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COMMENTARY
Year : 2018  |  Volume : 66  |  Issue : 11  |  Page : 1607-1608

Commentary: Using newer technology for an unresolved clinical dilemma


Eye7 Hospital, New Delhi, India

Date of Web Publication25-Oct-2018

Correspondence Address:
Dr. Raj Anand
Eye7 Hospital, Janakpuri, New Delhi - 110 058
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1127_18

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How to cite this article:
Anand R. Commentary: Using newer technology for an unresolved clinical dilemma. Indian J Ophthalmol 2018;66:1607-8

How to cite this URL:
Anand R. Commentary: Using newer technology for an unresolved clinical dilemma. Indian J Ophthalmol [serial online] 2018 [cited 2024 Mar 29];66:1607-8. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2018/66/11/1607/244034



Migration of the orbital implant is an infrequent but difficult complication following enucleation/evisceration with orbital implant. It is more frequently associated with enucleation technique where the extraocular muscles are imbricated in front of the spherical non-integrated orbital implant.[1]

In smaller degree of migration, it is still compatible with prosthesis, however when the implant migration is of greater degree, it can cause difficulty in prosthesis retention, shallowing of fornices, lid malposition, and of course reduced motility of the prosthesis.[2] Unfortunately, the treatment options like implant exchange and dermis fat graft have their own drawbacks[3],[4] like recurrence and graft necrosis.

As of now we do not have a means to 'push' these migrated implants back in their original intended position and maintain that pressure so that the implant does not slip back in the extraconal space. A 3-D printed Patient Specific Implant (PSI) indeed is indeed a brilliant idea that serves this purpose.[5],[6] Because of the custom contouring of the PSI, its base snugly fits into the infero-temporal basin contour of the orbit. This stable implant is rock steady in there and maintains constant pressure on the re-centered implant to remain the designated orbital position. Customizing the implant also gives an opportunity to adjust the height of the implant to control the amount of displacement for the migrated implant.

The authors deserve special credit for conceptualizing a treatment modality that is beyond the four walls of clinic, involving the expertise of 3-D printing and collaborating with Ocularistry services to get PSIs. This multidisciplinary approach to solve a clinical dilemma will surely inspire rest of us to use this technology for more such situations where there is no optimal management guideline at present.

This study also highlights the fact that prevention is better than cure. Even after using the best possible resources like 3-D printing of orbit and customizing the implant, the motility of the prosthesis does not match the motility of prosthesis over an optimal implant.[6]



 
  References Top

1.
Shome D, Honavar SG, Raizada K, Raizada D. Implant and prosthesis movement after enucleation. Ophthalmol 2010;117: 1638-44.  Back to cited text no. 1
    
2.
Allen L. the argument against imbricating the rectus muscle over spherical orbital implant after enucleation. Ophthalmol 1983;90: 1116-20.  Back to cited text no. 2
    
3.
Nentwich MM, Schebitz-Walter K, Hirneiss C, Hintschich C. Dermis fat grafts as primary and secondary orbital implants. Orbit 2014;33:33-8.   Back to cited text no. 3
    
4.
Sundelin KC, Dafgard Kopp EM. Complications associated with secondary orbital implantations. Acta Ophthalmol 2015;93:679-83.   Back to cited text no. 4
    
5.
Dave TV, Gaur G, Chowdary N, Joshi D. Customized 3D printing: A novel approach to migrated orbital implant. Saudi J of Ophthalmol 2018. [In press].  Back to cited text no. 5
    
6.
Dave TV, Tiple S, Vempati S, Palo M, Ali MJ, Kaliki S, et al. Low-cost three-dimensional printed orbital template-assisted patient-specific implants for the correction of spherical orbital implant migration. Indian J Ophthalmol 2018;66:1600-7.  Back to cited text no. 6
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