Complications associated with pegging hydroxyapatite orbital implants

Objective: Prior studies of hydroxyapatite orbital implant complications ha ve primarily focused on complications of the implant itself with only occas ional mention of the complications associated with the peg system. This in part may be because of a low rate of pegging and, thus, a small sample size to evaluate. Therefore, a full range of complications that can occur with pegging has not been presented. The objective of this study was to determin e the complications associated with pegging and to discuss ways to manage t hem. Design: Retrospective, noncomparative case series. Participants/Intervention: The authors analyzed all of the complications as sociated with pegging 165 of a possible 275 hydroxyapatite implants implant ed by 2 surgeons over 7 years. Main Outcome Measures: The following data were recorded: type of surgery pe rformed, size of implant used, type of hydroxyapatite used, peg system used , time of pegging, follow-up duration, problems encountered, and treatment. Results: Sixty-two (37.5%) of the 165 patients who had pegged implants were found to have problems with their pegs. Twenty-one (33.8%) of the 62 patie nts with peg problems had more than 1 peg-related problem. Complications as sociated with pegging included discharge (37%; 23 of 62), pyogenic granulom as (30.6%; 19 of 62), peg falling out (29%; 18 of 62), poor transfer of mov ement (11.2%; 7 of 62), clicking (11.2%; 7 of 62), conjunctiva overgrowing peg (4.8%; 3 of 62), poor-fitting sleeve (4.8%; 3 of 62), part of sleeve sh aft visible (4.8%; 3 of 62), peg drilled on an angle (4.8%; 3 of 62), hydro xyapatite visible around peg hole (3.2%; 2 of 62), peg drilled off-center ( 3.2%; 2 of 62), popping peg (3.2%; 2 of 62), and excess movement of peg (3. 2%; 2 of 62). The most serious complication occurring in two individuals (3 .2%) was implant infection requiring implant removal. Conclusion: There are several potential complications that can occur after pegging the hydroxyapatite implant. These problems are generally of a minor nature but often require additional patient visits that would not ordinari ly have been required if the peg was not in place. The most serious peg pro blem is implant infection, which may necessitate implant removal. These pot ential peg problems should be reviewed with the patient before the procedur e is performed.