Hydroxyapatite orbital implant. A light- and electron-microscopic and immunohistochemical study.

Abstract

This study aimed to characterize the constituents of the ingrown host tissue in explanted orbital coral spheres by means of light electron microscopy and immunohistochemistry and to compare findings at different intervals after implantation. A microscopic retrospective laboratory study of three explanted coral spheres from three different patients was undertaken. The first specimen was an infected hydroxyapatite orbital implant, which was removed after 18.5 months and processed for standard light microscopy and transmission electron microscopy. Immunohistochemistry was performed using vimentin, actin, CD-68, and CD-34 marker. Two other explanted spheres (after 3 weeks and 2.5 months) were examined by light microscopy only, because no fibrovascular ingrowth could be detected. On light microscopy, the pores of the first coral were filled entirely with the fibrovascular tissue. A basophilic line reminiscent of calcium deposition was seen along hydroxyapatite spicules, where it often was associated with newly formed bony lamellae. Similar lines were seen partially in the 2.5-month specimen but not in the 3-week specimen. Immunohistochemistry of the first specimen enhanced visualization of the capillary network when the CD-34 marker was used. The fibrovascular tissue was uniformly vimentin-positive and partially actin-positive. On transmission electron microscopy, typical fibroblasts and myofibroblasts were observed. The latter were separated by thin sheets of banded collagen and formed pseudoepithelial structures. Proliferating vessels often showed high endothelial cells. The fibrovascular ingrowth contains not only vimentin-positive regular fibroblasts but also actin-positive myofibroblasts. Interaction between the invading tissue and hydroxyapatite structures leads to long-term ossification.