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Purpose: A retrospective case note review was undertaken to elucidate any differences in the cosmetic results and rate of serious complications between hydroxyapatite (HA) and porous polyethylene (PP) orbital implants. Methods: Patients who had undergone orbital implant surgery during the period 1993 to 1997 by a single surgeon were identified. Twenty-six patients had an HA implant and twenty-six had received a PP implant. All patients were reviewed in the ocular prosthetics department in a masked manner. The orbits were scored for post-enucleation socket syndrome (PESS) score, and quantification of implant mobility was done. Data analysis was conducted using Mann-Whitney U test for two independent samples. Results: There was no significant difference in PESS scores in patients with an HA or a PP implant. Implant elevation was better in patients with secondary (p = 0.029) and exchange (p = 0.042) PP implants. Only one patient in each of the HA and PP groups suffered significant implant exposure that required dermis fat and mucous membrane graft cover. Conclusions: The complication rates and PESS scores were identical between the HA and PP implant groups. The implant mobility was better in the PP group. In clinical practice, the choice of the type of orbital implant inserted may also be governed by other factors such as surgeon experience, ease of use, and cost. [ABSTRACT FROM AUTHOR]