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To the Editor.
—The authors of "Postenucleation Orbital Implant Extrusion" (Archives 96:2064-2065, 1978) have observed that six consecutive patients with postenucleation orbital implant extrusion demonstrated nonkeratinized stratified squamous epithelium lining the implant pouch. They attribute this "conjunctival" lining to conjunctival ingrowth and the subsequent extrusion to that ingrowth. While there is no question that a buried section of conjunctiva might produce an implantation cyst, which in turn could lead to extrusion, it is my experience that all orbital implants are lined with a "pseudoconjunctiva" that represents, presumably, a metaplasia of the superficial cells of Tenon's capsule into this stratified squamous epithelial lining. The layers of this pseudoconjunctiva, we have observed, have always been uniform in depth and are invariably present over the full surface of the implant pouch. While one rarely has the opportunity to examine an implant that is not extruding, I am sure these retained implants must show
Ellis FD. Extrusion of Postenucleation Orbital Implant. Arch Ophthalmol. 1979;97(4):775-776. doi:10.1001/archopht.1979.01020010411033