The Effect of Continuous Suture of Conjunctiva and Tenon's Capsule with Polypropylene (Prolene(R)) on Exposure of Medpor(R) Implant

Lee, Tae Soo; Choi, Jin Ho; Park, Min Soo

Abstract

PURPOSE
The purpose of this study is to evaluate the effectiveness on decrease of the exposure rate of Medpor(R) implant (high-density porous polyethylene) when the suture material is left permanently without removal after continuous vertical suture of conjunctiva and Tenon's capsule with non-absorbable material, polypropylene suture (Prolene(R)). METHODS: We performed 66 cases of Medpor(R) orbital implantation in conjunction with enucleation, evisceration, or secondary orbital implantation between November 1997 and February 2002, and reviewed the charts of patients retrospectively. We divided 66 cases into 2 groups; One is Polypropylene group (P group, 30 eyes), in which conjunctiva and Tenon's capsules were sutured with double shoe string technique by 5-0 polypropylene sutures in one layer, and the other is control group (36 eyes), in which conjunctiva and Tenon's capsules were sutured by 5-0 polyglactin (Vicryl(R)) in separate layer, or Tenon's capsules were sutured by 5-0 Vicryl(R) and conjunctivae were 7-0 silk. We compared P group with control group with regard to the exposure rates, irritations, conjunctivitis and assessed covering of polypropylene suture by conjunctival epithelization. RESULTS: In control group, 5 of 36 eyes (13.8%) had the exposures of Medpor(R) implants, 21 eyes (58.3%) had the irritations, and 10 eyes had conjunctivitis. But, there was no exposure of Medpor(R) implants in all cases of P group, only two of 30 eyes had the irritations, and 3 eyes had conjunctivitis. There were significant differences between the two groups in the rates of exposure and irritations, but in the eyes with conjunctivitis, there was no significant difference between the two groups (Table 5, chi-square test). After 2 months of operation, the wound surfaces were smooth with complete covering of polypropylene suture by appropriate conjunctival epithelization. CONCLUSIONS: Continuous vertical suturing of conjunctiva and Tenon's capsule with non-absorbable polypropylene suture (Double shoestring technique) substantially reduced the exposure of Medpor(R) implant in addition to less inflammations, irritations and more comfortability. We concluded that the suture materials and methods must be considered as the important causes of exposure in enucleation or evisceration using proper Medpor(R) implant.