Cyst Formation Associated with Porous Polyethylene Orbital Floor Implant

A 28-year-old female presented with hyperglobus and inferior scleral show after the repair of an orbital floor fracture using a porous polyethylene (Medpor) implant. CT revealed a large inferior orbital cystic mass displacing the globe. The cyst was explored and excised and the implant was found to be free from any attachment to surrounding tissues and hence, removed without difficulty. The reason for the cyst development was most likely inadvertent epithelial inclusion at the time of surgery-a recognized risk with insertion of any foreign body via transconjunctival approach. Porous implants when placed in the subperiosteal space might not get incorporated with surrounding tissues and therefore behave like any traditional nonporous alloplastic material.     

Porous orbital implants in enucleation: a systematic review

Orbital implants have been used for cosmesis following surgical removal of the eyeball, or enucleation, for over a century. Implant design has progressed significantly in recent years with the use of porous devices, with the theoretical advantages of reduced complications and improved cosmesis. However, in some cases the theoretical benefits have not fully translated into clinical results. In this article the use of orbital implants in enucleation, with a particular focus on the newer porous biomaterials that have gained prominence over the last 15 years, is reviewed. Specific factors identified as affecting the performance of porous orbital implants include the material used, pore size, and morphology. Mechanical factors have received little consideration in the past and may form a basis for the use of higher compliance porous materials in the future. Of the porous materials in use, current clinical evidence is not sufficient to suggest either that porous implants are superior to non-porous implants, or that one material is more suited to the application than another. Future developments in this field require randomized controlled clinical trials with extensive follow-up as complications may not become evident until over 5 years post-implantation.     

121例多孔聚乙烯义眼座眶内植入的临床分析

目的 评价高密度多孔聚乙烯义眼座(Medpor)HN内植入的疗效及其并发症.方法 回顾分析2003年3月至2006年3月期间眶内植入多孔聚乙烯义眼座121例,男性91例,女性30例,平均年龄29岁(6～53岁).其中眼球摘除术后Ⅰ期植入20例,眼球内容剜除术后Ⅰ期植入54例,Ⅱ期植入47例.结果 随诊时间6～36个月,平均随访时间18个月.121例均取得满意效果,结膜创口愈合好,义眼座无脱出,无暴露及感染.义眼座植入眼眶后活动度较好,所配带的义眼外观满意.结论 Medpor义眼座眶内植入可明显地矫正眼窝凹陷,可采用自体巩膜包裹或者直接眶内植入,术后义眼座活动度好,并发症少.是一种理想的眶内植入物材料.     

Porous Orbital Implant Exposure: The Influence of Surgical Technique

Abstract

Objectives: To examine orbital implant exposure rates following enucleation and evisceration.

Methods: A retrospective chart review of all patients who underwent an evisceration or enucleation in a single centre over a 5-year period was performed. The indication for surgery, the type and size of orbital implant used, details of the surgical technique adopted and the postoperative complications observed, in particular orbital implant exposure, were recorded.

Results: Over a 5-year period 24 patients had enucleation and 14 had evisceration; 22 of these procedures were performed by an ophthalmic surgeon with a special interest in orbit and oculoplastics while the remaining 16 procedures were performed by 5 ophthalmic surgeons with other sub-specialty interests. Orbital implant exposure occurred in 8 cases. One case had been performed by the first of these surgeons described. Implant exposure occurred in 4% of cases performed by this surgeon. The remaining 7 cases had been performed by the group of surgeons with sub-specialty interests outside of orbit and oculoplastics. Implant exposure occurred in 48% of cases performed by this group.

Conclusions: Orbital implant exposure remains a significant cause of morbidity in patients undergoing enucleation and evisceration. Rates of orbital implant exposure were significantly lower when surgery was performed by an orbital surgeon. Differences in surgical technique are the most likely explanation.     

