Primary dermis fat graft as orbital implant after evisceration

Abstract

Aims: Orbital implants allow for cosmesis and volume replacement of an eviscerated eye. Alloplastic orbital implants are associated with potential complications, including exposure and extrusion. Dermis fat graft offers the advantages of its relative availability and autologous nature. This study aimed to provide evidence for dermal fat graft as a safe and stable orbital volume replacement following ocular evisceration.

Methods: This prospective case series involved the placement of dermis fat graft harvested from the paraumbilical area of the patient’s abdomen into the eviscerated scleral shell with the dermis sutured to the sclera and covered by conjunctiva. At 6 weeks postoperatively, patients received an ocular prosthesis. The volume of the dermis-fat grafted globe was measured at 1 month and 9 months postoperatively by plain magnetic resonance imaging of the orbit. Postoperative exophthalmometry was performed with the prosthesis in place at 1 and 9 months. A numerical satisfaction scale score was obtained from patients 9 months postoperatively.

Results: Eight patients underwent ocular evisceration and dermis fat graft implant. Six patients completed the study. The dermis fat–grafted globe showed a reduction of mean (standard deviation) of 1.92 (1.31) ml after 9 months (p = 0.028, Wilcoxon signed rank test). Clinical exophthalmometry showed a mean difference (standard deviation) of 2.14 (0.9) mm compared with the fellow eye after 9 months (p = 0.083, Wilcoxon signed rank test). Mean satisfaction score was 6.5 (range, 5 to 8).

Conclusions: Dermis fat graft is a viable alternative to alloplastic implants as a primary orbital implant following ocular evisceration. Despite the reduction in volume and clinical enophthalmos over time, it is a safe implant without significant complications. Dermis fat graft may be particularly useful for a subset of patients at risk of exposure or extrusion from alloplastic implants.