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 [].
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.