Bioactive glass and glass‐ceramic orbital implants

This review focuses on the applications of bioactive glasses and glass-ceramics in the field of orbital implants for ocular surgery. This use is relatively novel and less popular compared to the applications in orthopedics and dentistry for the repair of bone and teeth. Recent studies have shown the suitability of bioactive glasses and glass-ceramics in contact with soft tissues for promoting additional effects associated to the release of therapeutic inorganic ions. Specifically, the angiogenic and antibacterial actions that may be elicited by selected glass compositions are highly appealing for the development of new-generation orbital implants, since improved vascularization and antiseptic properties are the key for a higher success rate of anophthalmic socket procedures. An overall picture of existing orbital implants based on bioactive glasses is here provided, and the further potential and open challenges for future research in this field are highlighted and discussed.Politecn Torino, Inst Mat Phys & Engn, Dept Appl Sci & Technol DISAT, Turin, ItalyFed Univ Sao Carlos UFSCar, Ctr Res Technol & Educ Vitreous Mat CeRTEV, Dept Mat Engn DEMa, Sao Paulo, BrazilFed Univ Sao Carlos UFSCar, Dept Med, Sao Paulo, BrazilUniv Estadual Paulista, Fac Med Botucatu, Dept Ophthalmol, Sao Paulo, BrazilAmer Ceram Soc ACerS, Westerville, OH USAUniv Estadual Paulista, Fac Med Botucatu, Dept Ophthalmol, Sao Paulo, Brazi

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