Assessment of intraorbital hydroxyapatite implant exposure beyond 10 years of implantation

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 263; no. 7; pp. 2025 - 2032
• Main Authors: Ding, Xia, Su, Dai, Cao, Yuan, Zhu, Xiaowei, Xing, Yue, Lin, Ming, Li, Jin
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2025; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Antibiotics; Biocompatible Materials; Child; Chronic infection; Durapatite; Enucleation; Eye Enucleation; Eyelid; Female; Follow-Up Studies; Granulomas; Humans; Hydroxyapatite; Hyperplasia; Infections; Male; Medical records; Medicine; Medicine & Public Health; Middle Aged; Motility; Oculoplastics and Orbit; Ophthalmology; Orbit - surgery; Orbital Implants - adverse effects; Patients; Polyesters; Postoperative Complications; Prostheses; Prosthesis Implantation; Questionnaires; Retrospective Studies; Risk factors; Statistical analysis; Surgeons; Surgery; Sutures; Time Factors; Transplants & implants; Vascularization; Young Adult; Late exposure; Hydroxyapatite implant; Non-absorbable suture; Vascularization
• ISSN: 0721-832X; 1435-702X; 1435-702X
• DOI: 10.1007/s00417-025-06785-x

Background To analyze intraorbital Hydroxyapatite(HA) implant exposure occurring beyond ten years of implantation and suggest potential contributing factors. Design A retrospective cohort study based in the Shanghai Ninth People’s Hospital. Methods One hundred and one Chinese patients with HA implant exposure were identified, from which 38 patients with implants exposure after ten years of insertion were selected and analyzed for demographic and medical records, clinical manifestations, surgery type, implant size, exposure area, follow-up duration, complications, details regarding prosthesis care, and treatment methods. All of the removed implants were sent for an HE pathologic examination. Results The 38 cases experienced exposure 10 to 19 years after implantation and presented to the clinic with increased secretions, proliferation of granulation tissue, visible suture exposure, and difficulty in wearing the external prosthesis. Other complications included implant forward position in 3 patients, eyelid retraction in 4 patients, and all the patients presented with post-enucleation socket syndrome. Reviewing the medical history, HA implant sizes ranged from 18 to 22 mm. Fourteen patients underwent implant repair surgery, of which 2 experienced recurrence, and ultimately, 26 implants were removed. Of the 26 removed implants, histologic examination showed that 17 exhibited chronic infection, and 12 had limited fibrovascular ingrowth. The questionnaires indicated that 26 patients did not renew the external prosthesis regularly. Conclusion This study identified late complications and potential risk factors for implant exposure beyond ten years of implantation, including chronic infection, non-absorbable sutures, and low and delayed vascularization. Key messages What is known Hydroxyapatite (HA) implants are commonly used in ocular surgeries due to their potential advantages, such as lower migration and extrusion rates, improved resistance to infection, and enhanced motility. Implant exposure is a significant complication associated with HA orbital implants, with rates increasing over time and affected by various factors, including surgical technique, prosthetic care, and patient-specific factors. What is new This study analyzed late exposure of HA implants occurring beyond ten years post-implantation, identifying chronic infection, non-absorbable sutures, and delayed vascularization as key risk factors. The research highlighted that all patients presented with post-enucleation socket syndrome and did not regularly renew their external prosthesis, which could contribute to late implant exposure. The study's findings underscore the importance of long-term follow-up, proper prosthesis care, and timely medical attention to mitigate the risk of late complications in HA implant patients.