Predisposing Factors and Timing of Orbital Implant Exposure/Extrusion Following Enucleation or Evisceration: An 11-year study


  • Meesit Wongsaithong Department of Ophthalmology, Faculty of Medicine, Chiang Mai University
  • Susama Chokesuwattanaskul Chulalongkorn University
  • Sakarin Ausayakhun Department of Ophthalmology, Faculty of Medicine, Chiang Mai University


orbital implant extrusion, orbital implant exposure, evisceration, enucleation



Enucleation and evisceration are surgical procedures to remove a diseased eye. An extrusion/exposure of the orbital implants is the most common post-operative orbital implant-related complication. This study aimed to identify the incidence, timing, and possible risk factors of orbital implant exposure/extrusion in patients who underwent enucleation or evisceration.


The medical records of patients diagnosed with “exposure/extrusion orbital implant” following enucleation or evisceration at Chiang Mai University Hospital between January 2007 and December 2017 were retrospectively reviewed. Multivariable regression analysis was performed to identify the possible predicting factors.


Overall, 466 patients underwent either enucleation (313/466, 67.17%) or evisceration (153/466, 32.83%). Three hundred twelve patients (312/466, 67.16%) were male. The age ranged between 0 and 94 years. The incidence of exposure/extrusion was 12.14% (38/313) in the enucleation group and 17.65% (27/153) in the evisceration group. The most common indication for surgery was ocular infections (218/466, 46.78% patients). Using multivariable regression analysis, older age (p=0.008) and HIV infection (p<0.0001) were significantly associated with the occurrence of exposure/extrusion in patients who underwent enucleation but not the evisceration.


The incidence of extrusion/exposure of the orbital implants following enucleation or evisceration was not uncommon. We identified older age and HIV infection as possible risk factors of orbital implant exposure/extrusion in patients who underwent enucleation. In most cases, the complications occurred within a month following the enucleation (18/38, 47.37% patients) and during 1-12 months following the evisceration (16/27, 59.26% patients), suggesting the appropriate follow-up frequency and period.


Al-Farsi HA, Sabt BI, Al-Mujaini AS. Orbital implant exposure following enucleation or evisceration. Oman J Ophthalmol. 2017;10(2):87-90. doi:10.4103/ojo.OJO_156_2016

Ye J, Gao Q, He JJ, et al. Exposure rate of unwrapped hydroxyapatite orbital implants in enucleation surgery. Br J Ophthalmol. 2016;100(6):860-865. doi:10.1136/bjophthalmol-2015-307412

Schellini S, Jorge E, Sousa R, et al. Porous and nonporous orbital implants for treating the anophthalmic socket: A meta-analysis of case series studies. Orbit. 2016;35(2):78-86. doi:10.3109/01676830.2016.1139591

Viswanathan P, Sagoo MS, Olver JM. UK national survey of enucleation, evisceration and orbital implant trends. Br J Ophthalmol. 2007;91(5):616-619. doi:10.1136/bjo.2006.103937

Gradinaru S, Popescu V, Leasu C, et al. Hydroxyapatite ocular implant and non-integrated implants in eviscerated patients. J Med Life. 2015;8(1):90-93.

McElnea EM, Ryan A, Fulcher T. Porous orbital implant exposure: the influence of surgical technique. Orbit. 2014;33(2):104-108. doi:10.3109/01676830.2013.851706

Lin CW, Liao SL. Long-term complications of different porous orbital implants: a 21-year review. Br J Ophthalmol. 2017;101(5):681-685. doi:10.1136/bjophthalmol-2016-308932

Oestreicher JH, Liu E, Berkowitz M. Complications of hydroxyapatite orbital implants. A review of 100 consecutive cases and a comparison of Dexon mesh (polyglycolic acid) with scleral wrapping. Ophthalmology. 1997;104(2):324-329. doi:10.1016/s0161-6420(97)30316-9

Sami D, Young S, Petersen R. Perspective on orbital enucleation implants. Surv Ophthalmol. 2007;52(3):244-265. doi:10.1016/j.survophthal.2007.02.007

Wladis EJ, Aakalu VK, Sobel RK, et al. Orbital Implants in Enucleation Surgery: A Report by the American Academy of Ophthalmology. Ophthalmology. 2018;125(2):311-317. doi:10.1016/j.ophtha.2017.08.006

Yoon JS, Lew H, Kim SJ, et al. Exposure rate of hydroxyapatite orbital implants a 15-year experience of 802 cases. Ophthalmology. 2008;115(3):566-572.e2. doi:10.1016/j.ophtha.2007.06.014






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