Dermis Fat Graft Implantation into Anophthalmic Socket

Dermis fat graft implantation has been used for decades to augment orbital volume and surface area in patients with congenital anophthalmia as well as those suffering complications of secondary anophthalmia following enucleation. It is most commonly performed as a means of socket reconstruction in patients with an exposed or extruded orbital implant and to prevent socket contracture. In this video, a dermis fat graft is harvested from the buttock and implanted into an anophthalmic socket for treatment of exposure of orbital implant in the right socket of a patient who was status post enucleation in both eyes for painful blind eyes.

Suzanne K. Freitag, MD

Victoria Starks, MD

Zujaja Tauqeer

Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School

Removal of Orbital Implant Dermis Fat Graft Harvestation from Buttock and Implantation into Anophthalmic Socket Temporary Tarsorrhaphy
Exposure of orbital implant in the right socket of a patient who was status post enucleation in both eyes for painful blind eyes.
Active infection in the anophthalmic orbit, because putting the graft in place there would cause an abscess, which would be very bad.
The procedure is performed under general anesthesia in the operating room. The patient is prepped with diluted (5%) betadine, with sterile drapes exposing the eyes and separately the right buttock as the surgical field. A lid speculum is introduced into the eye that will be operated on.
Full ophthalmic examination with specific attention to inspection of the socket, superior sulcus, palpebral aperture and lid is performed. Degree of socket contracture is assessed. Presence of any scar tissue in the conjunctiva, lid, and socket is carefully assessed. Graft site is examined for adequate vascular support. Donor site is selected from an area of the body that is hairless, easily hidden under minimal wear, has presence of sufficient underlying fat, and is amenable to the patient. Recipient and donor sites are both free of infection prior to surgery. Anticoagulation is discontinued prior to surgery to prevent excessive bleeding during procedure.
The advantage of the procedure is that it can be used to augment orbital volume and surface area in anophthalmic eyes where orbital implants or prostheses have proven inadequate, in order to prevent enophthalmos and depression of eyelids. The disadvantage is the unpredictable rate of fat atrophy that occurs post-procedure.
Infection at donor site and socket. Fat graft failure in absence of adequate vascular support. Fat atrophy and volume loss: it is difficult to predict the degree of subsequent fat graft atrophy following procedure, though generally about one-third of the implanted fat graft is expected to shrink. Conjunctival cysts, granulomas, socket keratinization, and graft wound dehiscence.
Aryasit O, Preechawai P. Indications and results in anophthalmic socket reconstruction using dermis-fat graft. Clin Ophthalmol. 2015;9:795-9.

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