视网膜母细胞瘤保守治疗相关性临床因素分析

目的 分析及探讨视网膜母细胞瘤(Rb)保守治疗的相关临床因素.方法 对1996～2005年所收治采用保守治疗方法的34例(35只眼)Rb患儿的临床资料作回顾性分析.结果 保守治疗成功组初诊年龄、保守治疗时间以及瘤体直径分别为(16.33±16.28)月、(1055±554)d及(6.92±2.99)mm,失败组分别为(21.90±12.18)月、(878±76)d及(9.54±3.17)mm,差异无统计学意义(P＞0.05);保守治疗成功组瘤体厚度为(3.06±1.00)mm,失败组为(6.11±2.48)mm,差异具有统计学意义(P＜0.05);Rb肿瘤位于后极部保守治疗失败率为86%,周边部为44%,差异具有统计学意义(P＜0.05).结论 保守治疗效果与眼内肿瘤大小以及位置之间存在一定关系,肿物越小、位置越靠近周边部保守成功率越高;肿瘤较大、位置靠后是保守治疗失败的主要因素.     

Human Papilloma Virus in Retinoblastoma Tissues from Korean Patients

Purpose

Recent reports suggest the association of human papilloma virus (HPV) with retinoblastoma. This study was performed to elucidate whether HPV infection is related to retinoblastoma among Koreans.

Methods

A total of 54 cases diagnosed with retinoblastoma were enrolled from Seoul National University Children''s Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center. Presence of human papilloma viral DNA was detected by in situ hybridization in formalin-fixed paraffin-embedded retinoblastoma tissues using both probes against high- and low risk HPV types.

Results

The mean age at diagnosis was 22.0 months (range, 1.1 to 98.0 months), and the mean age at enucleation was 27.8 months (range, 1.5 to 112.7 months) among the 54 patients with retinoblastoma. HPV was not detected in any of the retinoblastoma samples using either high risk or low risk HPV probes.

Conclusions

Our study, being the first study in the Korean population, proposes that HPV infection may have no causal relationship with retinoblastoma in Koreans.     

A Histopathologic Study of Orbital Implant Vascularization

Purpose: To histopathologically assess the extent and pattern of vascularization of explanted porous polyethylene (PP) and hyrdoxyapatite (HA) orbital implants. To compare the vascularization in PP implants harvested after enucleation versus after evisceration. Methods: This is a comparative case series of six orbital implants explanted between 11 months and 5 years and 4 months post implantation. The implants were subjected to histopathological examination with various stains, after complete decalcification. Results: There were 2 post evisceration, 3 post enucleation and 1 secondary implant. The size of the implants varied from 18 to 23 mm diameter. The reason for explantation was exposure in all the 6 cases with additional infection in 2 cases. Histopathology revealed complete vascularization up to the core of the implant in all the cases. There was evidence of chronic inflammation within all the explanted specimens. Acute inflammation was present at the site of exposure in four of the implants. Three of these implants had additional evidence of necrosis. Two cases with clinically evident infection had Gram positive cocci within the implant. Foreign-body type giant-cells, melanophages and haemosiderin laden macrophages were also observed. Eviscerated specimens showed scleral remodelling and thickening. Conclusion: All the implants were vascularized up to the core. There was histologic evidence of chronic inflammation in all the explanted implants possibly indicating the foreign nature of the implant material. The sclera did not impede vascularization of the implants in eviscerated specimens. We found no difference in the degree of vascularization of the implant in enucleated versus eviscerated implants.     

