Implant Motility in Two-Scleral Flaps Evisceration

ABS TRACT Objective: To evaluate the presence of implant motility in each cardinal position associated with two-scleral flaps evisceration. Material and Methods: In this interventional case series, the medical records of 38 patients were reviewed retrospectively. Patients that underwent two-scleral flaps evisceration with placement of a spherical acrylic implant were reviewed. The patients instructed to look in 6 extreme gaze directions (superior, inferior, medial, and lateral and superior medial and inferior medial). The horizontal and vertical excursions were measured with a standard millimeter ruler based on any hollow on socket surface and over than four mm excursion was regarded as positive implant motility. Main outcome measure is implant motility. Results: Among the 38 patients, 19 (50%) were male and 19 (50%) were female. Mean patient age at the time of surgery was 29.1 years (range: 5-83 years); 6 patients were aged <14 years. Mean duration of postoperative follow-up was 6 months (range: 3-12 months). Medial and lateral excursions over 4 mm were achieved in all patients. Inferior excursion over 4 mm was achieved in 25 (65.9%) patients, superior excursions over 4 mm was achieved 20 (52.6%) patients. Oblique muscle function has been completely disabled in all patients. Mild ptosis was observed in all patients. Conclusion: In two-scleral flaps evisceration method some implant motility can obtained. But it does not take into account tenon’s capsule-pulley and physiological dynamics of extraocular muscles and check ligaments. Therefore this method is falling in contruction of full implant motility and it can not obviate incomitance between eviscerated eye and fellow eye.