Outcomes and Risk Factors for Complications of Dermis-Fat Graft as Primary Orbital Implant.

PURPOSE: To evaluate outcomes after dermis fat graft (DFG) as primary orbital implants after enucleation, complication rates, and possible risk factors for complications. METHODS: Retrospective analysis of all primary DFG (DFG I°) performed at the University Eye Hospital of Ludwig-Maximilians-University Munich from 2013 to 2022. RESULTS: A total of 257 sockets of 257 patients were reconstructed after enucleation with a DFG I°. 222 eyes with sufficient follow-up were included for analysis. Almost 59.9% (n = 133) of patients were male and 40.1% (n = 89) female. Median age at surgery was 60 years (range 10-93). The most common surgical indications were painful blind eye (148, 66.7%), malignancy (55, 24.8%), treatment-refractory perforated corneal ulcer (9, 4.0%), and disfiguring blind eye (5, 2.2%). Median time of follow-up was 10.6 months (range 0.7-123.2). Median time to fitting of the first prosthesis was 1.2 months (range 0.6-22.8). Prosthesis fitting was excellent in the majority of patients (156/168; 93%), as was prosthesis motility (119/158; 75%). Patient satisfaction was excellent in 81% (123/151). Complications were as follows: complete necrosis 1.8% (4/222), partial necrosis 2.7% (6/222), severe atrophy 1.8% (2/111), postoperative hemorrhage 0.5% (1/222), contracted socket 4.5% (5/111). Older age at surgery was statistically significantly associated with necrosis (p = 0.049), contracted socket (p = 0.042), and atrophy (p = 0.039). CONCLUSIONS: DFG is a safe and effective technique for primary socket reconstruction after enucleation, yielding favorable outcomes with rarely major complications. Older age at surgery was the sole significant risk factor identified for DFG necrosis, atrophy, and contracted socket.