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 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.