Smoking and immunomodulatory drugs increase the risk of orbital implant exposure

Investigators explored which systemic therapies and patients’ comorbid medical conditions were associated with orbital implant exposure following eye removal surgery.

Study design

This is a retrospective case series of 229 patients who underwent enucleation or evisceration with orbital implant placement at a single US center over a 10-year period. The primary outcome measure was the presence or absence of implant exposure. Medical comorbidities and the use of anticoagulation or immunomodulatory therapies before surgery were recorded.

Outcomes

The median follow-up time was 4.6 months. Sixty-two percent and 38% of patients underwent enucleation and evisceration, respectively, while 75% and 25% of implants were nonporous and porous, respectively. About 9% of patients experienced an exposed implant, at a median of 2.5 months after surgery. History of smoking and immunomodulatory therapy were identified as independent predictors of exposure; there was no significant difference in exposure rates among surgery types and implants used.

Limitations

This was a retrospective study with a heterogeneous group of individuals. The follow-up time was relatively short.

Clinical significance

Orbital implant exposure is a frustrating problem for patients and clinicians alike. This study gives useful information to discuss with patients with regard to minimizing the complication of exposure, as those patients who smoke and/or use immunomodulatory drugs are at an increased risk. It may be reasonable to consider a primary dermis fat graft in those patients who have significantly increased risk of implant exposure.