Update on surgical cosmetic solutions in equine ophthalmology.

Following eye removal surgery, ocular cosmetic solutions exist for the equine patient. The objective of this review is to summarize the current best evidence on equine ophthalmic cosmetic solutions. A literature review of ophthalmic cosmetic solutions in horses was conducted. Four cosmetic solutions are described. Cosmetic outcome, return to work, owner satisfaction, complication rates, implant choice and future perspectives are discussed under the light of most recent publications. Seventeen peer-reviewed articles were selected: five retrospective studies, four case series, five case reports and three narrative reviews. Additionally, two congress proceedings were included. Recent publications identify intrascleral prosthesis and intraorbital implants adjoined to a corneoscleral shell as cosmetically superior. The orbital meshwork implant requires improvement to be cosmetically acceptable. Return to work is deemed feasible and standing sedation is an option for orbital implant placement beneath sutured eyelids. 3D printing creates new possibilities for implant development.

A Decade of Evisceration: Investigating the Influence of Demographic, Clinical, and Psychosocial Factors.

Objectives: The study aimed to evaluate the demographic and clinical characteristics of evisceration cases and to assess the psychosocial effects of prosthesis usage using the newly defined Global Ocular Prosthesis Score (GOPS). Methods: The records of 245 patients who underwent evisceration surgery between January 2010 and May 2021 were retrospectively reviewed. The study included 216 eyes of 216 patients who had regular follow-up of at least 6 months. Their demographic characteristics, indications for surgery, surgical methods, implant size, and complications were recorded. A total of 175 patients with ocular prostheses were evaluated using a 20-item questionnaire called GOPS. Results: About 154 of the 216 patients were male (71.3%), and 62 were female (28.7%), with a mean age of 34.9 years (range: 3-83). The mean follow-up duration was 52.5±34.2 months (range: 6-125). Among the cases, 101 (46.7%) had a penetrating globe injury, 91 (42.1%) had painful absolute eyes, 10 (4.6%) had corneal abscess, 8 (3.7%) had painless blind eyes due to Behçet's disease, 7 (3.2%) had endophthalmitis, 1 (0.04%) had prematurity retinopathy, 1 (0.04%) had corneal melting due to toxic epidermal necrolysis, and phthisis bulbi. Most of the traumas (74.5%) were caused by young (mean age 33.6 years) males. Sphere extrusion was observed in 16 (7.4%) patients at an average of 3 months (15 days to 6 months). Tenon cyst excision was performed in two patients. The mean GOPS was 71.74. Conclusion: It has been observed that the most common reasons for evisceration in a tertiary eye hospital are globe injuries and painful eyes. Although losing an eye can have negative physical and psychological effects on patients and may prevent them from fulfilling their social roles, it has been observed that the use of ocular prostheses positively impacts patient satisfaction. The use of the GOPS questionnaire can be helpful in assessing the quality of life of evisceration patients.

The impact of polydioxanone (PDS) foil thickness on reconstruction of the orbital geometry after isolated orbital floor fractures.

PURPOSE: The orbital floor is frequently involved in head trauma. Current evidence on the use of reconstruction materials for orbital floor repair is inconclusive. Accordingly, this study aimed to compare the impact of polydioxanone (PDS) foil thickness on reconstruction of the orbital geometry after isolated orbital floor fractures. METHODS: Standardized isolated orbital floor fractures were symmetrically created in 11 cadaver heads that provided 22 orbits. PDS foils with thicknesses of 0.25-0.5 mm were inserted. Computed tomography (CT) scans of the native, fractured, and reconstructed orbits were obtained, and orbital volume, orbital height, and foil bending were measured. RESULTS: Orbital volume and height significantly (p < 0.01) increased after the creation of isolated orbital floor fractures and significantly (p = 0.001) decreased with overcorrection of the orbital geometry after orbital floor reconstruction with PDS 0.25 mm or PDS 0.5 mm. The orbital geometry reconstruction rate did not differ significantly with respect to foil thickness. However, compared to PDS 0.5 mm, the use of PDS 0.25 mm resulted in quantitatively higher reconstructive accuracy and a restored orbital volume that did not significantly differ from the initial volume. CONCLUSION: Orbital floors subjected to isolated fractures were successfully reconstructed using PDS regardless of foil thickness, with overcorrection of the orbital geometry. Due to its lower flexural stiffness, PDS 0.25 mm appeared to provide more accurate orbital geometry reconstruction than PDS 0.5 mm, although no significant difference in reconstructive accuracy between PDS 0.25 mm and PDS 0.5 mm was observed in this cadaveric study.

