J Korean Ophthalmol Soc.  2007 Nov;48(11):1554-1561.

The Effect of 4 Rectus Muscle Anterior Displacement in Porous Polyethylene Orbital Implant Exposure

• Jeung WJ
• Shin DM
• Ahn HB

Abstract

PURPOSE: To investigate the effects of anterior displacement of four rectus muscles in exposure of porous polyethylene orbital implant (Medpor(R)).
CASE SUMMARY
This retrospective study reviewed 4 eyes with exposed orbital implant who underwent evisceration with porous polyethylene orbital implant (Medpor(R)). The technique involves dissection of conjunctiva and tenon's capsule and isolation of four rectus muscles from sclera. Unsure if each muscle was sutured to each other or if a group of muscles were sutured to another group (i.e. superior and inferior to medial and lateral). Posterior tenon's capsule was closed interruptedly and conjunctiva was closed continuously. Orbital implant exposure was occurred at 2~36 months later after evisceration and implant insertion. One eye was noted wound dehiscence 1 week after operation, then re-suture was done. Re-exposure was notified in 1 eye at postoperative 3 months, but it was small, then we just observed. In other 3 cases, exposure was not identified till last follow up.
CONCLUSIONS
Four rectus muscle anterior displacement procedure may be simple and useful method in exposure of orbital implant.

Keyword

Four rectus muscle anterior displacement procedure; Orbital implant exposure

MeSH Terms

Conjunctiva
Follow-Up Studies
Muscles
Orbit*
Orbital Implants*
Polyethylene*
Retrospective Studies
Sclera
Tenon Capsule
Wounds and Injuries
Polyethylene

Figure

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  Figure 1. Four Rectus muscle anterior displacement. (A & B) After dissection of the conjunctiva and Tenon's capsule with Westcott scissors, we identified 4 rectus muscles with a muscle hook. Then, the rectus muscles were isolated in the insertion site with 6-0 Vicryl. (C & D) After 4 rectus muscles were separated from the sclera, inflammatory and necrotic tissues surrounding exposed orbital implant were removed. (E & F) Among 4 rectus muscles, the medial rectus muscle was sutured with the lateral rectus muscle and the superior rectus muscle was sutured with the inferior rectus muscle interruptedly. Finally, posterior Tenon's capsule was sutured with 5-0 Vicryl, and th conjunctiva was sutured with 6-0 Vicryl.

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  Figure 2. Case 1 (A) The small exposure site (2 mm×3 mm in size) of orbital implant was noted. (B). At 1 week postoperatively (4 rectus muscle anterior displacement), the conjunctiva was well sutured with 6-0 Vicryl. The conjunctiva was completely healed at the postoperative 3 weeks.

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  Figure 3. Case 2 (A) About 6 mm×7 mm-sized conjunctival defect around impacted MCP of an orbital implant was visible at 29 months postoperatively. Antiobiotic and steroid eye solutions were used. Providencia rettgeri was cultured from yellowish discharge. (B) At 4 months postoperatively, the orbital implant was re-exposed measuring about 2 mm×2 mm in size of the exposure. Thereafter the exposure site was not enlarged until the last follow up.

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  Figure 4. Case 3 About 7 mm×7 mm-sized conjunctival defect around the MCP inserted site of porous polyethylene orbital implant (Medpor®) was visible at postoperative 48 months. And Streptococcus viridans was cultured. After antibiotic therapy, the inflammation was controlled, and 4 rectus muscle anterior displacement was performed. At 6 weeks postoperatively, the conjunctiva was completely healed. (B) At 5 months postoperatively, the granulation tissue was noted, but re-exposure was not detected.

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  Figure 5. Case 4 (A) A 6 mm×6 mm-sized conjunctival defect developed at 2 months postoperatively, then the scleral patch graft was performed. Two months later, however, the conjunctival defect reccurred. (B) The dermis fat graft was done, but re-exposure of the orbital implant was noted at 3 months postopteratively. (C) After 4 rectus muscle anterior displacement was performed, the conjunctiva was completely healed at 6 weeks postopetatively.

Reference

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