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 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.