眼球摘除联合自体巩膜翻转包裹泡沫硅胶球植入临床应用

目的:观察改进的自体巩膜翻转包裹硅胶义眼植入的效果。方法:眼球摘除术后,将自体巩膜翻转,清除再包绕硅胶球植入术眼结果:30例眼球摘除患者植入此义眼,随访时间6月～3年。义眼活动度10°—25°,有效地防止了眼球摘除术后“空窝综合征”。结论:本术式有效地解决了义眼植入后不能转动的缺点,而且能得到满意的美容效果。眼科学报1995;11:111—112。     

眼球内视网膜母细胞瘤CT表现分析

目的:加深对眼球内视网膜母细胞瘤CT表现的认识。方法:眼球内视网膜母细胞瘤20例24只眼,均做眼眶轴位CT平扫,详细分析观察其CT表现。结果:视网膜母细胞瘤24只眼均表现为球内肿块伴钙化;按视网膜母细胞瘤生长模式分类,内生性者7只眼,外生性14只眼,混合性3只眼;伴有视网膜脱离17只眼,其中14只眼为外生性,3只眼为混合性。结论:根据CT表现可对视网膜母细胞瘤进行分类,有利于临床选择治疗方案。     

High-Density Porous Polyethylene Wedge Implant in Correction of Enophthalmos and Hypoglobus in Seeing Eyes

Introduction: To report the results of post-traumatic enophthalmos/hypophthalmos correction with high-density porous polyethylene wedge implants in seeing eyes.

Methods: This is an interventional case series of 25 patients (25 eyes) with post-traumatic enophthalmos and hypophthalmos, who underwent orbital reconstruction to correct the enophthalmos and hypophthalmos using Medpor^® wedge implant. The aim was an overcorrection of 1?mm in comparison to the other eye, intra-operatively. If needed, trimming of the wedge implant or adding Medpor^® sheets were used to achieve the goal. Success was defined as achieving the globe position within 1?mm of the other eye in the last follow-up. Improvement and failure were considered as correction outside the success range of 1?mm and no change in the amount of enophthalmos/hypophthalmos, respectively.

Results: Patients were followed for at least 6 months (mean= 12.66, SD= 12.32). Success, improvement and failure of enophthalmos correction were: 58.3% (14/24), 37.5% (9/24) and 1 (1/24, 4.1%), respectively. Success, improvement and failure of hypophthalmos correction were 73.68% (14/19), 15.78% (3/19) and 5.26% (1/19), respectively. There was no significant difference between the success rate of enophthalmos versus hypophthalmos correction (P= 0.8). Results of 1-month follow up change in enophthalmos and hypophthalmos significantly correlated (r= 0.92, P= 0.000) with the change recorded at last follow up.

Conclusions: Porous polyethylene wedge implants are useful and safe in correction of enophthalmos and hypoglobus in seeing eyes. Appropriately positioned implant yields no significant difference in correction of enophthalmos versus hypophthalmos.     

Porous and nonporous orbital implants for treating the anophthalmic socket: A meta-analysis of case series studies

Purpose: To assess the efficacy and safety of porous and nonporous implants for management of the anophthalmic socket.

Methods: Case series meta-analysis was conducted with no language restriction, including studies from: PUBMED, EMBASE and LILACS. Study eligibility criteria were case series design with more than 20 cases reported, use of porous and/or nonporous orbital implants, anophthalmic socket and, treatment success defined as no implant exposure or extrusion. Complications rates from each included study were quantified. Proportional meta-analysis was performed on both outcomes with a random-effects model and the 95% confidential intervals were calculated. Results: A total of 35 case series studies with a total of 3,805 patients were included in the meta-analysis. There are no studies comparing porous and nonporous implants in the anophthalmic socket treatment. There was no statistically significant difference between porous polyethylene (PP) and hydroxyapatite (HA) on implant exposure: 0.026 (0.012–0.045) vs 0.054 (0.041–0.070), respectively and, neither on implant extrusion: 0.0042 (0.0008–0.010) vs. 0.018 (0.004–0.042), respectively. However, there was a significant difference supporting the use of PP when compared to bioceramic implant: 0.026 (0.012 –0.045) vs. 0.12 (0.06–0.20), respectively, on implant exposure. Conclusion: PP implants showed lower chance of exposure than bioceramic implant for anophthalmic socket reconstruction, although we cannot rule out the possibility of heterogeneity bias due to the nature and level of evidence of the included studies. Clinical trials are necessary to expand the knowledge of porous and nonporous orbital implants in the anophthalmic socket management.     

