Use of the hydroxyapatite ocular implant in the pediatric population
P. De Potter, C. L. Shields, J. A. Shields and A. D. Singh
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa.
OBJECTIVES: There is always a hesitancy to use an ocular implant after
enucleation in children, especially in cases of eyes enucleated for
retinoblastoma. DESIGN AND SETTING: In this prospective study, we report
our experience of 60 consecutive cases in which we used the hydroxyapatite
ocular implant after enucleation in children younger than age 10 years.
RESULTS: The mean age at the time of enucleation and hydroxyapatite
placement was 27 months (range, 1 to 108 months). The histopathologic
diagnoses after enucleation included retinoblastoma in 51 patients,
endophthalmitis in two patients, persistent hyperplastic primary vitreous
in two patients, neovascular glaucoma resulting from Coats' disease in one
patient, uveal melanoma in two patients, undifferentiated intraocular
neoplasm in one patient, and blind painful traumatized eye in one patient.
After a mean follow-up of 19 months (range, 6 to 36 months), two cases of
conjunctival erosion and five cases of conjunctival thinning were recorded.
These problems were associated with a flat posterior prosthesis vault in
all seven cases. There were no cases of orbital cellulitis, implant
extrusion, or implant migration. All children showed good small-degree
prosthesis motility despite the lack of peg placement. Only one older child
underwent drilling and peg placement and she had excellent small- and
large-degree prosthesis motility. We generally postpone the drilling and
peg placement stage and tedious prosthesis revision in children until they
are able to fully cooperate with the ocularist. CONCLUSIONS: The
hydroxyapatite ocular implant is well tolerated and provides good
prosthesis motility in children with few complications. It is critical for
the ocularist to fit the prosthesis comfortably with a high posterior
vault.
