ENHANCEMENT OF THE COSMETIC AND FUNCTIONAL OUTCOME OF ENUCLEATION WITH THE CONICAL ORBITAL IMPLANT

Objective: The authors evaluated a new design of a conical-shaped enuc leation implant to help minimize the occurrence of superior sulcus def ects and maximize motility of the prosthesis. The implant shape is a m odification of a sphere. It has a posterior conical projection paralle ling the orbital walls, a superior projection supporting the soft tiss ues of the upper eyelid sulcus, a flattened anterior surface, and chan nels for each rectus muscle. Design: The study design was a consecutiv e case series from the Oculoplastics and Orbital Service of the Massac husetts Eye and Ear Infirmary. Intervention/Participants: A total of 4 5 patients (average age, 40 years; range, 13-75 years) had placement o f a conical implant (39 primary enucleations, 6 secondary implants) wi th a minimum of 1 year' follow-up (range, 12-36 months). All of the pr imary enucleations and two of the secondary procedures had the anterio r portion of the implant covered with autologous fascia. Four of the s econdary implants were covered with pseudocapsule harvested from the e xplanted primary implant. Prostheses were fit 6 to 10 weeks after surg ery. Main Outcome Measures: Postoperative appearance of patients was a ssessed by qualitative appearance of the superior sulcus and prostheti c motility, and subjectively by patients' satisfaction, Results: A tot al of 43 patients had minimal or no superior sulcus defect, whereas 2 patients had moderate defects. There were no severe sulcus defects. Al l patients were satisfied with their appearance and did not seek furth er surgery to correct any upper sulcus asymmetry. Prosthetic motility with small-angle ductions (<10 degrees) and saccades was good in all c ases. There were two cases of conjunctival wound dehiscence. Both occu rred within 4 weeks of surgery. One wound dehiscence was sutured, wher eas the other healed spontaneously. There were no cases of implant ext rusion, migration, or infection. Conclusion: The conical orbital impla nt provides appropriate reconstitution of orbital volume while minimiz ing superior sulcus defects with adequate prosthetic motility.