Primary or staged re-implantation with no exposures for orbital implants requiring explantation: a retrospective study over 10 years

Orbital implant exposure is a frequent and challenging complication following eye removal. Large exposures or infected defects often require implant removal, leading to complex challenges in volume restoration. This study aims to evaluate the efficacy and surgical outcomes of managing orbital implant exposure requiring explantation followed by a specific protocol of one-stage replacement or secondary implantation. This retrospective study included 43 patients who underwent orbital implant removal between January 2012 and December 2023. Patients were categorized into non-infection ( n = 11) and infection ( n = 32) groups. The non-infected group received one-stage implant replacement, while the infection group underwent a staged approach: initial explantation and infection control, followed by delayed secondary implantation at least 3 months later. Clinical characteristics, re-exposure rate, and long-term surgical outcomes were analyzed. Late exposure (> 3 months post-implantation) occurred in 90.7% of cases, with a mean interval of 62.1 ± 63.1 months. The infection group exhibited a significantly longer clinical course from symptom onset to explantation compared to the non-infection group (27.2 ± 29.3 vs. 9.4 ± 7.1 months, P = 0.0089). Eye-socket contracture was observed in 28 patients (65.1%), with a higher incidence trend observed in infected cases (71.88% vs. 45.45%). Among the 26 patients who received a new porous polyethylene implant, none experienced recurrent exposure, extrusion, or pyogenic granuloma over a mean follow-up of 64.4 months. Five patients (19.2%) reported postoperative volume deficiency. Tailoring surgical management to the infection status provides excellent long-term outcomes for patients requiring orbital implant explantation. Immediate primary replacement is safe for non-infected cases, whereas a staged secondary implantation strategy with meticulous surgical techniques is highly effective for infected cases to prevent re-exposure. Given that prolonged infection exacerbate socket contracture, early clinical recognition and prompt surgical intervention are paramount.