Micropulse laser trabeculoplasty under maximal tolerable glaucoma eyedrops: treatment effectiveness and impact of surgical expertise

AIM: To retrospectively compare postoperative outcomes after primary enucleation and placement of a hydroxyapatite (HA) implant without wrapping, wrapped with auricular cartilage or donor sclera. METHODS: Medical records of patients presented as intraocular tumor or severe ocular injury were identified from the electronic medical record system. Cases underwent enucleation and HA orbital implantation were enrolled in this study and were divided into 3 groups according to the wrapping material of HA implant. Cases with autogenous cartilage caps were enrolled in group A (n=11), with donor sclera caps in group B (n=12), and without any wrapping material in group C (n=9). Follow-ups were set at 1, 2wk,1, 3, 6, and 12mo after surgery. RESULTS: Altogether 32 cases finished the follow-up and were enrolled in this study. Three cases (27.27%) in group A, 4 cases (33.33%) in group B, and 4 cases (44.44%) in group C developed one complication each after surgery. No HA exposure occurred in group A and 3 cases (27.27%) developed mild complications, including one conjunctival inclusion cysts and two severe conjunctive chemosis. One (8.33%) HA exposure occurred in group B and 3 other cases (25%) developed mild complications, including one conjunctive inclusion cysts, one severe conjunctive chemosis, and one conjunctival granuloma. One (11.11%) HA exposure occurred in group C and 3 other cases (33.33%) developed mild complications, including one conjunctive granulation and two severe conjunctive chemosis. The case of exposure of none-wrapped implant was noted in the first 6mo after placement of the orbital implant. The case of exposure of donor sclera-wrapped implant was noted at the 12mo after placement of the orbital implant. Both exposure cases were treated successfully with conservative treatment.CONCLUSION: With low incidence of implant exposure and mild complications, auricular cartilage can be a good choice of alternative wrapping material of orbit implant with satisfied outcome.