Surgical management of orbital implant exposures after evisceration or enucleation: Retrospective study - Limoges University Hospital.

INTRODUCTION: Implant exposure is the most frequent complication after evisceration or enucleation, and multiple surgical techniques for the management of orbital implant exposure. The goal of our study is to investigate the success rate and risk factors for failure of various surgical procedures. METHODS: This was a retrospective study performed at the University Hospital of Limoges. We collected data from the files of every patient operated on for implant exposure between January 2005 and December 2020. The main criterion was the percentage of success for each procedure. Secondary objectives were to identify risk factors for failure of Müller's muscle flaps and to determine the incidence of post-enucleation socket syndrome depending on whether the orbital implant was maintained. RESULTS: Fifty-one patients were included: 26 patients who underwent Müller's muscle flap, 16 dermis-fat graft, 3 conjunctival flap, 2 amniotic membrane graft, 1 temporalis fascia graft, 1 buccal mucosa graft, 1 implant rotation, and 1 implant exchange. The dermis-fat grafts were more successful (87.5%) than the Müller's muscle flaps (52.2%) (P=0.0213). The study highlighted the importance of good vascularization of the implant (OR=32.00, P-value=0.0245) for the success of Müller's muscle flaps, and we found no statistically significant difference between the patients who maintained their implants and those who did not (P=0.3865) with regard to the incidence of post-enucleation socket syndrome. CONCLUSION: Müller's muscle flap may remain a reasonable option in the management of medium-sized implant exposures of well-vascularized implants confirmed on MRI in patients with no systemic healing disorders. Dermis-fat graft remains the option of choice in other cases, especially in large exposures or complicated orbits.

Presurgical Virtual Planning and Intraoperative Navigation with 3D-Preformed Mesh: A New Protocol for Primary Orbital Fracture Reconstruction.

PURPOSE: This pilot study aims to evaluate the feasibility and effectiveness of computer-assisted surgery protocol with 3D-preformed orbital titanium mesh (3D-POTM), using presurgical virtual planning and intraoperative navigation in primary inferomedial orbital fracture reconstruction. METHODS: Between March 2021 and March 2023, perioperative data of patients undergoing surgery for unilateral inferomedial orbital fracture treated with 3D-POTM were analyzed. Presurgical virtual planning with a Standard Triangle Language file of preformed mesh was conducted using the mirrored unaffected contralateral side as a reference, and intraoperative navigation was used. The reconstruction accuracy was determined by: correspondence between postoperative reconstruction mesh position with presurgical virtual planning and difference among the reconstructed and the unaffected orbital volume. Pre- and postoperative diplopia and enophthalmos were assessed. RESULTS: Twenty-six patients were included. Isolated orbital floor fracture was reported in 14 (53.8%) patients, meanwhile medial wall and floor one in 12 (46.1%) cases. The mean difference between final plate position and ideal digital plan was 0.692 mm (95% CI: 0.601-0.783). The mean volume difference between reconstructed and unaffected orbit was 1.02 mL (95% CI: 0.451-1.589). Preoperative diplopia was settled out in all cases and enophthalmos in 19 (76.2%) of 21 patients. CONCLUSION: The proposed protocol is an adaptable and reliable workflow for the early treatment of inferomedial orbital fractures. It enables precise preoperative planning and intraoperative procedures, mitigating pitfalls and complications, and delivering excellent reconstruction, all while maintaining reasonable costs and commitment times.

Tongue-in-Groove: A Novel Implant Design for a Blow-Out Fracture.

