Revisiting the Role of the Channel Implant in Late and Revision Orbital Fractures

OBJECTIVE: To revisit the role of the porous polyethylene channel implant (PPCI) in consecutive patients with late or revision orbital floor fractures. METHODS: A retrospective, institutional review board-approved chart review was performed, encompassing all consecutive patients who underwent PPCI implantation over an 18-year period (2007-2025). Demographic data and clinical examination findings were systematically documented. Selected cases included patients with: (1) late (≥1 year) orbital fractures and (2) revision orbital fractures with complicated hardware. Anophthalmic patients with late (neglected) orbital fractures or with extensive bony loss were not excluded. RESULTS: Sixteen orbits in 15 patients (12 males, 3 females; mean age, 30 years) met the inclusion criteria. Eleven late fractures (68.75%) underwent primary repair with PPCI, while 5 orbits (31.25%) underwent revision surgery following complicated titanium or patient-specific implants. The mean interval between trauma and PPCI placement was 15.2 months, and this interval was significantly shorter in revision fractures (6.2 months) compared with late fractures (17.4 months, p < 0.0001). Overall, all patients experienced improvement in enophthalmos and hypoglobus, despite incomplete availability of quantitative measurements across the cohort. Four PPCI designs were used, with follow-up averaging 23.3 months. Enophthalmos improved from 3.875 mm to 1.5 mm, and diplopia resolved in 62.5% of patients. Intraoperative complications included linear fissure fractures of the PPCI (n = 2), which occurred during attempts to contour the device to accommodate a combined orbital floor and medial wall defect, and fracture (fishmouthing) of the PPCI channel entry (n = 3). Postoperative complications included palpable screws (n = 2), permanent hyperglobus (n = 1), and recurrent enophthalmos (n = 1). CONCLUSION: In selected patients, the PPCI provides a simple all-in-one solution with adequate volume restoration and relatively few complications.