Orbital Implants and Wrapping Materials

Following globe removal, the surgeon must determine the best orbital implant to place into the anophthalmic socket. A decision on appropriate implant size, whether to place a porous or nonporous implant, and a patient’s total clinical picture must be considered to prevent future complications. Other considerations, including whether to wrap an implant and place a motility peg, must also be made. The modern implant is built on the foundation of anophthalmic socket reconstruction—implant retention, volume replacement, and adequate prosthetic motility. This chapter will review the special considerations the ophthalmic surgeon must weigh when choosing an orbital implant following enucleation and evisceration surgeries

Enucleation and Techniques of Orbital Implant Placement

Enucleation is a surgical procedure that involves removal of the eye and anterior optic nerve, most commonly with retention of the extraocular muscles which are then sewn to the implant. Meticulous surgical technique is essential to prevent long-term complications and ensure optimal long-term function and cosmesis of the anophthalmic socket. When appropriate surgical technique is used, the patient often has a significant improvement in both function and cosmesis after an enucleation, and is quite grateful for the relief of pain they can achieve. It is critical that the surgeon approach this surgery keeping the long term view of the anophthalmic socket in mind. Generally, this involves providing the patient with the largest implant that will fit the socket without undue tension during Tenon’s capsule and conjunctival closure, thereby minimizing socket and eyelid asymmetry and preventing future forniceal and eyelid issues. This chapter reviews basics of enucleation surgery, with a focus on methods to achieve optimal results. Also, the chapter discusses implant placement techniques and provides a brief review of enucleation implants. Additionally, it describes how enucleation implants have evolved and improved over time