Background: During blow-out fracture surgery, restoration of the orbital volume and rigid implant fixation are essential. The migration of an implant is a concern of most surgeons. The purpose of this study was to introduce a simple idea of molding and fixing an orbital implant. Methods: In the tongue-in-groove method, an incision of about 2 mm was made on the edge of the implant and it was bent to form a slot. A hole was made in the center of the implant for fitting a bone hook, and the implant was firmly fit into the remaining intact bone. Before and after surgery, computed tomography (CT) was used to evaluate changes in the orbital volume and the location of the implant. Statistically significant restoration of the orbital volume was confirmed on postoperative CT. Results: Compared with the unaffected orbital volume, the affected orbital volume was increased from 87.06 ± 7.92% before surgery to 96.14 ± 6.11% after surgery (p < 0.001). There was one case of implant migration during follow-up. However, the degree of movement was not severe, and there were no events during the follow-up period. Conclusions: The tongue-in-groove technique offers advantages, such as easy fixation of the implant, with minimal trauma to the surrounding tissues. In addition, the method offers advantages, such as being easy to learn, requiring little time for trimming the implant, and being relatively low cost. Therefore, it can be one of the options for implant fixation.

Customized orbital implant versus 3D preformed titanium mesh for orbital fracture repair: A retrospective comparative analysis of orbital reconstruction accuracy.

This study aimed to compare the accuracy of inferomedial orbital fracture restoration using customized orbital implant versus 3D preformed titanium mesh. Patients were divided into two groups. Group 1 underwent surgery with customized orbital implants and intraoperative navigation, while group 2 was treated using 3D preformed titanium meshes with preoperative virtual surgical planning (VSP) and intraoperative navigation. Reconstruction accuracy was assessed by: (1) comparing the postoperative reconstruction mesh position with the preoperative VSP; and (2) measuring the difference between the reconstructed and unaffected orbital volume. Pre- and postoperative diplopia and enophthalmos were also evaluated. Fifty-two patients were enrolled (25 in group 1 vs 27 in group 2). The mean difference between final plate position and ideal digital plan was 0.62 mm (SD = 0.235) in group 1 and 0.69 mm (SD = 0.246) in group 2, with no statistical difference between the groups (p = 0.282). The mean volume differences between the reconstructed and unaffected orbits were 0.95 ml and 1.02 ml in group 1 and group 2, respectively, with no significant difference between the groups (p = 0.860). Overall clinical improvements, as well as complications, were similar. 3D preformed titanium meshes can reconstruct inferomedial fractures with the same accuracy as customized implants. Therefore, in clinical practice, it is recommended to use 3D preformed meshes for this type of fracture due to their excellent results and the potential for reducing time and costs.

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

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.

Surgical outcomes of unwrapped acrylic orbital implants: A review of 192 patients.

PURPOSE: The purpose of this study is to report the results in a series of acrylic orbital implant placements without the use of wrapping material. METHODS: We retrospectively reviewed the records of the patients who underwent enucleation with acrylic orbital implant insertion without scleral wrapping at the Department of Ophthalmology, Poznan University of Medical Sciences, Poland, between 2013 and 2020. RESULTS: There were 192 patients: 102 women and 90 men, mean age: 60 years (range: 13-90 years). In the majority of cases, the reason for enucleation was uveal melanoma (148 patients-77.1%), followed by secondary glaucoma in 22 patients (11.5%) and painful, phthisical eye in 16 (8.3%). The median follow-up was 23 months (range: 1-96 months). The stability of the implants was satisfactory in the majority of cases, and there were no cases of implant migration identified during the study period. We noted a total of 4 (2%) implant exposures. Other postoperative complaints included eyelid malposition-21 patients (11%), Tenon's capsule thinning (15 patients-7.8%) and post-enucleation eye socket syndrome (PEES)-7 patients (3.6%). The rate of postoperative complications was associated only with a history of previous ocular surgery (P=0.006). CONCLUSIONS: The stability and functional outcomes of unwrapped acrylic orbital implants in this group of patients were satisfactory during the follow-up period.

Foam Sclerotherapy for Conjunctival Inclusion Cyst Post Evisceration.

Orbital conjunctival epithelial cysts have traditionally been excised, with the risk of leaving behind remnants that may result in recurrences. We present an 18-year-old male who complained of a poorly retained prosthesis three years after a primary evisceration and polymethylmethacrylate (PMMA) ball implant. We performed cyst aspiration and injection foam sclerotherapy for the cyst, which resolved completely in six weeks, allowing the prosthesis to be retained comfortably. Aspiration and injection of sclerosing agents may result in the collapse of the cyst along with fibrosis of their walls with obliteration of the lumen, resulting in complete resolution.

