Dermis-fat grafts and enucleation in Ghanaian children: 5 years’ experience

Abstract

Background: Enucleation in young children often results in retarded orbital growth ipsilaterally. The need for an implant that will naturally grow with the child, like Dermis-fat Graft (DFG), for managing the anophthalmia has been of interest over the years.

Objective: To evaluate the use of DFG as an implant for volume replacement post-enucleation.

Study Design: A prospective non-comparative case series involving 18 consecutive children who had DFG either primarily or secondarily in  conjunction with enucleation for intraocular pathologies, from December
2007 to September 2012, at the ophthalmology unit, Korle-Bu. Data from patients who had a minimum of three months follow up(FUP) were analysed.

Outcome measures: Complete covering of DFG with healthy conjunctiva, increase in volume of DFG, and presence or absence of   complications.

Results: Fifteen patients were analysed, aged nine months to ten years (mean (SD), 3.7±2.7years). Eight (53.3%) were females. Thirteen (86.7%) DFGs were secondary and 2(13.3%) primary. Indications for enucleation
were intraocular retinoblastoma (n=10, 66.7%), unexplained retinal detachment mimicking retinoblastoma (n=3,20.0%), anterior staphyloma
(n=1,6.7%) and medulloepithelioma (n=1,6.7%). Fourteen (93.3%) patients showed increase in volume of DFG. Time for Conjunctival  reepithelialisation of the dermal surface was four to fourteen weeks
(mean/median=5.5/4.0). Complications encountered were infection (n=1,6.7%), infection with necrosis (n=1,6.7%), melanosis /keratinization (n=2, 13.3%) and cysts(n=2,13.3%). The patients were followed up
for 3 to 54 months (mean/median 20.13 /16.00).

Conclusion: DFG for management of post-enucleation anophthalmia in Ghanaian children showed 93.3% success.

Keywords: Dermis- fat graft, enucleation, volume replacement,
anophthalmia