Jp. Adenis et al., Treatment of the postenucleation socket syndrome with a new hydroxyapatitetricalcium phosphate ceramic implant, OPHTHAL PL, 15(4), 1999, pp. 277-283
Purpose: Surgical correction of the postenucleation socket syndrome (PESS)
is challenging. Various biomaterials are used for reconstruction of the ano
phthalmic orbit, often with unsatisfactory long-term results. Implants have
been placed between the periorbital and the orbital floor. The authors des
cribe a new material composed of hydroxyapatite tricalcium phosphate (HA-TC
P) in the form of ceramic blocks, to be placed into the orbital fat as a ne
w surgical site.
Methods: Ten patients with PESS underwent surgery to compensate the volume
deficit of the anophthalmic orbit. Blocks of HA-TCP were created by fragmen
tation of a larger piece, tailored as needed, and implanted in the orbital
fat. The patients were monitored regularly with clinical and radiologic exa
minations to evaluate the behavior of the implants.
Results: The volume of the HA-TCP was measured in 5 cases (mean, 2.95 +/- 1
.08 ml). A significant reduction of enophthalmos was obtained: mean Hertel
exophthalmometry measured 12.7 +/- 2.5 mm preoperatively and 14 +/- 2.4 mm
postoperatively (P < 0.05). The average prosthesis volume was significantly
reduced in the cases measured: 2.7 ml +/- 0.94 ml preoperatively and 1.8 /- 0.7 ml postoperatively (p < 0.02). There was a negative correlation betw
een the HA-TCP implant volume and postoperative prosthesis volume (correlat
ion coefficient = -0.925; p < 0.05). According to photographic evaluation,
correction of the enophthalmos and of the superior sulcus depression were o
btained in 70% and 90% of cases, respectively. Magnetic resonance imaging s
eems to demonstrate that the blocks become well integrated into the surroun
ding orbital tissue.
Conclusion: The HA-TCP blocks correct some anomalies of PESS. Placement of
the blocks directly into the orbital fat is a promising alternative to the
traditional subperiosteal location.