Evisceration with four anterior relaxing incisions and circumferential posterior sclerotomies with porous polyethylene orbital implants: an 8‐year study

Purpose: To present long‐term follow‐up data on eviscerations carried out with scleral modification and placement of spherical porous polyethylene implants. Methods: We conducted a retrospective, interventional study on eviscerations performed with four anterior relaxing incisions and posterior sclerotomies made circumferentially behind the equator at approximately 330° and placement of porous polyethylene spherical implant, performed between March 2000 and August 2007 by a single surgeon. Patient age, sex, causative diagnosis, axial length, implant size, follow‐up duration, complications and treatment were recorded. Results: In total, 92 patients were identified. The mean implant size was 19.46 mm. During the follow‐up period (mean: 60 months, range: 19–107 months), there were no cases of implant exposure. In some patients, mild discharge, ptosis and conjunctival cysts developed. Conclusions: Primary evisceration with four anterior relaxing incisions and posterior sclerotomies made circumferentially behind the equator at approximately 330°, combined with porous polyethylene orbital implant placement, is a useful technique for treating a variety of end‐stage eye diseases.     

Porous orbital implant after enucleation in retinoblastoma patients: indications and complications

This study aims to identify risk factors associated with complications in retinoblastoma patients following primary and secondary enucleations with porous implant placement.

A retrospective case-control study was performed between 2010 and 2015. Data pertaining to subjects’ demographics, medical history, clinical, and pathological findings, implant characteristics and complications were collected.

The analysis included 103 eyes of 101 patients age 27.8 ± 21.9 months undergoing enucleation for retinoblastoma. Postoperatively, 19/103 (18%) eyes developed exposure, extrusion, or hematoma requiring subsequent surgery. Exposure was the most common postoperative complication (12/19, 63%). Age at enucleation 24 months or younger, Hispanic ethnicity, female gender, and intravenous chemotherapy prior to enucleation were associated with increased odds of implant complications. In contrast, patients who were given intravitreal melphalan (IM), subtenons carboplatin (SC), or external beam radiation therapy (EBRT) did not demonstrate an increased risk of complications.

In this cohort of retinoblastoma patients undergoing primary or secondary enucleation with porous implants, implant exposure was the most common postoperative complication. Our findings suggest that female gender, Hispanic ethnicity, age at enucleation 24 months or younger, and intravenous chemotherapy prior to enucleation may increase the risk of complications.     

Intraoperative Dexamethasone Implant in Uveitis Patients with Cataract Undergoing Phacoemulsification

Abstract

Purpose: To study the role of intraoperative intravitreal dexamethasone implant in patients of uveitis with cataract undergoing phacoemulsification.

Methods: This prospective study included 20 patients with uveitis and cataract who underwent phacoemulsification with intraocular lens implantation. Ten patients (10 eyes) received an intravitreal dexamethasone implant intraoperatively (implant group), and 10 patients (10 eyes) received oral steroids (steroid group). Outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), and central macular thickness (CMT).

Results: The logMar BCVA improved from 0.93?±?0.49 to 0.23?±?0.23 and from 1.29?±?0.47 to 0.22?±?0.16 in the implant and steroid groups, respectively. Postoperative IOP and CMT showed no statistically significant differences between the two groups. None of the patients in either group had significant IOP rise requiring any surgical intervention.

Conclusions: A single intraoperative intravitreal dexamethasone implant during phacoemulsification in patients of uveitis with cataract seems to be an effective alternative for postoperative oral steroids.     

