Three-year outcomes of enucleation with cross-hatched rectus muscle attachment to a polyethylene orbital implant.

PURPOSE: Orbital implant exposure remains a significant complication following enucleation. This study evaluates outcomes of enucleation using a polyethylene orbital implant with an integrated suturing platform and a modified cross-hatched rectus muscle attachment technique without oblique muscle reattachment. METHODS: Retrospective series of 76 patients who underwent enucleation with a polyethylene orbital implant featuring an integrated suturing platform (October 2022-October 2025). Each of the four rectus muscles was sutured to the opposite suture point on the platform, creating a cross-hatched configuration over the anterior implant surface. Oblique muscles were transected and left. Primary outcomes included implant exposure, extrusion, infection, and socket complications; secondary outcomes included cosmetic appearance and prosthetic motility. RESULTS: The cohort comprised 76 patients (72 primary enucleations, 4 secondary implantations) with a mean follow-up of 28 months (range: 6-41). Indications included uveal melanoma (n = 52, 68%) and painful blind eye (n = 20, 26%); 4 patients (5%) underwent secondary implantation after prior trauma. Mean implant diameter was 20 mm (range: 14-22 mm). Complications comprised one suturing platform breakage and one implant exposure following orbital biopsy for suspected malignancy recurrence. No other complications occurred. Both primary and secondary groups achieved satisfactory cosmetic outcomes motility.    . CONCLUSIONS: Cross-hatched rectus muscle attachment to a polyethylene implant with a suturing platform, was associated with low complication rates and satisfactory outcomes. The cross-hatched configuration may provide adequate coverage despite absent oblique attachment, although coverage was not measured directly and no comparison group was available. Longer follow-up is needed to confirm risks.