A 47-year-old gentleman complained of an ill fitting prosthesis with frequent loss of the prosthesis from the eye socket. On clinical examination, the medial caruncular portion of the prosthesis was elevated from the conjunctival surface []. The inferior fornix was shelved and the implant was palpable anterior to the inferior orbital rim with inferotemporal migration []. Volume loss was evident in terms of SSD and enophthalmos. CT scan of the orbit showed an 18-mm orbital implant, migrated into the extraconal space in the inferotemporal quadrant []. He had undergone two socket surgeries in the past including an enucleation with implant for a painful blind eye followed by fornix formation sutures for a shallow inferior fornix. Based on the above findings, a diagnosis of inferotemporal implant migration was made and a PSI was fabricated as described above. This was placed in the basin of the inferior orbital fissure to recenter the migrated orbital implant. The surgical steps were as discussed in methods. A customized ocular prosthesis (COP) remained stable and central thereafter over his follow-up of 2 years. He underwent a ptosis surgery for mild anophthalmic ptosis after 18 months []. The spherical orbital implant was maintained in the central position over his entire follow-up period []. Hertel's exophthalmometry on both sides was equal. Postoperative CT scan of the orbit showed the PSI in place with intraconal recentration of the spherical implant []. There was no reduction in prosthesis motility.
A 25-year-old gentleman presented to us with an unstable prosthesis on the right side. He was diagnosed to have right eye secondary glaucoma with ciliary staphyloma at the age of 8 years for which he underwent an enucleation with 18-mm PMMA implant. Six years later, he developed post-enucleation socket syndrome with a shallow of inferior fornix. He was operated for fornix formation over three sittings in the postoperative period over the next 11 years; however, he had recurrent shortening of the fornix. On examination, there was lower eyelid laxity with shallow inferior fornix and a grade 2 SSD. The implant was migrated in the inferotemporal quadrant and palpable anterior to the inferior orbital rim. He underwent a PSI placement in the inferotemporal quadrant. This was followed by a fornix formation suture with mucus membrane graft for surface expansion. A COP was fabricated and dispensed 6 weeks thereafter. Over the next 20 months, both the implants remained stable and so did the inferior forniceal depth. There was a posterior movement of the spherical implant in the z-axis along with its centration in the orbit following the placement of PSI [].