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

PURPOSE: To assess long-term outcomes and reinterventions for exposed and nonexposed intraconal orbital implants after single-stage socket revisional surgery. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Type IV Hypersensitivity to Gold Weight Upper-Eyelid Implant: Case Report and Review of the Literature.

PURPOSE: Complications associated with gold-weight insertion for lagophthalmos are uncommon, recent reports have provided evidence to suggest that type IV hypersensitivity to gold can cause a persistent inflammatory reaction. METHODS: We present a case of a 46-year-old man who experienced persistent post-operative inflammation, and summarize previously documented cases. This patient underwent uncomplicated insertion of an upper eyelid gold weight for right-sided facial nerve palsy. He had no allergies or implanted metalwork. Post-operatively erythema was noted at seven-weeks and did not resolve. The weight was removed after six-months. RESULTS: The histopathological findings were in keeping with type IV hypersensitivity and similar to previous cases. CONCLUSIONS: Although infrequent, this complication has poor outcomes. The definitive management is removal of the weight. Information regarding implanted gold, and previous reactions should be elicited pre-operatively. Type IV hypersensitivity should be considered in patients with persistent inflammation that do not respond to antibiotic or steroid therapy.

Rate of posterior capsule opacification in eyes with the Akreos intraocular lens.

PURPOSE: To determine the rate of posterior capsule opacification (PCO) in eyes with an Akreos Adapt or Akreos Fit intraocular lens (IOL) (Bausch & Lomb) over a minimum follow-up of 18 months. SETTING: Department of Ophthalmology, Worthing and Southlands Hospital NHS Trust, Worthing, United Kingdom. METHOD: This was a retrospective analysis of 102 patients who had uneventful phacoemulsification with implantation of an Akreos Adapt IOL or Akreos Fit IOL from September 2001 to May 2004. Patients from a single surgeon's operating list were recruited into the study. Exclusion criteria included posterior subcapsular cataract, history of uveitis, diabetic retinopathy, glaucoma, and age-related macular degeneration. The protocol included the determination of logMAR best corrected visual acuity (BCVA) and PCO scoring using the Evaluation of Posterior Capsular Opacification System (EPCO 2000) by digital photography of the posterior capsule. The number of patients having a neodymium:YAG (Nd:YAG) capsulotomy was also recorded. RESULTS: The mean follow-up was 30 months +/- 10.3 (SD). The mean BCVA was 20/32 (0.2 logMAR). The mean EPCO score at the central 6.0 mm of the posterior capsule was 0.39 +/- 0.53 and at the central 3.0 mm, 0.18 +/- 0.40. The Nd:YAG capsulotomy rate was 8.8%. CONCLUSIONS: All patients had stable visual acuity with low rates of PCO 2.5 years after surgery. The PCO rate with the Akreos IOL was similar to that with other acrylic IOLs reported in the literature.