Injected calcium hydroxyapatite can reduce enophthalmos in an anophthalmic socket

Calcium hydroxyapatite (CAHY) filler is used in aesthetics for facial wrinkles, and may also be helpful in treating volume loss in the anophthalmic socket following enucleation or evisceration.

Study design

This was a 10-year observational study of 31 patients with post-enucleation enophthalmos who received a single injection of CAHY filler for orbital volume augmentation. The primary outcome was reduction in enophthalmos severity, as measured by Hertel's exophthalmometry.

Outcomes

A 3.4-mm mean reduction in enophthalmos was noted at 6 months after surgery and a mean 3.0-mm reduction was noted at 3 years. No long-term complications were reported.

Limitations

This was a noncomparative study with a small sample size. Also, since CAHY filler was injected into an anophthalmic socket, there was a lower risk of incorrect filler injection into the central retinal artery or ophthalmic artery to cause a vessel obstruction (e.g., central retinal artery occlusion).

Clinical significance

Anophthalmic sockets often have volume loss, and the traditional solutions of orbital surgery and implants require postsurgical recovery time and have the potential for many complications, including infection and implant migration/extrusion. Results from this pilot study demonstrate that retrobulbar injection of CAHY was effective in addressing the volume loss with minimal complications and can be considered in the armamentarium for orbital volume augmentation in the anophthalmic socket. Further studies are needed to evaluate its role in an orbit with a seeing eye.

Financial Disclosures: Dr. Anne Barmettler discloses no financial relationships.