[Embedded 3D printing of porous silicon orbital implants and its surface modification].

OBJECTIVE: To prepare customized porous silicone orbital implants using embedded 3D printing and assess the effect of surface modification on the properties of the implants. METHODS: The transparency, fluidity and rheological properties of the supporting media were tested to determine the optimal printing parameters of silicone. The morphological changes of silicone after modification were analyzed by scanning electron microscopy, and the hydrophilicity and hydrophobicity of silicone surface were evaluated by measuring the water contact angle. The compression modulus of porous silicone was measured using compression test. Porcine aortic endothelial cells (PAOECs) were co-cultured with porous silicone scaffolds for 1, 3 and 5 days to test the biocompatibility of silicone. The local inflammatory response to subcutaneous porous silicone implants was evaluated in rats. RESULTS: The optimal printing parameters of silicone orbital implants were determined as the following: supporting medium 4% (mass ratio), printing pressure 1.0 bar and printing speed 6 mm/s. Scanning electron microscopy showed that the silicone surface was successfully modified with polydopamine and collagen, which significantly improved hydrophilicity of the silicone surface (P < 0.05) without causing significant changes in the compression modulus (P > 0.05). The modified porous silicone scaffold had no obvious cytotoxicity and obviously promoted adhesion and proliferation of PAOECs (P < 0.05). In rats bearing the subcutaneous implants, no obvious inflammation was observed in the local tissue. CONCLUSION: Poprous silicone orbital implants with uniform pores can be prepared using embedded 3D printing technology, and surface modification obviously improves hydrophilicity and biocompatibility of the silicone implants for potential clinical application.

Comparison of Anatomical Preformed Titanium Implants and Patient-Specific CAD/CAM Implants in the Primary Reconstruction of Isolated Orbital Fractures-A Retrospective Study.

BACKGROUND/AIM: Reconstruction of the fractured orbit remains a challenge. The aim of this study was to compare anatomical preformed titanium orbital implants with patient-specific CAD/CAM implants for precision and intraoperative applicability. MATERIAL AND METHODS: A total of 75 orbital reconstructions from 2012 to 2022 were retrospectively assessed for their precision of implant position and intra- and postoperative revision rates. For this purpose, the implant position after digital orbital reconstruction was checked for deviations by mirroring the healthy orbit at 5 defined points, and the medical records of the patients were checked for revisions. RESULTS: The evaluation of the 45 anatomical preformed orbital implant cases showed significantly higher deviations and an implant inaccuracy of 66.6% than the 30 CAD/CAM cases with only 10% inaccuracy. In particular, the CAD/CAM implants were significantly more precise in medial and posterior positioning. In addition, the intraoperative revision rates of 26.6% vs. 11% after 3D intraoperative imaging and the postoperative revision rates of 13% vs. 0 for the anatomical preformed implants were significantly higher than for patient-specific implants. CONCLUSION: We conclude that patient-specific CAD/CAM orbital implants are highly suitable for primary orbital reconstruction. These seem to be preferable to anatomical preformed implants in terms of precision and revision rates.

An Ex Vivo Pilot Study to Assess the Feasibility of 3D Printing of Orbital Implants in Horses.

Severe ophthalmic conditions such as trauma, uveitis, corneal damage, or neoplasia can lead to eye removal surgery. Poor cosmetic appearance resulting from the sunken orbit ensues. The aim of this study was to demonstrate the feasibility of manufacturing a custom-made 3D-printed orbital implant made of biocompatible material for the enucleated horse and usable in conjunction to a corneoscleral shell. Blender, a 3D-image software, was used for prototype design. Twelve cadaver heads of adult Warmbloods were collected from the slaughterhouse. On each head, one eye was removed via a modified transconjunctival enucleation while the contralateral eye was kept intact as control. Ocular measurements were collected on each enucleated eye with the help of a caliper and used for prototype sizing. Twelve custom-made biocompatible porous prototypes were 3D-printed in BioMed Clear resin using the stereolithography technique. Each implant was fixated into the corresponding orbit, within the Tenon capsule and conjunctiva. Heads were frozen and thin slices were then cut in the transverse plane. A scoring system based on four criteria (space for ocular prosthesis, soft-tissue-coverage, symmetry to the septum, and horizontal symmetry), ranging from A (proper fixation) to C (poor fixation), was developed to evaluate implantation. The prototypes reached our expectations: 75% of the heads received an A score, and 25% a B score. Each implant cost approximately 7.30€ and took 5 hours for 3D-printing. The production of an economically accessible orbital implant made of biocompatible porous material was successful. Further studies will help determine if the present prototype is usable in vivo.

