Eyeworld

121 EW INTERNATIONAL October 2016 surgery has been associated with a limitation in the orbital implant size and motility, today, innovations have overcome these limitations," Dr. Klett said. EW the recti muscles. This allows vascu- larization of the anterior porous hy- droxyapatite part of the implant and stabilizes the long-term biomechan- ics of the system," Dr. Klett said. Dr. Klett and colleagues re- viewed more than 100 patients who were operated on using this new modified technique since 1995. The surgical outcomes revealed that the implants were easily closed using local tissue flaps without any subse- quent recurrence. Dr. Klett was able to measure the motility of artificial eyes as transmitted by the implants in a series of 60 patients from 1997 to 2003. He could demonstrate that muscle pedunculated flaps increase horizontal motility by about 3 mm and vertical motility by about 2.5 mm compared with the previous technique in which the muscles were sutured crosswise in front of the implant. He recommended the placement of an autologous dermis fat graft in very young patients to facilitate or- bital rehabilitation. The extra surface area produced by the use of the graft helps in preserving deep superior and inferior fornices and allows the use of larger implants. Apply- ing dermis fat also seems to permit a more anterior placement of the implant, which may help maintain orbital volume and assist in motili- ty. In adult patients, autologous fat grafts are used secondary to implant extrusion. Complications of enucleation include retrobulbar hemorrhage, orbital edema, and the extrusion of the implant. Dr. Klett considers the use of muscle pedunculated sclera as a possible means of reducing postop- erative complications. "These special surgical tech- niques include modifications that improve prosthesis motility and re- duce the risk for postoperative extru- sion of the implant. Preserving the remaining scleral shell through evis- ceration maintains ocular structures that are used to support the implant and benefit the outcomes greatly. The same is true for preserving the extraocular muscle attachments. The less soft tissue material needed to cover the anterior implant surface, the better the motility transmission to the artificial eye. Although tradi- tional evisceration and enucleation Reference 1. Stephenson CM. Evisceration of the eye with expansion sclerotomies. Ophthal Plast Reconstr Surg. 1987;3:249–51. Editors' note: Dr. Klett has no financial interests related to his comments. Contact information Klett: Artur.Klett@itk.ee Visit www.malosa.com and experience the benefi ts of single-use now REDUCE THE RISKS OF TASS IN PHACO Single-use instruments do not require enzymatic detergents, a potential cause of TASS

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