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—In regard to the letter by Dr Ellis concerning our article on implant extrusion, we have the following comments.There are multiple clinical observations supporting the impression that epithelial downgrowths contribute to implant extrusion. Patients with exposure or loss of an implant have frequently presented long-standing problems to their physicians. Either replacement of the implant into the pocket with closure of the defect, or primary closure if the implant is still in place, regularly fail. Patch grafts with sclera or other materials do occasionally succeed. Implant replacement procedures have used scleral covers, mesh, alternate routes to the orbit, suturing to the periostium, placement behind Tenon's capsule, and others. These varied difficulties and variably successful approaches to the problem indicate our previous lack of understanding of the pathology.The surgical success of our procedure of removing the downgrowth is strong evidence in support of our hypothesis. No failures have
Dryden RM, Leibsohn J. Extrusion of Postenucleation Orbital Implant-Reply. Arch Ophthalmol. 1979;97(4):776. doi:10.1001/archopht.1979.01020010411034