Primary placement of a motility coupling post in porous polyethylene orbital implants

The placement of a motility coupling post (MCP) to integrate the prosthesis with a porous orbital implant may enhance prosthetic motility following en ucleation. Previously, MCP placement has required a second operation usuall y at least 6 months following enucleation. We developed a technique to plac e an MCP reliably and safely into a porous orbital implant at the time of e nucleation. Eligibility criteria included high motivation to achieve maxima l prosthetic motility, adequate conjunctiva to ensure desirable wound closu re, and isolation of the 4 rectus muscles. Enucleation was performed in sta ndard fashion with implantation of a conical porous polyethylene orbital. i mplant. implanted MCPs protruded anteriorly 2 to 4 mm. The Tenon capsule an d conjunctiva were closed in separate layers over the protruding MCP. Thirt y-two patients underwent primary placement. Follow-up ranged from 1 to 33 m onths (mean, 15 months). Nine MCPs spontaneously exposed within the first 4 months. One additional post autoexposed at 12 months. Three patients under went a secondary procedure to expose the MCP. There were no cases of infect ion, explantation, or gross MCP malposition. Minor complications included p yogenic granuloma (n=2) and conjunctival overgrowth (n=1). All patients wer e successfully fit with prostheses. Prosthetic motility was acceptable in a ll patients. Motility coupling post placement at the time of enucleation su rgery in selected patients is an effective, efficient surgical option.