After placement of an orbital implant in enucleation, the anterior layers (ant Tenon's and conj) are simply closed.
In the interest of increasing (eventual) ocular prosthesis motility, would it be advantageous to tack these layers together?
Perhaps with an alcohol to denature some fat, followed by a mild caustic, suctioned, then irrigated-out?
Suture sclera, tenon layer and conjunctiva separately. That way you will have a better sealed wound with less chances of implant extrusion. Avoid alcohol in the area, it will lead to non-adhesion. My preferred suture is 5/0 polyglactin for sclera, 7/0 polyglactin for tenon's and the same for conjunctiva
Thank you for your comment. Yes, these layers are generally sutured individually. My 2013 question is directed to maximizing ocular prosthesis motility after enucleation.
When, as in the currently usual manner, an orbital implant is placed behind posterior Tenon's capsule to increase tissues over the implant, the nature of anterior Tenon's capsule implies a lubricity between it and the posterior layer. This altered anatomy seems to me to be invoking a slip-space that may reduce the translation of motility from the implant to the subsequent ocular prosthesis. Thus, scarring these layers together might aid motility.
Whether it makes sense to reduce movement between these over-layers to increase motility is debatable. Some surgeons, conceiving that motility is induced primarily from the conjunctival fornices, recommend a sutural bite into the fornix.
Any assistance to symmetrical motility would greatly aid the patient's future appearance.