THE MULLER MUSCLE FLAP FOR REPAIR OF AN EXPOSED HYDROXYAPATITE ORBITAL IMPLANT

A 36-year-old woman was experiencing discomfort and discharge after pl acement of an orbital implant 1 year previously. Her ocular history in cluded iridocorneal endothelial syndrome, requiring two trabeculectomi es, the last of which included the use of 5-fluorouracil (5-FU). After enucleation, a hydroxyapatite orbital implant was placed. Shortly the reafter, an implant exposure developed and continued to enlarge to 11 mm even after her ocularist had elevated the prosthesis off the expose d area and surrounding conjunctiva. Magnetic resonance imaging with ga dolinium enhancement was not obtained because of the prohibitive cost. Fourteen months later, a vascularized Muller muscle pedicle flap was devised and tunneled underneath the existing conjunctiva to cover the defect. The overlying levator was undisturbed; however, transient ptos is occurred that returned to baseline after 2 weeks. This is a new and novel approach to restore orbital implant exposure and may be most he lpful after antimetabolite treatment to the conjunctiva or radiation t o the orbit.