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 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.