One‐stage explant–implant procedure of exposed porous orbital implants

Purpose: To investigate the risks of implant exposure after a combined explant–implant procedure in patients with an exposed porous orbital implant. Methods: Twenty‐four consecutive patients who had a combined explant–implant procedure of an exposed hydroxyapatite (21) or porous polyethylene (3) orbital implant from January 2000 to February 2009 were included. The patient records were reviewed; patients were interviewed by telephone and invited for a clinical examination. Histopathological examination was carried out on the removed implants. Main outcome measures were: presence of exposure of the new implant or not, patient graded satisfaction with the cosmetic result, and presence of poor motility. Results: None of the new implants became exposed or infected in the follow‐up period of 25 [3–94] months (median [range]). The patients scored their satisfaction with the cosmetic result to a median score of 9 (range 5–10). Poor motility was present in six of 17 patients. Micro‐organisms were identified in three removed implants and signs of inflammation were present in 20 removed implants. Conclusions: If a decision of implant removal has been made, it is safe to replace the implant at the same procedure in sockets without profound signs of infection. The procedure carries a possible risk of poor motility.     

用蛋白质芯片技术筛选视网膜母细胞瘤患者血清中标志蛋白

目的:探讨用表面增强基质辅助激光解析离子化-飞行时间质谱(SELDI-TOF-MS)筛选视网膜母细胞瘤(Retinoblastoma,Rb)血清标志蛋白,为Rb筛查、早期诊断及鉴别诊断寻找新的方法。方法:采用IMAC30和CM102种蛋白芯片对18例Rb患者和17名年龄匹配的正常小儿血清进行了蛋白质谱检测。统计分析采用Ciphergenproteinchip3.0.2软件,2组间蛋白峰强度的比较采用t检验,率的比较采用Fisher精确概率法。结果:IMAC30蛋白芯片结果显示:与正常幼儿相比,视网膜母细胞瘤患者血清中有26个差异表达的蛋白峰,其中高表达有21个,质/荷比(m/z)分别为:7746、7014、11713、3049、7084、7299、5888、2544、12575、5489、9658、9575、9929、10161、8955、1886、10617、6209、2411、7374和6614;低表达有5个,分别为:8382、7923、7972、8590和66576,统计学检验P值均小于0.001。其中以7014m/z峰进行两组统计学分析时,敏感性和特异性分别为94.4%和82.4%。与正常小儿相比,经CM10蛋白芯片分析显示:视网膜母细胞瘤患者血清中有4个差异表达的蛋白峰,其中高表达有3个,分别为:质/荷比(m/z)分别为5888、6097和7798;低表达蛋白峰为8590m/z。统计学检验P值均小于0.01。当选择7798m/z差异峰进行统计学分析时,敏感性和特异性分别是83.3%和70.6%。结论:视网膜母细胞瘤患者血清中存在较多标志蛋白,SELDI-TOF-MS蛋白质芯片技术有望成为Rb筛查、早期诊断及鉴别诊断的新的有效工具。     

Quantitative Analysis of Tumor Size in a Murine Model of Retinoblastoma

Murine models can provide valuable insight into mechanisms of tumorigenesis. Tumor size is often used to assess the impact of genetic insult or therapeutic treatment, usually using in vivo imaging of advanced tumors. We now describe a highly sensitive method to quantify tumor volume in a mouse model of retinoblastoma, from the earliest stages of tumor initiation to large, advanced tumors. This methodology combines immunohistochemistry, digital slide scanning and computer image analysis, and can be applied to quantitatively assess and characterize early tumor development in other models.     

Enucleation combined with orbital implants for malignant melanoma of the uvea

Advanced malignant melanomas of the uvea unsuited for an eye salvaging approach require enucleation of the tumor containing eye. A series of 68 patients is reported who underwent enucleation combined with insertion of a spherical dura-encased implant after 30 Gray pre-irridiation therapy of the orbit. Postoperative results with special attention to cosmetic outcome and motility of the prosthesis suggest that the insertion of an orbital implant should be preferred to the enucleation with no implant.