Outcome of myoconjunctival enucleation in Bangladesh

Abstract

Objectives: To evaluate the implant motility of myoconjunctival enucleation with polymethyl methacrylate (PMMA) implant, compared to the conventional enucleation with muscle imbrication with PMMA implant, and also to that of enucleation with porous polyethene implant. Material and Methods: A prospective, non-randomised, interventional study was conducted at the Department of Ophthalmology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, Bangladesh, from January 2020 to June 2025. Among the 30 patients of the study population, all were equally allocated to 3 groups. So that 10 patients were included in each group, namely, Group 1: myoconjunctival PMMA group, Group 2: conventional PMMA group, and Group 3 : porous polyethene group. All patients were evaluated at the 6th postoperative week and the 12th postoperative week. Post-operative results were compared on the follow-ups in terms of motility index. Analysis of orbit implant movement was carried out using the Mann-Whitney U test, and a P value of < 0.03 was considered significant. Results: Implant movement with the myoconjunctival PMMA implant was better (p = 0.001) than that of either the conventional PMMA (p = 0.003) or porous polyethene (p = 0.002) implants. The average motility index of the implant (sum of medial movement, lateral movement, upward movement, and downward movement divided by 4) in the myoconjunctival PMMA group was significantly improved compared to the other two groups. The myoconjunctival PMMA result was 3.21 mm on the 6th week and 3.25 mm on the 12th week, whereas it was 2.24 mm and 2.48 mm at the 6th week and 2.27mm and 2.54 mm at the 12th week, respectively, in the conventional PMMA and porous polyethene groups. Conclusion: Myoconjunctival enucleation technique with a PMMA implant provides statistically and clinically significantly better implant motility compared to that of conventional PMMA implant and porous polyethene implant. In myoconjunctival enucleation technique, each rectus is sutured to the respective fornix, thus preventing stretching, increasing implant stability, and motility.