Auricular cartilage versus donor sclera as a wrapping of hydroxyapatite orbital implants

Abstract

Aim: To retrospectively compare postoperative outcomes after primary enucleation and placement of a hydroxyapatite (HA) implant without wrapping, wrapped with auricular cartilage or donor sclera.

Methods: Medical records of patients presented as intraocular tumor or severe ocular injury were identified from the electronic medical record system. Cases underwent enucleation and HA orbital implantation were enrolled in this study and were divided into 3 groups according to the wrapping material of HA implant. Cases with autogenous cartilage caps were enrolled in group A (n=11), with donor sclera caps in group B (n=12), and without any wrapping material in group C (n=9). Follow-ups were set at 1, 2wk, 1, 3, 6, and 12mo after surgery.

Results: Altogether 32 cases finished the follow-up and were enrolled in this study. Three cases (27.27%) in group A, 4 cases (33.33%) in group B, and 4 cases (44.44%) in group C developed one complication each after surgery. In group A, no HA exposure occurred, but conjunctival inclusion cyst occurred in one and severe conjunctive chemosis in two cases. In group B, one HA exposure occurred, conjunctive inclusion cysts occurred in one, severe conjunctive chemosis occurred in one, and conjunctival granuloma occurred in one case. In group C, one HA exposure occurred, severe conjunctive chemosis occurred in two cases, and conjunctival granuloma occurred in one case. The case of exposure of none-wrapped implant was noted in the first 6mo after placement of the orbital implant. The case of exposure of donor sclera-wrapped implant was noted at the 12mo after placement of the orbital implant. Both exposure cases were treated successfully with conservative treatment.

Conclusion: With low incidence of implant exposure and mild complications, auricular cartilage can be a good choice of alternative wrapping material of orbit implant with satisfied outcome.

Keywords: auricular cartilage; complication; donor sclera; hydroxyapatite orbital implants; wrapping.

Figure 1. The surgical procedure of enucleation and HA orbital implantation with an auricular cartilage cap

A, B: Autogenous ear cartilage graft was harvested from the conchal lateral wall through a post-auricular incision as a rectangular strip of the right ear and be preserved in a mixture of gentamicin and normal saline; C: The HA implant was placed in the cone after soaking in a mixture of gentamicin, hexadecadrol and normal saline for 5min; D: Autogenous ear cartilage was then sutured to wrap the frontal part of the implant; E: Muscles were sutured to attach at the original place; F: Tenon's tissue was then closed with multiple interrupted 6-0 vicryl sutures and conjunctiva was closed with a continuous 6-0 vicryl sutures.

Figure 2. Photograph taken at 12mo follow-up in one patient with an auricular cartilage cap. No exposure was occurred.

Figure 3. Axial T2 scan through the orbits of a 63-year-old patient 12mo after enucleation and HA orbital implant with auricular cartilage cap in left eye

The HA implant showed an increased T2 signal centrally (black arrow). The auricular cartilage cap shows as a linear area of intermediate signal in front of HA implant (white arrow).