We congratulate De Potter et al1 for their article in the February issue of the Archives. They are to be lauded for their many outstanding contributions to the literature. Our experience, however, is somewhat different from that of De Potter et al regarding ocular implants following enucleation in this patient population.
Since the introduction of the hydroxyapatite implant by Perry,2 implant size selection by many ophthalmologists has shifted toward smaller implants. Reasons for this include less chance of erosion or extrusion and the ability of the ocularist to fit a cosmetically superior prosthesis. The authors state that oversizing the implant in the young pediatric patient can help to produce a more normal orbit as the patient grows.
One must remember, however, that the placement of too large an implant may cause many short-term problems that outweigh these potential benefits.
Placement of an oversized implant increases the risk of
Mazow ML, Trawnik R. Use of the Hydroxyapatite Ocular Implant in the Pediatric Population. Arch Ophthalmol. 1995;113(1):16. doi:10.1001/archopht.1995.01100010018004