Problem of orbital implants after enucleation.

GREAT efforts have been made by ophthalmologists in the last 10 years to design an implant conveying good prosthetic mobility, to offset in part the tragic result of excision. The immediate success of the implants aroused enthusiasm, but subsequent complications, including suppuration and expulsion, have led to further modifications. So frequent were these disappointments in spite of changes in technique that most ophthalmologists returned to the idea of a less mobile implant, which would neither cause suppuration nor be expelled. It became evident that these complications were due to the fact that where part of an implant protruded through an open wound, the wound rarely healed. As I had the same disappointments as others with this technique, I used a three-quarter sphere plastic implant with tunnels through which the four recti were drawn and sutured. This implant was completely buried and had no peg attached to it. My friend Moura-Brazil had observed that if an implant had a peg buried some distance from the conjunctival wound, it would slowly perforate the conjunctiva without any visible wound being formed around it. Since this implant had certain defects of shape in my opinion, he and I agreed to add a peg to my implant, to employ his method of conjunctival suture and to name this the Arruga-Moura-Brazil technique. The result is an acrylic implant 3/4 or 2/5 of a sphere of 16-18 mm. diameter with one or two noncorrodible metal pegs 1 mm. thick and 7 mm. long projecting from the upper part of its anterior surface (Figs 1 and 2).