A 24-year-old gentleman presented to us with complaint of frequent loss of the prosthesis from the eye socket. He had undergone right eye enucleation with a 16-mm implant for retinoblastoma at the age of 4 years. He was diagnosed to have inferotemporal implant migration with a shallow inferior fornix at the 3-month postoperative visit. Two years later, he underwent fornix formation sutures for the right side; however, the inferior fornix remained shallow in the postoperative period. He then underwent a PSI placement along with a fornix formation suture and over a follow-up period of 17 months, there were no complications noted. The postoperative scan revealed a posterior movement of the spherical implant in the z-axis along with its centration in the orbit following placement of PSI.
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.