Intraosseous hemangioma of the orbit: a case report involving pre-operative embolization with reconstruction using a custom porous polyethylene implant.

A 28-year-old female presented with a slowly enlarging, left cheek mass over two years. She underwent neuroimaging and was found to have a well-defined, low attenuating lesion with thickened vertical trabeculation of the left zygoma, consistent with intraosseous hemangioma. To minimize the risk of severe intraoperative hemorrhage, the patient underwent embolization of the mass by neuro-interventional radiology two days prior to resection. The patient subsequently underwent a left anterior orbitotomy and partial zygoma resection followed by reconstruction of the lateral orbit with a custom porous polyethylene zygomaxillary implant. The postoperative course was uneventful with a good cosmetic outcome.

Single or double? A comparison of evisceration techniques.

PURPOSE: We compared the rates of implant exposure and extrusion after evisceration with single and double scleral closure techniques. METHODS: This retrospective cohort study included all patients who underwent evisceration with an implant insertion over the past 18 years at Tung Wah Eastern Hospital and Pamela Youde Nethersole Eastern Hospital. Clinical documents and operation records were reviewed. RESULTS: A total of 81 ethnic Chinese patients (44 male) who underwent evisceration with primary implant insertion were reviewed. 39 (48%) patients underwent the double scleral closure technique with an implant placed posterior to the posterior sclera, and 42 (52%) patients underwent the single scleral closure technique with an implant inserted in the intra-scleral cavity. The follow-up interval was 70 months. The surgical indications were endophthalmitis (35%), painful blind eye (23%), traumatic disfigured globe (22%) and phthisis bulbi (20%). Silicone was the most used implant material (69%). The patients who underwent double scleral closure had a larger size of the implant (19.7 vs 17.9 mm, p < 0.05). Both implant exposure (26% vs 3%, p < 0.05) and implant extrusion (26% vs 0%, p < 0.05) were more common in patients who underwent single scleral. CONCLUSIONS: Double scleral closure technique allows a larger implant, and it is associated with a lower rate of implant exposure and extrusion. The double scleral closure technique is a superior technique of choice in these patients with primary implant placement.

Non-visual complications of orbital cellulitis (NVCOC) in pediatric vs adult populations.

PURPOSE: There have been many publications evaluating the visual outcomes of patients treated for orbital cellulitis. The aim of this study was to evaluate non-visual complications of post-septal orbital cellulitis (NVCOC) present 30 days after discharge from index hospitalization. METHODS: This was an IRB-approved, retrospective chart review. RESULTS: Ninety patients (45 pediatric, 45 adults) were identified with OC. NVCOC were significantly more common in adult patients as compared to children (40.0% vs 15.6% respectively; p < 0.05). The most common NVCOC among children was persistent ptosis, while clinically significant scarring was most common in adults. NVCOC were less persistent in children as compared to adults with 71.4% of complications in children resolving spontaneously by 6 month follow up as compared to 11.1% adults. (p < 0.05). The only statistically significant risk factor identified for the development of NVCOC in children and adults was the presence of ICE (intracranial extension) during index hospitalization (p < 0.05) and the presence of an infected orbital implant (p < 0.05) respectively. CONCLUSIONS: Adult patients experience NVCOC complications more often than children. Furthermore, the nonvisual complications in children are more likely to resolve spontaneously than those in adults. The intracranial spread of infection is a significant risk factor for late complications in children. The presence of an orbital wall/floor implant is a significant risk factor for late complications in adults. There are many differences in the etiology, pathophysiology, and course of NVCOC in children and adults, so information on these two populations should be reported separately.

