Anterior surface breakdown and implant extrusion following secondary alloplastic orbital implantation surgery

Shadi Axmann, Dion Paridaens

Research output: Contribution to journalArticleResearchpeer-review


BACKGROUND: Secondary orbital implantation surgery can be complex due to scarring of the orbital tissues and can be complicated by implant exposure and extrusion.

PURPOSE: To evaluate the incidence and risk factors of implant exposure and extrusion following secondary alloplastic orbital implantation surgery in anophthalmic patients.

METHODS: Retrospective analysis of a consecutive series of patients who underwent secondary placement of an alloplastic orbital implant by one surgeon between 2001 and 2016 in the Rotterdam Eye Hospital.

OUTCOME PARAMETERS: implant exposure or extrusion. Other complications.

RESULTS: Sixty-three patients underwent secondary orbital placement of scleral-wrapped acrylic (60) or silicone (three) spherical implants. A subset of 25 patients had undergone earlier secondary orbital implant placement (by other surgeons) with exposure/extrusion necessitating additional implant surgery. Two patients were excluded due to lack of follow-up (<3 months). Mean age was 49 years (range: 1-84.5 years). The mean follow-up was 4.1 years (range: 0.25-13, 6 years). Implant exposure or extrusion occurred in six of 18 (33%) patients in whom no muscle had been reattached during secondary orbital implantation and in five of 43 (12%) patients in whom the extraocular recti muscles had been attached, but the follow-up time was shorter for the latter group. Surgical treatment for implant exposure/extrusion was required in eleven of 61 patients (18%). Other complications included postoperative volume deficiency despite optimal prosthesis (five of 61, 8%), inclusion cysts (four of 61, 7%) and conjunctivitis sicca (two of 61, 3%). Seven of 61 (11%) patients required fornix deepening and seven (11%) blepharoptosis correction.

CONCLUSION: Secondary orbital implantation of sclera-wrapped alloplastic implants was complicated by implant extrusion or exposure in 12% of cases in which the extraocular muscles were attached to the implant.

Original languageEnglish
Pages (from-to)310-313
Number of pages4
JournalActa Ophthalmologica
Issue number3
Publication statusPublished - May 2018


  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anophthalmos/surgery
  • Child
  • Child, Preschool
  • Coated Materials, Biocompatible
  • Eye Evisceration
  • Female
  • Follow-Up Studies
  • Foreign-Body Migration/diagnosis
  • Humans
  • Incidence
  • Infant
  • Male
  • Middle Aged
  • Netherlands/epidemiology
  • Orbital Implants/adverse effects
  • Polymethyl Methacrylate
  • Postoperative Complications/diagnosis
  • Reoperation
  • Retrospective Studies
  • Sclera/transplantation
  • Young Adult


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