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Repair of Exposed Hydroxyapatite Orbital Implants by Subconjunctival Tissue Flaps

Lu, Linna MD; Shi, Wodong MD; Luo, Min MD; Sun, Ying MD; Fan, Xianqun MD, PhD

Journal of Craniofacial Surgery: July 2011 - Volume 22 - Issue 4 - p 1452-1456
doi: 10.1097/SCS.0b013e31821d1860
Technical Strategies

Purpose: The purpose of the study was to determine the feasibility of the use of subconjunctival tissue flaps to repair exposed hydroxyapatite (HA) orbital implants.

Methods: One hundred thirty-eight consecutive patients underwent repair of exposed HA orbital implants via a procedure that involved the creation of subconjunctival tissue flaps. After the superior and inferior subconjunctival flaps were created, they were sutured together in the tension-free state to seal the exposure. During follow-up examinations, complications were assessed.

Results: Twelve patients were lost after the 3-month follow-up, leaving 126 patients who were followed from 12 to 60 months (average, 24 months). Problems occurred in 22 patients (17.5%), including recurrence of exposure in 4 patients (3.2%), ptosis in 12 patients (9.5%), pyogenic granulomas in 1 patient (0.8%), a conjunctival cyst in 1 patient (0.8%), implant infection in 1 patient (0.8%), and poor transfer of movement in 3 patients (2.4%).

Conclusions: The use of the subconjunctival tissue flaps for repairing exposed HA orbital implants is a promising alternative for the management of implant exposure. Although this novel technique is associated with some complications, these problems can be minimized by careful case selection and careful surgery.

From the Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.

Received November 10, 2010.

Accepted for publication December 3, 2010.

Address correspondence and reprint requests to Dr. Xianqun Fan, Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China; E-mail:

L.L. and W.S. contributed equally.

This study was supported by the Shanghai Leading Academic Discipline Project (S30205), the National Natural Science Foundation of China (30973279 and 81000404), and the Science and Technology Commission of Shanghai (10JC1409100).

The authors report no conflicts of interest.

© 2011 Mutaz B. Habal, MD