3%), had a trend toward greater event-free recovery (odds ratio [OR], 1.6; 95% confidence interval [CI], 0.3-7.7) and lower exposure rate (OR, 2.1; 95% CI, 0.4-10.5).The use of polymer-coated hydroxyapatite implants is associated with favorable outcomes in the pediatric population. Despite observed complications, long-term implant retention is possible in most children.The author(s) have no proprietary or commercial interest in any materials discussed in this article.