Copyright © 2019 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. Unauthorized reproduction of this article is prohibited. Ophthal Plast Reconstr Surg, Vol. 35, No. 1, 2019 67 Purpose: The aim of this study was to evaluate the efficacy of the nonporous polyethylene barrier sheet as an alternative for nylon foil (SupraFOIL) implants in repair of orbital fractures. Methods: This is a prospective, case series using the Stryker 0.4-mm-thick nonporous polyethylene barrier sheet in all patients over the age of 18 years presenting with orbital fractures from December 2014 to June 2015. Patient’s age, location of fracture, etiology of injury, presence of preoperative restriction and diplopia, and postoperative diplopia and/or enophthalmos was recorded. Institutional review board approval was received, and consent was obtained from all participants. Patients were followed for at least 6 months when possible. Scanning electron microscopy was used to compare the thickness, surface characteristics, and porosity of the nonporous polyethylene barrier and nylon foil implants. Beam deflection testing was also performed to compare the biomechanical properties of each implant. Results: Forty-six patients who underwent repair of orbital fractures with the nonporous polyethylene barrier sheet were included in this series. Average age was 43.3 years (range: 18–84 years). Twenty-six of 46 patients (56.5%) were males, and 20 (43.4%) were females. The most common causes of injuries were assault (38.3%), falls (25.5%), motor vehicle accident (14.9%), and sports related (10.5%). Twenty of 46 patients (43.4%) had isolated orbital floor, and 2 patients (4.3%) had isolated medial wall fractures. Fifteen patients (32.6%) had combined floor and medial wall fractures involving the inferomedial orbital strut, and 9 (19.6%) had floor fractures associated with zygomaticomaxillary complex or lateral wall fractures. Twenty-eight patients (60.9%) had preoperative diplopia. Timing of surgery was between 3 and 55 days, with the median of 11.5 days. Five of 46 patients (10.8%) had residual diplopia at their 1-week postoperative visit, 4 of those patients’ diplopia had resolved at 2 months postoperatively. One patient had residual diplopia at 6-month follow up. Electron microscopy showed that the 0.4-mm nonporous polyethylene barrier implant was thinner (0.33 mm) than expected and thinner than 0.4-mm SupraFOIL (0.38 mm). Scanning electron microscopy exhibited that the surface of the nonporous polyethylene barrier was smooth and nonporous. Beam deflection testing showed that for small forces (<100 mN), the 2 materials behaved nearly identically, but at higher forces, the nonporous polyethylene implant exhibited less stiffness. Conclusions: The use of nonporous polyethylene barrier sheet implant for orbital fracture repair is a safe and effective alternative to nonporous nylon foil implants. There were no complications and one case of residual diplopia (2.1%) in this case series. (Ophthal Plast Reconstr Surg 2019;35:67–70) N onporous nylon foil implants were first used for repair of orbital fractures in 1965 by Browning and Walker. 1,2 Various alloplastic implants have largely supplanted autogenous grafts as the primary choice in orbital fracture repair, due to their ease of use, decreased intraoperative time, and decreased donor site morbidity. 3–12 Nylon foil (SupraFOIL; S. Jackson Inc, Alexandria, VA, U.S.A.) has been the authors’ implant of choice given it is an inert material that is smooth and nonporous, and 0.4-mm thick implants provide excellent and predictable struc- tural support to the orbital wall defect with no tissue incorpora- tion. However, in late 2013, there was an unexpected halt in the production of the SupraFOIL implant, resulting in a nationwide shortage of the nylon foil implants for over a year. For those sur- geons who primarily use nylon foil implants, this led to a need for a similar implant for orbital fracture repair. The production of SupraFOIL implants resumed in August of 2015; however, this sudden shortage exhibited the benefits of having alternative implants readily available. In this study, the authors report the outcomes and inci- dence of complications in the repair of orbital fractures in their series of 46 patients using the 0.4-mm nonporous polyethylene barrier sheet implant (Fig. 1; Stryker, Kalamazoo, MI, U.S.A.) and review the literature reporting the complication rates with nylon foil and porous polyethylene (Medpor, Stryker, Kalamazoo, MI, U.S.A.) implants. The authors also compare the nylon foil implants and nonporous polyethylene barrier sheet implants with scanning electron microscopy (SEM) and with beam deflection testing to further compare the surface characteristics and biomechanical properties of the 2 implants. METHODS This is a prospective, case series using the Stryker 0.4-mm-thick nonporous polyethylene barrier sheet in 47 patients presenting with DOI: 10.1097/IOP.0000000000001176 Accepted for publication June 4, 2018. Supported in part by Research to Prevent Blindness, New York, NY. The authors have no conflicts of interest to disclose. Address correspondence and reprint requests to Christopher J. Compton, M.D., Department of Ophthalmology and Visual Sciences, University of Louisville, 7520 Beechspring Farm Blvd, Louisville, KY 40241. E-mail: cjcompton@gmail.com Early Experience With Nonporous Polyethylene Barrier Sheet in Orbital Fracture Repair Christopher J. Compton, M.D.*, Andrew T. Melson, M.D.†, Jason A. Sokol, M.D.‡, William R. Nunery, M.D., F.A.C.S.*§, Manuel Ochoa, B.S.§, Babak Ziaie, Ph.D.§, and H.B. Harold Lee, M.D.║ *Department of Ophthalmology and Visual Sciences, University of Louisville, Kentucky, U.S.A.; †Department of Ophthalmology, Oklahoma University, Oklahoma City, Oklahoma, U.S.A.; ‡Department of Ophthalmology, Kansas University, Kansas City, Missouri, U.S.A.; §Birck Nanotechnology Center, Weldon School of Biomedical Engineering, Purdue University, Lafayette, Indiana, U.S.A.; and ║Oculofacial Plastic and Orbital Surgery, Indianapolis, Indiana, U.S.A. ORIGINAL INVESTIGATION