Diplopia ; etiology ; Fracture Fixation ; adverse effects ; methods ; Humans ; Orbital Fractures ; diagnosis ; diagnostic imaging ; surgery ; Orbital Implants ; Tomography, X-Ray Computed

Female ; Hemorrhage ; etiology ; Humans ; Middle Aged ; Orbital Diseases ; etiology ; Orbital Fractures ; surgery ; Prostheses and Implants ; adverse effects ; Silicones ; adverse effects ; Staphylococcal Infections ; etiology

OBJECTIVETo investigate the effects and complications of primary and secondary placements of motility coupling post (MCP) in the unwrapped porous polyethylene orbital implant (PPOI) following enucleation.

METHODSWe investigated 198 patients who received PPOI implantation following the standard enucleation procedure in the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, from 2002 to 2004. These patients were subgrouped into PPOI-only patients (112 cases, received PPOI following enucleation), primary MCP patients (46 cases, received primary placement of MCP during PPOI operation), and secondary MCP patients (40 cases, received secondary placement of MCP 6 months after the initial surgery). Effects and complications among these three groups were compared.

RESULTSThe PPOI-only patients took shorter treatment course when compared with other two MCP groups (P<0.001), without significant difference noted between the two MCP groups. However, the two MCP groups had better prosthetic motility than PPOI-only group (P<0.001), without significant difference between the two MCP groups. In the early stage, 2 eyes in the PPOI-only group and 1 eye in the primary MCP group had PPOI infection. In PPOI-only group, 3 (2.68%) eyes had PPOI exposure, which occurred after fitting the prostheses; 4 eyes (8.70%) in primary MCP group and 1 eye (2.50%) in secondary MCP had PPOI exposure, which occurred before fitting the prostheses. After prosthesis was fit successfully, the excessive discharge and granuloma were 33.9% and 1.79% in PPOI group-only, 53.3% and 8.9% in primary MCP group, and 52.5% and 7.5% in secondary MCP group, respectively.

CONCLUSIONBoth primary and secondary placements of MCP into the PPOI following enucleation can help patients to obtain desirable prosthetic motility, but may be associated with more complications. The primary placement of MCP with skilled operation in selected patients is more recommendable than secondary placement.

Adult ; Biocompatible Materials ; Eye, Artificial ; adverse effects ; Female ; Granuloma ; etiology ; Humans ; Infection ; etiology ; Male ; Middle Aged ; Movement ; Orbital Implants ; adverse effects ; Polyethylene ; Postoperative Complications ; etiology

Alloplastic implants are known to be inert for many years, though complications are infrequently reported many years after their insertion. We report the case of a patient who had undergone a blow-out fracture repair five years before the discovery of a hematic cyst. He had been free of symptoms for the first five years after his orbital floor repair but then developed pain on eyeball movement and persistent vertical diplopia, which finally led to surgical intervention. At surgery, a hematic cyst was found to have formed around the implanted silastic plate. When alloplastic material is used in orbital fracture repair, we should be alert for late complications which may occur many years after surgery.
Adult ; Biocompatible Materials ; *Blood ; Bone Cysts/diagnosis/*etiology ; Humans ; Male ; Orbital Diseases/diagnosis/*etiology ; Orbital Fractures/diagnosis/*surgery ; Postoperative Complications ; Prostheses and Implants/*adverse effects ; Reoperation ; Silicone Elastomers/*adverse effects ; Tomography, X-Ray Computed

PURPOSE: We present a case of orbital abscess following porous orbital implant infection in a 73-year-old woman with rheumatoid arthritis. METHODS: Just one month after a seemingly uncomplicated enucleation and porous polyethylene (Medpor(R)) orbital implant surgery, implant exposure developed with profuse pus discharge. The patient was unresponsive to implant removal and MRI confirmed the presence of an orbital pus pocket. Despite extirpation of the four rectus muscles, inflammatory granulation debridement and abscess drainage, another new pus pocket developed. RESULTS: After partial orbital exenteration, the wound finally healed well without any additional abscess formation. CONCLUSIONS: A patient who has risk factors for delayed wound healing must be examined thoroughly and extreme care such as exenteration must be taken if there is persistent infection.
Prosthesis-Related Infections/diagnosis/*etiology/surgery ; Porosity ; Orbital Implants/*adverse effects ; Orbital Diseases/diagnosis/*etiology/surgery ; Magnetic Resonance Imaging ; Humans ; Follow-Up Studies ; Female ; Eye Enucleation ; Device Removal ; Aged ; Abscess/diagnosis/*etiology/surgery

OBJECTIVETo evaluate the efficacy of semiconductor low level laser irradiation for the treatment of postoperative exposure of hydroxyapatite orbital implants.

METHODS22 cases with postoperative exposure of hydroxyapatite orbital implants were divided into three groups according to the size of implants exposure. The exposure wound in the 3 groups was irradated with semiconductor low level laser 5 min per day for 5-15 days. The follow-up period ranged from 2 to 24 months.

RESULTSIn the group with less then 3 mm of exposure, the wound healed in 1 week after 5-10 days irradiation; in the group with implant exposure of 4-7 mm, the would healed in 1-2 weeks after 10-15 days irradiation; in the group with implant exposure of 8-10 mm, the would healed in 2-3 weeks after 10-15 days irradiation. Compared with the treatments of drugs and/or surgical repair, which was used for another 20 cases of exposure of hydroxyapatite orbital implants, semiconductor low level laser increased healing rate obviously in the groups with implant exposure of 4-7 mm and 8-10 mm (P = 0.019, 0.018).

CONCLUSIONSemiconductor low level laser has better effects than drugs and/or surgical repair for exposure of hydroxyapatite orbital implants.

Adolescent ; Adult ; Aged ; Child ; Durapatite ; therapeutic use ; Eye ; pathology ; radiation effects ; Female ; Follow-Up Studies ; Humans ; Low-Level Light Therapy ; methods ; Male ; Middle Aged ; Orbital Implants ; adverse effects ; Postoperative Complications ; etiology ; radiotherapy ; Semiconductors ; Treatment Outcome