Porous implant exposure: Incidence, management, and morbidity

Purpose: To identify what factors may predispose patients to exposure of porous anophthalmic implants and to determine the outcome of exposed porous implants. Methods: Examination of pooled data obtained through a PubMed literature search of English-language publications from 1989 through 2004 using the key words enucleation, evisceration, and socket reconstruction. Results: Porous implants were inserted in 80% (3012 of 3777) of the cases identified from 49 publications. The difference in exposure rate between coralline hydroxyapatite (4.9%) and porous polyethylene (8.1%) implants is primarily related to a higher reported complication rate of uncovered porous polyethylene implants, particularly in retinoblastoma patients. Other techniques associated with increased exposures include wrapping implants with bovine pericardium or polyglactin mesh. Evisceration and secondary procedures did not have statistically different complication rates compared with enucleation. There are more late exposures of porous polyethylene than coralline hydroxyapatite implants. Spontaneous healing of exposures occurred in 13% (19 of 145) of cases. Covering exposures with patch grafts underneath vascularized conjunctival flaps was the most successful method of surgical repair. Implant removal was necessary after 29% (42 of 145) of exposures. Conclusions: Although the published literature between 1989 and 2004 reports higher complication rates for uncovered porous implants and implants wrapped with bovine pericardium or polyglactin mesh, pooling data from different studies may mask very good or poor results obtained by individual surgeons. Spontaneous healing of exposed porous implants is relatively uncommon. However, many exposed porous implants can be salvaged with secondary repair.