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Outcomes of enucleation and porous polyethylene orbital implant insertion in patients with paediatric retinoblastoma: a long-term follow-up study
  1. Min Kyu Yang1,
  2. Min Joung Lee2,
  3. Namju Kim3,
  4. Hokyung Choung4,
  5. Sang In Khwarg1
  1. 1Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
  2. 2Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
  3. 3Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
  4. 4Department of Ophthalmology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
  1. Correspondence to Dr Hokyung Choung, Ophthalmology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Dongjak-gu 07061, Seoul, Republic of Korea; hokyung214{at}


Background/Aims To report the long-term outcomes of enucleation and insertion of porous polyethylene (PP) orbital implant according to the evolving surgical techniques and implant in patients with paediatric retinoblastoma .

Methods Patients with paediatric retinoblastoma who underwent enucleation and PP implant insertion from December 1998 to December 2014 were retrospectively reviewed and divided into four groups: group A, classic enucleation +PP implant; group B, enucleation +PP implant +anterior closure of the posterior Tenon’s (ACPT) capsule; group C, enucleation +PP implant +free orbital fat graft +ACPT and group D, enucleation +smooth surface tunnel PP implant +ACPT. Survival analysis of implant exposure and eyelid malpositions was performed.

Results One hundred and ninety-eight eyes of 196 patients were included. The median follow-up period was 13.0 years (range, 5.0–21.1). A 20 mm implant was inserted for 149 eyes (75.3%). The 10-year exposure-free survival probabilities were 44.6% in group A, 96.4% in group B, 97.4% in group C and 97.7% in group D. ACPT was associated with significant reduction in implant exposure (p<0.001). The most common eyelid malposition was upper eyelid ptosis (24.2%). The eyelid malposition-free survival probability did not differ among the four groups. However, the insertion of a 20 mm implant was associated with significant reduction in upper eyelid ptosis and lower eyelid entropion (p=0.004 and 0.038, respectively).

Conclusions The long-term postenucleation implant exposure was rare after PP implant insertion and ACPT, even with a 20 mm-diameter implant. A larger implant can be beneficial in long-term prevention of eyelid malposition.

  • eye (globe)
  • orbit
  • neoplasia
  • treatment surgery

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  • Contributors MKY: collected the data and wrote the paper. HC: designed the study. MJL, NK, HC, SIK: recruited the subjects. HC, MJL, NK, SIK: revised the manuscript and approved the final version of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval Institutional review board approval was obtained, and the study was performed in accordance with the principles of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Our deidentified participant data are available upon reasonable request. Contact ORCID: 0000-0001-5740-1639.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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