Three Surgical Approaches for Orbital Implantation: A Retrospective Review

Purpose: To compare the outcomes of 3 different surgical techniques for orbital implantation: 2-petal evisceration, 4-petal evisceration, and enucleation with “on-the-table” evisceration. Methods: We retrospectively reviewed the clinical charts of all patients who underwent evisceration surgery with orbital implantation at our center between 2015 and 2023. Patients were categorized into 3 groups based on the surgical technique used: 4-petal evisceration, 2-petal evisceration, and enucleation with “on-the-table” evisceration, which involved enucleation followed by an evisceration with autologous sclera wrapping on the anterior surface of the implant. Results: 231 patients were included. The mean duration of surgery was 60.4 minutes and was statistically significantly lower in the 2-petal group (47.6 minutes). There was no statistical difference between the groups in terms of complications, as only 8 patients experienced implant exposure (3.5%) and 2 patients developed chronic infection that necessitated implant removal (0.9%). Both mobility and aesthetic results were considered satisfactory for the majority of patients. One-third of patients underwent a secondary procedure, with ptosis surgery being the most common (19.9%), followed by lipostructure (fat grafting) (10.4%). The only significant statistical difference observed among the groups was implant size, which was notably larger in the “on-the-table” group. Conclusion: The 3 different surgical techniques are similar in terms of complications and functional outcomes.