A 43-year-old lady presented to us with complaints of frequent fall of the prosthetic eye from the left eye socket since the past 4 years. She had undergone an evisceration for panophthalmitis followed by secondary implant for volume augmentation 10 years ago. On examination, she had a sunken appearance of the prosthesis with a grade IV SSD and a 4-mm enophthalmos on the left side. There was inferotemporal implant migration with a shallow fornix. She underwent a PSI placement that helped center the migrated spherical implant. The fornix deepened after PSI placement. However, the SSD persisted for which she had a filler injection. Over a follow-up period of 15 months there were no complications noted with either implants. The fornix remained deep thereafter.
A 3-year-old boy was referred to us following enucleation with PMMA implant (18 mm) for retinoblastoma. On examination, there was a shallow inferior fornix and an inferotemporal implant migration. The implant was palpable anterior to the inferior orbital rim. The child was unable to retain a COP in the eye socket. A PSI was implanted into the basin of the inferior orbital fissure to recenter the implant. He underwent a Fornix formation suture (FFS) with mucus membrane grafting to deepen the fornix after 6 weeks. Over a follow-up period of 12 months, no complications were noted.\nThe baseline demographics, pre- and postoperative socket findings, and the results of surgery are as described in . None of the six patients developed complications of the spherical or PSI over a mean of 21-month follow-up. Three patients underwent a simultaneous inferior fornix formation suture for a shelved inferior fornix. Two patients underwent subsequent fornix formation suture and mucus membrane graft for grade 1 contracted socket with shallow inferior fornix. One patient required a levator reattachment for anophthalmic ptosis and one patient had persistent severe SSD for which hyaluronic acid gel filler was injected into the brow fat. The mean pre- and postoperative enophthalmos was 2.33 ± 0.81 and 0.5 ± 0.83 mm, respectively (P = 0.14). The mean preoperative SSD was grade 2 and postoperatively grade 0 (P = 0.1). The mean pre- and postoperative COP weights were 2.7 ± 1.25 and 2.2 ± 0.88 g, respectively (P = 0.37). The mean pre- and postoperative COP thickness was 7.16 ± 2.99 and 6.33 ± 1.21, respectively (P = 0.47). The mean PSI implant weight was 2.66 ± 0.53 g. There was no reduction in ocular motility post surgery with PSI []. The average patient score of satisfaction with the final prosthetic outcome was 9 on 10.