Complications of sclera-covered enucleation implants

PURPOSE: To determine the incidence of complications associated with the use of donor human sclera to cover porous and nonporous enucleation implants. METHODS: A retrospective case series of 207 patients receiving donor scleral-covered implants during a standardized enucleation procedure. RESULTS: There was a single case of exposure among the 112 patients (0.9%) receiving nonporous implants. None of the 95 porous implants (0%) demonstrated primary exposure. Conditions leading to the removal of 3 of the 207 (1.4%) implants included primary exposure (n = 1), secondary exposure after peg insertion (n = 1), and postoperative pain (n = 1). Two patients (1%) required postoperative tarsorrhaphies to control chemosis. Conjunctival granulomas developed in 2 patients (1%). Asymptomatic implant rotation was observed in 31% (5/16) of patients receiving flattened porous implants. There were no cases of implant migration or prolonged inflammation related to the covering material. CONCLUSIONS: Donor sclera covering of both porous and nonporous enucleation implants appears to be a successful surgical technique associated with few serious complications. The potential benefits of this technique must be balanced by the increased cost of the wrapping material and the rare but potential risk of transmitting infectious disease.