COMPLICATIONS OF MOTILITY PEG PLACEMENT FOR THE HYDROXYAPATITE ORBITAL IMPLANT

Purpose: The hydroxyapatite implant is an ocular motility implant desi gned to provide natural movement of the artificial eye. The movement o f the prosthesis is maximized when the implant is coupled to the prost hesis via a peg. The purpose of this study is to determine the complic ations of the hydroxyapatite motility peg and the factors related to t hose complications. Design: Retrospective review of 47 cases over 5 ye ars. Methods: A retrospective review was performed on all cases of hyd roxyapatite motility peg placement. The technique of hydroxyapatite an d peg placement, follow-up details, and complications of the peg were recorded. Results: The complications of peg placement included peg ext rusion in 26% (12 of 47), nonspecific conjunctivitis in 6% (3 of 47), audible click in 6% (3 of 47), temporary excessive conjunctival edema in 4% (2 of 47), and temporary excessive postoperative pain in 4% (2 o f 47). There were no cases of infection, persistent pain, persistent e dema, or discharge at peg site. The median time interval from peg plac ement to extrusion was 16 months (range, 1-52 months). The only statis tically significant factor related to peg extrusion was age over 50 ye ars (P = 0.04). There was a trend toward peg extrusion with use of a n onsleeved peg (versus sleeved peg) (P = 0.10). The extrusion rate was 32% (12 of 38) for nonsleeved pegs and 0% (0 of 9) for sleeved pegs. F actors unrelated to peg extrusion were patient sex, prior ocular surge ry or radiotherapy, presence of giant papillary conjunctivitis, time i nterval from enucleation to peg placement, and degree of implant vascu larization on magnetic resonance imaging. Of the 12 nonsleeved pegs th at extruded, a sleeved peg system was subsequently successfully placed in 5 patients, a nonsleeved peg in 1 patient, and 6 patients remained without a peg system. Conclusions: Hydroxyapatite motility pegs have relatively few complications except for extrusion. The rate of extrusi on can be minimized by employing a sleeved peg rather than a nonsleeve d peg system.