Enophthalmos Wedge Implant
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This is Richard Allen at the University of Iowa. This video demonstrates placement of an enophthalmos wedge implant for an anophthalmic patient with enophthalmos. The patient is inspected and the superior sulcus deformity is noted. The prosthesis is removed and inspection of the prosthesis shows that the ocularist has attempted to fill the volume of the superior sulcus with superior volume on the prosthesis. 4-0 silk suture is placed through the lower eyelid margin to provide traction during the case and to provide a Frost suture post-operatively. A subciliary incision is made with the needle tip cautery extending from the punctum medially to the lateral canthotomy incision laterally. A transcutaneous incision is preferred over a transconjunctival incision in anophthalmic patients so that the conjunctiva is not shortened. Dissection is then carried out between the orbicularis muscle and the orbital septum to the inferior orbital rim. The periosteum of the inferior orbital rim is incised and the periosteum is elevated from the orbital floor. A subperiostel pocket is developed medial to the infraorbital groove. The enophthalmos wedge implant is inspected and oriented. These implants come in right, left, medium, and large sizes. The wedge implant is placed into the subperiosteal space. This effectively adds volume posterior to the orbital implant. The implant is then fixated to the inferior orbital rim with a screw. The periosteum is then closed over the implant with 4-0 vicryl suture. A conformer is then placed and the subciliary incision is closed with fast absorbing suture. If preferred, a lateral tarsal strip can also be performed. This is a relatively young patient who does not need horizontal tightening. The Frost suture is taped to the forehead and a double eye pad is placed. The patient returns in one week for patch and suture removal.