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 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.