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Editorial 
 

Current Status of Orbital Implants in 
Pakistan 

 
Anophthalmic socket reconstruction should start at 
the time of primary surgery. An orbital implant is 
regarded as the first step for making platform for an 
ocular prosthesis. Not long ago quite a few ophthal-
mologists in Pakistan believed that no implantation 
should be done at the end of evisceration for endoph-
thalmitis thinking that infection may persist. However, 
now mostly an appropriate sized acrylic ball is impla-
nted after evisceration and a conformer is inserted. 
Evisceration and acrylic ball implantation is also used 
by some surgeons in the cases of painful blind eye. 

Similarly after enucleation for ocular malignancy 
no implantation was done with a false belief that 
recurrence of tumour may be masked. On the contrary 
it is now believed that an implant makes detection of 
recurrence much easier. However, previously 
available implants had several problems. Allen 
implant has truncated front surface with sharp edges. 
Hence, it not only gives poor volume replacement but 
there is also an increased risk of wound dehiscence 
and implant exposure. 

Some surgeons have used acrylic ball wrapped in 
various donor materials. Each material has problems 
of its own. Sclera is scarcely available in Pakistan and 
there is associated risk of microbial transmission. 
Other autogenous materials like fascia lata, temporalis 
fascia and pericranium have been tried for wrapping 
the implants. There are several reports of exposure 
and infection with Merselene mesh. All these materials 
have the associated problem of extended surgical time 
and risk of disease transmission. As some of these 
patients undergo postoperative chemo or radiotherapy, 
there is an added risk of delayed wound healing in 
donor area. 

A relatively recent addition to the implants is a 
family of bio-integrable implants. These implants have 
minute pores that invite fibro-vascular in growth, 
hence it becomes part of body or bio-integrates. These 
implants have advantage of possibility of a peg 
insertion which allows the prosthesis to be directly 
connected to the bio-integrated implant and hence 
improved motility. The implants of this category 
include hydroxyapatite, Medpor, Biopore and 
Bioceramic. Hydroxyapatite is made up of a naturally 

occurring coral. It has the associated difficulties of 
wrapping material. There is also a green lobby against 
damage to the natural life. Other problems associated 
with these implants are recurrent infection, exposure 
and cost. An average bio-integrable implant costs 
approximately US$1000 in Pakistan. Once the cost of 
services is added, it becomes out of reach for most of 
the patients not only in Pakistan, but also in other 
developing countries. The pegging can also be 
associated with recurrent granuloma formation and 
dislocation; hence only 10% of these implants get 
pegged anyway.  Moreover, some authorities are quite 
skeptical about the claims of improved motility with 
the peg. Secondary orbital implantation is encountered 
with even more problems, like exposure, migration 
and infection. 

With the onset of implant manufacturing in 
Pakistan the cost has become bearable. Moreover; 
indigenously developed implants like Sahaf and OFI 
(Omnifit Orbital Implant) implants have tried to 
address quite a few of the problems for Pakistani 
patients. Locally manufactured implants are readily 
available at a fraction of the cost of porous implants 
which are available after 6 weeks of placement of the 
order. Some of the locally available implants 
incorporate a magnet, which can be later coupled with 
a piece of metal in prosthesis to increase motility. 
 
REFERENCE 
1. Kelman CD: Phacoemulsification and aspiration: A new 

technique of cataract removal. Am J Ophthalmol. 1967; 64: 23. 
2. Saeed M, Monis M, Cheema AM, et al. Surgical treatment of 

anopthalmic socket - An experience with 42 intra -orbital 
implants. J Coll Physcians Surgeon Pak. 2000; 10: 175-8. 

3. Trichopoulos N, Augsburger JJ. Enucleation with unwrapped 
porous and nonporous orbital implants: a 15-year experience. 
Ophthal Plast Reconstr Surg. 2005; 21: 331-6. 

4. Ashworth J, Brammar R, Inkster C. Leatherbarrow. A study of 
the hydroxyapatite orbital implant drilling procedure. Eye. 
1998; 12: 37-42. 

5. Jordan DR. Problems after evisceration surgery with porous 
orbital implants: experience with 86 patients. Ophthal Plast 
Reconstr Surg. 2004; 20: 374-80. 

6. Current trends in managing the anophthalmic socket after 
primary enucleation and evisceration. Ophthal Plast Reconstr 
Surg. 2004; 20: 274-80. 

7. Kamal Z, Girdharilal AA. A review of Sahaf orbital implants 1. 
Pak J Ophthalmol. 2007; 21: 331-6.