The scleral filet technique for secondary orbital implantation surgery.

OBJECTIVE

To describe a simple procedure, the scleral filet technique, to place a secondary implant and take advantage of the scleral remnant.

SETTING

Oculoplastic service at a university-affiliated hospital in Ottawa.

PATIENTS: Three patients from Middle Eastern countries who had undergone evisceration following trauma without placement of an orbital implant. All three had a scleral remnant, enophthalmos and poor prosthetic motility.

INTERVENTIONS: The scleral remnant was incised (fileted) in a crisscross fashion, allowing access to the retrobulbar space. A hydroxyapatite implant was placed, and the scleral remnants were closed without disrupting the muscle attachments, leaving the socket motility intact.

RESULTS

All three patients had an uneventful postoperative course and were fitted with a prosthesis between 6 to 8 weeks. There was no implant exposure during the follow-up period of 8 to 15 months. Implant drilling and peg placement was carried out 6 to 10 months postoperatively. One of the patients had excellent motility, and two had good or fair motility. All were very satisfied with the results.

CONCLUSIONS

Advantages of the scleral filet technique include simplicity, ability to use the patient's own vascularized scleral remnant to act as a protective cap over the implant and avoidance of donor material. We advocate the use of this procedure when a scleral remnant is present in a patient presenting for consideration of secondary implantation.