Abstract ID: 26-548
Management of exposed porous bio-ceramic orbital implant using dermis-fat graft overlay: surgical decision-making and demonstration of implant vascularisation
Author: Ananth Ranjit Base Hospital / Institution: Northern Care Alliance NHS Foundation Trust
Presentation Type: Video Presentation
Purpose
To demonstrate surgical management of an exposed porous bioceramic orbital implant using dermis-fat graft overlay without implant removal, and to highlight intraoperative evidence of implant vascularisation and biointegration.
Methods
Surgical video case report of a 30-year-old female with a blind painful eye secondary to perforating trauma complicated by limbal anterior staphyloma and corneal scarring. Due to concerns regarding sympathetic ophthalmia, the patient underwent enucleation
with porous bioceramic orbital implant placement. Despite prior temporalis fascia patch graft for initial minimal exposure and amniotic membrane transplantation for progressive conjunctival thinning, she developed a persistent 3 mm central implant exposure with associated granuloma. The patient wished to retain the implant as they were satisfied with the prosthetic motility and the aesthetic appearance from the orbital volume it provided. Surgical revision was therefore performed using implant burring and dermis-fat graft overlay
rather than implant explantation.
Results
The surgical video demonstrates significant bleeding from the porous bioceramic implant following exposure and burring, illustrating fibrovascular ingrowth and implant vascularisation. The implant was successfully retained and covered with dermis-fat graft. Postoperatively, the patient maintained good prosthetic motility and orbital volume with stable socket surface reconstruction.
Conclusion
Porous orbital implants permit fibrovascular integration, which may support implant salvage despite exposure. In selected patients with good implant motility and orbital volume, dermis-fat graft overlay may provide an effective alternative to implant removal.
With the advent of novel bioceramic implants featuring graded pore design and improved biointegration, the scope for less invasive management of implant exposure is likely to increase.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Farhan | Qureshi | Northern Care Alliance NHS Foundation Trust |
| Mehreen | Iqbal | Northern Care Alliance NHS Foundation Trust |