Grant W. Heinz

Exposure rate of hydroxyapatite spheres in the anophthalmic socket: Histopathologic correlation and comparison with silicone sphere implants

We retrospectively reviewed enucleations and secondary anophthalmic socket sphere implantations for a 3 year period. We compared the incidence of exposure of hydroxyapatite implants to the incidence of exposure of silicone implants. We found that the incidence of hydroxyapatite exposure following enucleation was 3 of 27 (11.1%), and following secondary anophthalmic socket implantation was 3 of 32 (9.4%). The incidence of silicone sphere exposure following enucleation was 0 of 48 (0%), and following secondary implantation was 1 of 30 (3.3%). The difference in exposure rate between hydroxyapatite and silicone reached statistical significance in the enucleation group (p = 0.043) and in the combined enucleation and secondary implantation group (p = 0.033), but not in the secondary implantation group when considered separately. Osteoinduction and fibrovascular infiltration were found in all hydroxyapatite specimens examined histopathologically. In the exposed implants, liquefaction necrosis of the implant occurred. In the nonexposed implant, complete fibrovascular ingrowth was noted at 7 months. We believe that the hydroxyapatite anophthalmic sphere is associated with a higher incidence of exposure and postoperative inflammation when compared to silicone anophthalmic spheres. Patient selection and technique modification may reduce the incidence of hydroxyapatite implant exposure.

Extrusion rate of silicone spherical anophthalmic socket implants.

The most popular technique of placement of an anophthalmic spherical implant was first described by Frost and Lange in 1886, and has remained essentially unchanged since that time. That technique incorporates imbrication of recti muscles over an 18 mm spherical implant, and purse stringing of conjunctiva and Tenons fascia in a single layered closure. The Frost-Lange technique has led to previously reported extrusion rates as high as 11.3%. The technique is also associated with superotemporal implant migration and poor prosthetic motility. Our technique modification includes suturing recti muscles independently to a 20 mm spherical implant reinforced with autogenous fascia or preserved sciera. We then close Tenons fascia and conjunctiva independently as separate layers. The extrusion rate for our patients during a 10 year study period was 0.84% (1 of 119). We found no implant migration, no painful socket, and prosthetic motility was good. We recommend our technique modification to replace the traditional Frost-Lange technique.

Socket Reconstruction With Combined Mucous Membrane and Hard Palate Mucosal Grafts

OBJECTIVE To evaluate the use of combined mucous membrane and hard palate mucosal grafts in the reconstruction of contracted eye socket. PATIENTS AND METHODS Thirteen eyes of 13 patients with contracted sockets underwent socket reconstructive surgery with combined mucosal membrane and hard palate mucosal grafts. RESULTS The average follow-up period was 33 months. Five of 13 patients required additional surgery after initial socket reconstruction. However, all patients who underwent socket reconstruction with hard palate mucosal grafts were able to wear a cosmetically acceptable ocular prosthesis postoperatively. CONCLUSION Combined mucosal membrane and hard palate mucosal grafts can be effectively used in the reconstruction of contracted sockets.

The effect of buphthalmos on orbital growth in early childhood: Increased orbital soft tissue volume strongly correlates with increased orbital volume

PURPOSE Our purpose was to evaluate the effect of increased orbital soft tissue volume on orbital growth. METHOD Patients with unilateral or significantly asymmetric bilateral buphthalmos as determined by axial computed tomography scan were recruited. Volumetric determinations of the bony orbit with use of axial 1.5 mm sections on computed tomography were undertaken. Statistical analysis of the paired ocular length measurement and bony orbital volume measurements for each patient were performed. RESULTS Eight patients (mean age 41 months) with a 15% or greater difference in axial length were enrolled. The mean axial length of the buphthalmic globes was 23% greater than that of the contralateral globes. Orbits harboring a buphthalmic globe had an orbital volume 11% greater than on the contralateral side. CONCLUSION Increased orbital soft tissue volume as evidenced by buphthalmos was significantly associated with enlarged bony orbital volume. This indicates that soft tissue volume is a determinant of orbital volume and suggests that orbital tissue expanders might enhance bony development in patients with anophthalmos or microphthalmos and after early enucleation.

Eccrine adenocarcinoma of the eyelid in a young patient

Malignant eccrine adenocarcinoma of the lower eyelids is described in a 16-year-old girl. This rare tumor has previously been reported only in males, whose average age was 64 years. Our patient remains tumor free 7 years after wide resection of the eyelid and reconstruction.