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 16-year-old boy presented with a tilted and unstable custom ocular prosthesis. On examination, he had a decentred prosthesis with its inferior edge resting on the lower eyelid margin. There was shelving of the inferior fornix with inferotemporal migration of the orbital implant resulting in frequent loss of prosthesis from the eye socket. The implant was palpable anterior to the inferior orbital rim. There was no apparent conjunctival surface loss. Volume loss was evident in terms of grade IV SSD. CT scan of the orbit showed an 18-mm orbital implant migrated inferotemporal into the extraconal space. He had undergone three socket surgeries in the past starting with an evisceration with implant for a painful blind eye followed by implant exchange twice with fornix formation sutures for inferotemporal implant migration and forniceal shelving. Owing to recurrent implant migration, we anticipated fibrosis in the orbit and hence did not consider an implant exchange. The patient refused a DFG after explaining about the donor site morbidity. Hence, we placed a PSI in the inferotemporal orbit that would push the migrated implant centrally. The postoperative course was uneventful and both the implants remained centered over 36 months of follow-up. There was no reduction in seen in the motility of the COP after PSI placement []. This was the pilot case treated in this series.