Secondary orbital ball implants after enucleation and evisceration: surgical management, morbidity, and long-term outcome

Purpose: To investigate effectiveness of a simplified surgical technique for secondary ball implantation in anophthalmic sockets and to compare long-term results of secondary ball implantation in patients previously enucleated or eviscerated. Methods: The study is a case series analysis of the clinical charts of 110 consecutive patients who underwent secondary ball implantation after enucleation or evisceration, from January 1998 to December 2011, under the care of 1 surgeon. Patients undergoing primary evisceration and implant exchange were excluded. Primary surgery was due to trauma in 48.8% patients, endophthalmitis and phthisis bulbi in 25.6%, tumors in 22.1%, and orbital vascular malformations in 3.5%. This study adheres to the principles outlined in the Declaration of Helsinki. Results: Of 110 identified cases, 24 were excluded for insufficient follow-up (less than 2 years); mean follow-up was 6.4 years. Group A patients (previously enucleated) received a polyglactin mesh-wrapped implant. Group B patients (previously eviscerated) kept their own sclera as a secondary anterior capping on the polyglactin mesh-wrapped implant. There were 2 implant exposures (4.9%; 2 of 41) in group A. Hard palate graft was used to repair the exposed implant successfully. No exposure was noted in group B. No statistically significant between-group difference in exposure rate was found. Conclusions: Stable secondary ball implantation can be achieved long term, and a reliable surgical technique is the most important factor in predicting implant stability. In patients who had secondary implants following evisceration, sclera and polyglactin mesh may act as duplicate barriers between anterior surface of implants and overlying tissues.