Embedded 3D printing of porous silicon orbital implants and its surface modification / 南方医科大学学报

OBJECTIVE@#To prepare customized porous silicone orbital implants using embedded 3D printing and assess the effect of surface modification on the properties of the implants.@*METHODS@#The transparency, fluidity and rheological properties of the supporting media were tested to determine the optimal printing parameters of silicone. The morphological changes of silicone after modification were analyzed by scanning electron microscopy, and the hydrophilicity and hydrophobicity of silicone surface were evaluated by measuring the water contact angle. The compression modulus of porous silicone was measured using compression test. Porcine aortic endothelial cells (PAOECs) were co-cultured with porous silicone scaffolds for 1, 3 and 5 days to test the biocompatibility of silicone. The local inflammatory response to subcutaneous porous silicone implants was evaluated in rats.@*RESULTS@#The optimal printing parameters of silicone orbital implants were determined as the following: supporting medium 4% (mass ratio), printing pressure 1.0 bar and printing speed 6 mm/s. Scanning electron microscopy showed that the silicone surface was successfully modified with polydopamine and collagen, which significantly improved hydrophilicity of the silicone surface (P < 0.05) without causing significant changes in the compression modulus (P > 0.05). The modified porous silicone scaffold had no obvious cytotoxicity and obviously promoted adhesion and proliferation of PAOECs (P < 0.05). In rats bearing the subcutaneous implants, no obvious inflammation was observed in the local tissue.@*CONCLUSION@#Poprous silicone orbital implants with uniform pores can be prepared using embedded 3D printing technology, and surface modification obviously improves hydrophilicity and biocompatibility of the silicone implants for potential clinical application.

[Morphological evaluation of orbital implants in postenucleation reconstruction (an experimental study)]. / Morfologicheskaya otsenka orbital'nykh implantatov v postenukleatsionnoi rekonstruktsii (eksperimental'noe issledovanie).

About 12 thousand surgeries for eyeball removal are performed every year in the Russian Federation. Formation of the supporting stump and implantation of the proper orbital implant is essential for successful cosmetic prosthesis. PURPOSE: Comparison of materials biocompatibility, design of different orbital implants and morphological condition of formed postenucleation stumps in an in vivo experiment. MATERIAL AND METHODS: In the course of the study 24 rabbits were operated, divided into three comparable groups. Enucleation with primary implantation of an orbital implant was performed in all subjects. The following implants were used: polymeric orbital implant - in the main (experimental) group, polytetrafluorethylene insertion implant - in the control group 1, and silicone endoprosthesis - in the control group 2. We assessed features of the implantation process, implant design, general condition of the operated animals, condition of the postenucleation stumps, passive motility of the stumps, and reaction of the surrounding tissues to the implants. RESULTS: Performed surgeries did not negatively affect the general condition of the rabbits, and there was no significant local tissue reaction to the implants. The structural and design features of the implants used in the main group were found to be more convenient for implantation, ensured stable fixation and position in the orbit. Postenucleation stump motility was comparable in all groups during the early postoperative period. This parameter decreased at later follow-up times mostly in the control group 2. When extracting the implants, it was revealed that in the main group it had secure fixation to the orbital tissues and stable position, did not cause abundant proliferation of connective tissue. Pathomorphological examination revealed that tissue reaction to the implants was less prominent and was reversed soon with fine connective tissue capsule formation in the main group and control group 2. In the control group 1 tissue reaction increased progressively, and capsule formation was delayed. CONCLUSION: Polymeric implant is the most suitable orbital implant for postenucleation orbital reconstruction.

An Orbital Mystery: A Unique Case of an Obsolete Orbital Implant With a Review of Orbital Implant Materials.

Orbital implant materials have evolved greatly over the past century and include but are not limited to metal, ceramic, polymer, silicone, and glass. Knowledge of historically used materials is clinically relevant to patient care as certain materials carry a greater risk of migration, extrusion, infection, and limitations for imaging modalities utilized to visualize adjacent structures. We report an unusual case of an 80-year-old male who presented to our community hospital with seizure-like activity. CT imaging of the brain revealed several white matter and cortex lesions with the largest lesion measuring 2.5 × 2 × 1.9 cm. The patient had a history of enucleation with placement of an orbital implant following a penetrating injury to the left eye at four years of age. Hounsfield scale analysis was read by radiology as being most consistent with a thin metallic shell surrounding the orbital implant. The potential for metallic material was consistent with the implant's age and time of placement. Few reviews on ocular implant materials from this period exist in the current medical literature. A single case report discussing a hollow metal orbital implant with similar-appearing imaging was identified. Due to concern for possible metal implant materials, the patient underwent implant exchange so MRI imaging could safely be performed. Intraoperatively, the implant was identified as a clear, hollow, non-metallic, non-porous polymer sphere. Following surgery, the patient was able to undergo appropriate neuroimaging with subsequent diagnostic biopsy. Current literature reviewing CT or photographic imaging of ocular implant devices prior to the 1940s is limited. This case highlights the importance of detailing materials historically used in orbital implants, their effects on clinical decision-making, and the utility of Hounsfield scale values to identify a material's radiodensity on CT imaging.

