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.
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.