Long-term outcomes of pegged and unpegged bioceramic orbital implants.

Purpose: To evaluate the long-term outcomes of pegged and unpegged bioceramic orbital implants. Methods: A retrospective analysis of 101 cases of evisceration, enucleation, or secondary implant surgery with placement of a bioceramic porous implant was conducted. Type of surgery, existence of a peg, peg system used, time of pegging, problems encountered before and after pegging, treatment methods, and final status were recorded. Results: Evisceration was performed on 74, enucleation on 16, and secondary implant surgery on 11 patients. The patients were observed for a mean of 68.4 months (3 months-12 years). Fifty-three of the 101 patients were pegged. Patients were pegged at a mean of 9.3 months (6-23 months). Hydroxyapatite-coated, titanium-sleeved, titanium pegs were used in 43 patients, and titanium peg and sleeve system was used in 10 patients. Major complications were exposure and infection. Three patients presented with early exposure and late exposure developed in 14 of pegged and 4 of unpegged patients. The difference in late-exposure rates between pegged and unpegged group was statistically significant (p < 0.05). Implant infection developed in 9 of the pegged and in 1 of the unpegged patients. Implant exposure was noted in 6 of these 10 patients with infection. The difference in infection rates between the pegged and unpegged patients was statistically significant (p < 0.05). In 2 of the pegged patients, removal of bioceramic implant was required and after resolution of infection, another type of porous implant was implanted and repegged. The peg system was removed in 6 patients for the management of either exposure, infection, extrusion, hypermobility of sleeve, or peg falling out. Four patients were repegged. The time period between peg insertion and development of complications ranged from 15 days to 10 years. 86.8% of pegged patients were free of major complications and satisfied with the result at the last follow-up visit. Conclusion: Despite potential complications that can occur as late as 10 years, bioceramic porous implants yield satisfactory long-term results. Existence of a peg system appears to play a role in the increased rate of late-onset complications. Further investigations on new and safer pegging systems should be conducted. (Ophthal Plast Reconstr Surg 2012;28:264-267)