Purpose: The purpose of this article is to assess surgical outcomes of 3-dimensional (3D)
printed custom porous polyethylene cast-molded orbital implants with the use of digital
mirroring from the contralateral orbits in diverse orbital reconstruction settings.
Methods: A retrospective chart review of patients receiving 3D-printed custom orbital implants
at a single tertiary center from 2020 to 2023 was performed. Each patient had undergone
a detailed ophthalmologic examination and was evaluated radiologically by using thin-slice
multiplanar CT imaging preoperatively. For each patient, high-resolution CT scans
were utilized to generate 3D models of their existing bony structures (Fig. 1). The contralateral orbit’s 3D shape on the CT scan was digitally mirrored to the
affected side (Fig. 2). Subsequently, a skull was 3D printed, and a custom porous polyethylene implant
(Stryker, Kalamazoo, MI) was fabricated via cast-molding to achieve the intended normal
orbital contour, with the implant designed to fill the defect in comparison to the
contralateral side (Fig. 3). Patient data included demographics, preoperative computed tomography findings,
pre- and postoperative clinical features, surgery duration, and surgical complications.
Results: A total of eight patients (five males and three females) were included in the study.
The mean age of patients was 47.8 years (range: 23–73 years). Indications for surgery
were diplopia, enophthalmos, hypoglobus, orbital, or facial deformities after significant
trauma or tumor removal. One patient had bilateral orbital defects due to orbital
blow-out fractures while others had unilateral orbital defects. The mean follow-up
time was 27.88 ± 9.66 months (range: 7–38 months). Trauma accounted for six (75%)
cases, silent sinus syndrome for one (12.5%), and facial deformity for one (12.5%)
after tumor resection. Orbital fractures most commonly involved the orbital floor
(n = 6, 100%), followed by medial (n = 2, 33.3%), and lateral walls (n = 1, 16.6%). The mean surgery duration was 183.4 minutes (range: 61–245), with 66.7%
of trauma cases (n = 4/6) needing prior hardware removal. Postoperative improvement was seen for enophthalmos
in seven of eight cases, hypoglobus in three of five cases, and diplopia in three
of four cases, and the average exophthalmometry asymmetry improved from 3.1 to 0.5 mm.
Conclusion: 3D-printed custom orbital implants designed using contralateral orbit mirroring techniques
demonstrated effectiveness and safety in this diverse series of orbital reconstruction
cases, yielding significant improvements in enophthalmos, hypoglobus, and diplopia
even in the presence of bilateral orbital defects. This study supports the use of
3D printed custom orbital implant use for a variety of complex orbital reconstruction
indications.
