Orbital Volume Augmentation with Calcium Hydroxyapatite Filler in Anophthalmic Enophthalmos

Purpose: To report the long‑term results of orbital volume augmentation using calcium hydroxyapatite filler injections in patients with anophthalmic sockets. Methods: Twelve eligible patients with post‑enucleation socket syndrome (PESS) and small orbital volumes were included in our study. In this investigation, 1.5 mL injectable calcium hydroxyapatite (Radiesse) was utilized in an off‑label application under local anesthesia. We evaluated the effect of orbital volume augmentation for correction of enophthalmos. Results: Five women and seven men with a mean age of 35 years (range, 21‑72 years) were included in the study. The mean follow‑up was 19.5 months (range, 16‑27 months). Enophthalmos and deep superior sulcus were reduced in all patients during all follow‑up visits postoperatively. The mean improvement of enophthalmos was 2.58 mm (range, 1‑5 mm) and the improvement in deformity grading of superior sulcus was 0.83 (range, 0‑4 grade). The mean marginal reflex distance increased by 0.6 mm (range of ‑1 to 3 mm). Complications included increase in ptosis in two cases and extrusion of the filler accompanied by discoloration of the skin in one case. Conclusion: The use of injectable calcium hydroxyapatite for orbital volume restoration in anophthalmic sockets is a simple, fast, and minimally invasive method with considerable long‑term effects and low complications.