Trends in Eye Removal Surgeries at a Tertiary Care Hospital Over Three Decades.

PURPOSE: To determine the trends in eye removal surgeries at a tertiary hospital in Nigeria over 26 years. METHODS: A retrospective comparative review of clinical records of all patients who had eye removal surgery at a tertiary hospital in Ile-Ife, Nigeria, between 2014 and 2019 was done. Patients' demographic and clinical data, including indication for eye removal and type of surgery were analysed and compared with two earlier studies at the same hospital between 1994 and 2013. RESULTS: There was an average of 14.3 surgeries per year between 2014 and 2019. Patients' ages ranged from 2 to 102 years, M:F was 1.5:1, the commonest indication for eye removal was infection (n=30, 34.9%), and the most common surgery was evisceration (n=70, 81.4%). Studies from 1994 to 2003 and 2005 to 2013, reported an average of 9.2 and 10 surgeries per year; ages ranging from 4 days to 88 years and 3 months to 88 years; with a M:F of 2.1:1 and 3.4:1 respectively. In both studies, the commonest indication for eye removal was trauma (43.4% and 43.8% respectively) and the most common surgery was enucleation (57.6% and 55% respectively). Trend data showed a progressive increase in eye infections (12% vs 15% vs 34.9%) and eviscerations (19.6% vs 31.2% vs 81.4%) over time. CONCLUSION: There was a change in trend towards an increase in eviscerations and infective indications for eye removal at the hospital over three decades. Prompt and optimal treatment of orbito-ocular infections is recommended to reduce the incidence of eye removal surgeries.

BUT: Déterminer les tendances des chirurgies d'ablation de l'oeil dans un hôpital tertiaire du Nigeria sur une période de 26 ans. MÉTHODES: Un examen comparatif rétrospectif des dossiers cliniques de tous les patients ayant subi une chirurgie d'ablation de l'œil dans un hôpital tertiaire d'Ile-Ife, au Nigeria, entre 2014 et 2019, a été effectué. Les données démographiques et cliniques des patients, y compris l'indication de l'ablation de l'œil et le type de chirurgie, ont été analysées et comparées à deux études antérieures menées dans le même hôpital entre 1994 et 2013. RÉSULTATS: Il y avait une moyenne de 14,3 chirurgies par an entre 2014 et 2019. L'âge des patients allait de 2 à 102 ans, le rapport M:F était de 1,5:1, l'indication la plus courante pour l'ablation de l'œil était l'infection (n=30, 34,9%), et la chirurgie la plus fréquente était l'éviscération (n=70, 81,4%). Les études menées de 1994 à 2003 et de 2005 à 2013 ont fait état d'une moyenne de 9,2 et 10 interventions chirurgicales par an, d'âges allant de 4 jours à 88 ans et de 3 mois à 88 ans, et d'un rapport M:F de 2,1:1 et 3,4:1 respectivement. Dans les deux études, l'indication la plus courante pour l'ablation de l'œil était le traumatisme (43,4 % et 43,8 % respectivement) et la chirurgie la plus courante était l'énucléation (57,6 % et 55 % respectivement). Les données sur les tendances ont montré une augmentation progressive des infections oculaires (12 % vs 15 % vs 34,9 %) et des éviscérations (19,6 % vs 31,2 % vs 81,4 %) au fil du temps. CONCLUSION: On constate un changement de tendance vers une augmentation des éviscérations et des indications infectieuses pour l'ablation des yeux à l'hôpital sur trois décennies. Un traitement rapide et optimal des infections orbitooculaires est recommandé pour réduire l'incidence des chirurgies d'ablation des yeux. Mots clés: Anesthésie, énucléation, éviscération, exentération, implant orbitaire, tendances.