Complications of primary placement of motility post in porous polyethylene implants during enucleation

Abstract

Purpose: To evaluate the complications associated with the primary placement of a motility coupling post (MCP) in spherical porous polyethylene (PP) implants at the time of enucleation.

Design: Retrospective, interventional case series.

Methods: The records of all patients who had undergone primary enucleation and spherical PP implant with MCP insertion, and who were followed for at least six months were reviewed. The MCP was screwed to a wrapped implant to protrude 3 mm to 4 mm anteriorly. After placing the implant into the orbit, the extraocular muscles were sutured to the implant, and the Tenon capsule and conjunctiva were closed onto the MCP. When the MCP was not exposed spontaneously within two months after surgery, it was externalized with a conjunctival cut-down procedure.

Results: The study included 52 patients (29 male, 23 female; age range, three to 76 years). The MCP became exposed spontaneously in 10 patients (19%). In the early postoperative period, we recorded nine complications in seven patients (13%), which might be related to primary MCP placement. These included prominent MCP decentration associated with implant motility restriction (6%), preseptal cellulitis (4%), and conjunctival prolapsus (8%). An ocular prosthesis was fit successfully onto the MCP in 51 patients. During the late period, 22 complications occurred in 15 patients (29%), including excessive discharge (15%), MCP decentration (4%), implant exposure (6%), implant infection (2%), pyogenic granuloma (8%), conjunctival overgrowth over the MCP (2%), conjunctival discoloration (4%), and lax eyelid syndrome (2%). Mean follow-up time was 34 months (range, six to 68 months).

Conclusions: Although MCP placement in the spherical PP implant during enucleation is a useful technique, it may be associated with complications such as MCP decentration, excessive discharge, exposure, and infection of the implant.