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We have read with avid interest the article by Gupta et al on the use of bovine pericardium as a wrapping material for hydroxyapatite orbital implants.1 We are highly impressed by their results as none of the patients had implant extrusion. This is really commendable since implant extrusion rates have ranged from 9% to 21% in previous studies,2 and it indicates meticulous technique and follow up. We would like to clarify a few pertinent issues.
Although bovine pericardium is generally considered non-reactive, it has been reported to produce severe inflammatory reaction in cardiac use.3 Another area of major concern with cardiovascular use of bovine pericardium has been the development of calcification seen in both laboratory studies and cardiac patients.4 It is still uncertain what impact such a calcification would have on an orbital implant and assessment of its effect would certainly require studies with a larger number of patients and longer follow up. However, it has been suggested that it may hamper its motility.2 We suggest that the possibility of misinterpretation of imaging findings in cases of orbital recurrence of tumours should not be overlooked.
Another crucial area of concern is the risk of infection with xenografts, which cannot be totally eliminated even by highly stringent screening and processing procedures. We are referring to the group of bovine spongiform encephalopathies including Creutzfeldt-Jakob disease (CJD) and its variant found in the United Kingdom (vCJD).
Therefore, the quest for a comparable synthetic wrapping material and better implants which do not require wrapping continues, and bovine pericardium should be considered, bearing in mind its above mentioned shortcomings.