This is a retrospective case series over 11 years of 25 patients with exposed synthetic hydroxyapatite orbital implants who underwent explantation and simultaneous replacement with a dermis fat graft. All patients had signs of infection and had been treated with systemic and topical antibiotics, and had at least 5mm of exposed implant. Eight had had previous surgery in the form of various grafts to treat the exposure. Gram-positive cocci were found in 59%, the remaining 41% were negative. All the implants were sent for histopathological analysis which showed reduced fibrovascular in-growth and chronic inflammation. All patients did well from the dermis fat grafting; none had further orbital surgery and only four needed lid surgery, although one was volume deficient but declined further augmentation. It is unclear from the discussion whether the authors believe that poor initial surgical technique leads to exposure and secondary infection, or poor fibrovascular in-growth into the implant is the primary problem which itself results in exposure and infection. Either way it is clear that once significant exposure and infection have occurred in a porous implant, explantation is preferable to further salvage surgery. The study is useful in showing that simultaneous dermis fat grafting can be undertaken safely with good cosmetic results, and there is no need to postpone this over concerns of infection.

Management of porous orbital implants requiring explantation: a clinical and histopathological study.
Quaranta-Leoni FM, Moretti C, Sposato S, et al.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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