Primary replacement for the management of exposed orbital implant.

Purpose: We present a series of primary orbital implant replacement for cases of implant exposure to describe our experience of this one-staged surgical approach. Methods: This study reports on a one-stage technique which involved the removal of the exposed implant or dermis fat graft (DFG) and insertion of a secondary (replacement) in the same procedure, with a variety of materials, including autologous tissue. Re-exposure in a socket where a DFG was placed was defined as a new defect in the newly epithelialized conjunctiva or dehiscence of the dermis-conjunctiva junction. All cases of primary replacement for the management of exposed orbital implant, porous and non-porous, were included, even when there were clinical signs suggestive of infection. The primary outcome was the rate of re-exposure, requiring additional surgical procedures. Infection following primary replacement was a secondary outcome. Results: Seventy-eight patients had primary replacement for the management of an exposed orbital implant. 6.4% had re-exposure at a mean follow-up of 49.7 months (9.1% for ball implants and 4.5% for DFG). The rate of exposure was higher in those with prior signs of infection than those without (8% vs. 3.6%). Re-exposure occurred in 4.5% of cases with DFG implantation, 4.3% of cases with non-porous implants and in 20% of cases with porous implants. Conclusion: Primary replacement for management of exposed orbital implant, porous and non-porous, has a high rate of successful outcome even in cases with presumed or confirmed infection.

Evaluation of the Northern Ireland National Artificial Eye Service: A Regional Audit of Patient and Prosthetic Characteristics.

PURPOSE: The purpose of this study is to establish an up-to-date baseline of the profile of patients using the National Artificial Eye Service in Northern Ireland and to understand key areas of service provision, to contribute to patient and health-care provider education, and thus to improve patient outcomes for future researchers. METHODS: A prospective audit of artificial eye wearers attending the Northern Ireland National Artificial Eye Service between May 18, 2015 and June 26, 2015 was conducted. RESULTS: A total of 131 patients, who attended consecutively for appointments over the 6-week period, were included: males 68%; females 32%. The majority of eyes were lost secondary to trauma (54%). In recent decades, medical causes have now taken over as the primary referral cause for prosthetic eyes. Approximately, one-third of patients attending the service required further education on how to maintain the hygiene of their ocular prosthesis. CONCLUSION: Patients attending artificial eye services should be further educated about using lubricants to maintain the hygiene of their prosthesis. Primary care health professionals (General Medical Practitioners and Primary Care Optometrists) should be informed about artificial eye services and of how to contact the service for advice if required. Trauma remains the most common cause for referral; however, in recent decades more patients are attending secondary to a medical cause of eye loss. Health service providers should be aware of the changing profile of patients attending artificial eye services and of the medical and traumatic causes of eye loss.