Orbital implant exchange after evisceration
Richard C. Allen, MD, PhD
Additional Notes: Length 04:23
Posted March 20, 2017
This is Richard Allen at the University of Iowa. This video demonstrates exchange of an orbital implant in a patient who had undergone a prior evisceration. The patient now has an exposed silicone implant. Westcott scissors were used to dissect along the surface of the implant. The area of the exposure is opened horizontally. This is performed both laterally as well as medially. A towel clamp is then used to engage the implant. The scleral shell is opened slightly in order to facilitate removal of the implant. The implant can then be removed. The inside of the scleral shell is inspected. Dissection is then carried out along the surface of the scleral shell in order to mobilize it from the surrounding Tenons and conjunctiva. This will help with closure later. The posterior surface of the sclera is then opened with a 15 blade. A new implant will be placed posterior to posterior sclera. The posterior sclera is demonstrated and an implant is placed posterior to posterior sclera. This is an 18 mm PMMA implant. The posterior sclera is then closed over the PMMA implant with interrupted 4–0 Vicryl sutures. This will result in placement of the implant in the intraconal space. After the posterior sclera has been closed the anterior sclera will be closed. This is performed with a running mattress suture using the same 4-0 Vicryl suture. This results in 2 layers of sclera over the implant. The conjunctiva will then be closed over the sclera. This is performed with a combination of interrupted and running 7–0 Vicryl sutures. At the conclusion of the case, there are 3 layers of tissue covering the new implant: posterior sclera, anterior sclera, and conjunctiva. A medium conformer is placed. In this case a suture tarsorrhaphy will be performed. This is performed by placing mattress sutures which enter the skin and exit the Meibomian gland orifices followed by entering the Meibomian gland orifices and exiting the skin. This is a 5-0 chromic sutures. 3 sutures will be placed along the length of the lid margin.
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