Implantation of a Bio-Eye orbital implant
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This is Richard Allen at the University of Iowa.
This video demonstrates the use of a Bio-Eye implant by Integrated Orbital Implants.
I have no financial disclosures. The patient has had an enucleation performed in the standard manner, as demonstrated in my other enucleation videos. The Bio-Eye implant has a smooth covering and can be slipped into the orbit. Some surgeons will use a piece of plastic drape to help guide the implant into the orbit. Due to the smooth covering of the implant, I do not feel that this is necessary. The rectus muscles are then attached to the implant using the holes in the covering of the implant. Some surgeons advocate overlapping the muscles across the anterior surface of the implant. The reason to do this is to advance as much vascularized tissue as possible across the anterior surface of the implant to prevent subsequent exposure. I prefer trying to keep the muscles in their normal anatomic position with the thought that this is better for motility, but I have no evidence to support this.
The medial rectus is attached followed by the lateral rectus. The suture used is a 5-0 Vicryl suture on a spatula needle, which can sometimes be difficult to place under the covering. Bending the needle can be helpful if there is difficulty in advancing the needle under the covering. The inferior rectus is then attached followed by the superior rectus. Again, I think there are multiple acceptable ways to attach the muscles to the implant. I have had good luck with regards to a low exposure rate in using the method demonstrated here. The Tenon's and conjunctiva can then be closed in the standard fashion. Please see my other enucleation videos for demonstration of the closure.