Table 1.
Demographics and ocular characteristics of patients with HA implants who developed chronic orbital inflammation unresponsive to conventional medical therapy
| Case | Gender | Age, years | Eye | Enucleation/evisceration | Cause of implantation | Implant size, mm | Symptoms | Elapse of time since implantation | Treatment | CT | Pathology |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | F | 44 | RE | Evisceration | Trauma | 20 | Pain and chronic conjunctivitis | 6 months | HA removal and DMFG | HA implant with significant thickening along the preseptal area, eyelid edema, and no evidence of postseptal extension | |
| 2 | M | 36 | LE | Evisceration | Trauma | 20 | Persistent purulent conjunctivitis and severe discharge | 3 weeks | HA removal | Revealed HA implant surrounded by inflammation, involving also the retrobulbar fat and optic nerve sheath, with significant dirty fatty appearance as well as involvement of tendinous insertion of the extraocular muscles group | Multiple small “foreign bodies” surrounded by granulomatous reaction composed by giant cells and numerous eosinophils |
| 3 | M | 28 | RE | Enucleation and donor sclera | Trauma | 18 | Intermittent uncomfortable socket, with severe mucopurulent conjunctivitis and HA exposure 4 times | 24 months | HA removal | - | Multiple granulomas composed by foreign body reaction surrounding the exposed implant |
| 4 | M | 33 | RE | Enucleation and donor sclera | Trauma | 18 | Discharge and redness | 24 years | HA removal and DMFG | Preseptal soft tissue swelling affecting the right upper and lower eyelids including the medial canthal area and medial rectus muscle | Multiple granulomas with foreign body reaction and numerous eosinophils |
| 5 | M | 44 | LE | Enucleation and donor sclera | Trauma | 20 | Inflamed anophthalmic socket with a 6 mm exposed HA implant and contracted fornix | 10 years | HA removal | Inflamed socket mainly around the implant and affecting the anterior portion of the orbit | Intense fibrosis and granulomatous reaction |
| 6 | F | 9 | LE | Enucleation and donor sclera | Retinoblastoma | 20 | Continuous chronic discharge, redness and contracted fornix | 2 years | HA removal and DMFG | - | - |
RE, right eye; LE, left eye; DMFG, dermis fat graft; HA, hydroxyapatite; CT, computed tomography.