RESUMEN
Much - possibly even too much - has been published about chemosensory dysfunction as a consequence of COVID-19. Studies have reported prevalence of taste loss in up to 89.9%, which is in a similar range as COVID-19 related smell loss. However, most of these publications rely solely on patients' self-reports. Only few studies used validated psychophysical tests to specifically address olfaction and gustation. Especially for gustation, it is evident that subjective reporting does not correlate well with more objective psychophysical findings, often leading to an overestimation of subjectively impaired taste.
Asunto(s)
COVID-19 , SARS-CoV-2 , Trastornos del Gusto , Humanos , COVID-19/epidemiología , COVID-19/complicaciones , Prevalencia , Trastornos del Gusto/epidemiología , Trastornos del Gusto/virología , Trastornos del Gusto/etiología , Trastornos del Olfato/epidemiología , Trastornos del Olfato/virología , Trastornos del Olfato/etiologíaRESUMEN
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the mucous membranes of the nose and sinuses. Eosinophilic inflammation is described as a common endotype. The anti-IL5 antibody mepolizumab was approved in November 2021 as an add-on therapy to intranasal glucocorticosteroids for the treatment of adults with severe chronic rhinosinusitis with nasal polyps when systemic glucocorticosteroids or surgery do not provide adequate disease control. While national and international recommendations exist for the use of mepolizumab in CRSwNP, it has not yet been adequately specified how this therapy is to be monitored, what follow-up documentation is necessary, and when it should be terminated if necessary. METHODS: A literature search was performed to analyze previous data on the treatment of CRSwNP with mepolizumab and to determine the available evidence by searching Medline, Pubmed, the national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including 10/2022 were considered. RESULTS: Based on the international literature and previous experience by an expert panel, recommendations for follow-up, adherence to therapy intervals and possible therapy breaks, as well as termination of therapy when using mepolizumab for the indication CRSwNP in the German health care system are given on the basis of a documentation sheet. CONCLUSIONS: Understanding the immunological basis of CRSwNP opens up new non-surgical therapeutic approaches with biologics for patients with severe, uncontrolled courses. Here, we provide recommendations for follow-up, adherence to therapy intervals, possible therapy pauses, or discontinuation of therapy when mepolizumab is used as add-on therapy with intranasal glucocorticosteroids to treat adult patients with severe CRSwNP that cannot be adequately controlled with systemic glucocorticosteroids and/or surgical intervention.
Asunto(s)
Medicina Ambiental , Pólipos Nasales , Procedimientos Quírurgicos Nasales , Rinitis , Sinusitis , Adulto , Humanos , Rinitis/tratamiento farmacológico , Enfermedad Crónica , Sinusitis/tratamiento farmacológico , Atención a la SaludRESUMEN
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the paranasal sinus mucosa with eosinophilic inflammation as the most common endotype. The anti-IL5 antibody mepolizumab was approved for the treatment of severe CRSwNP in the EU in November 2021. METHODS: A literature search was performed to analyze the immunology of CRSwNP and determine the available evidence by searching Medline, Pubmed, and the German national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including 12/2021 that investigated the effect of mepolizumab in CRSwNP were considered. RESULTS: Based on the international literature and previous experience, recommendations for the use of mepolizumab in CRSwNP in the German health care system are given by an expert panel on the basis of a documentation form. CONCLUSIONS: Understanding about the immunological basis of CRSwNP opens new non-surgical therapeutic approaches with biologics for patients with severe courses. Mepolizumab is approved since November 2021 for add-on therapy with intranasal corticosteroids for the treatment of adult patients with severe CRSwNP who cannot be adequately controlled with systemic corticosteroids and/or surgical intervention.
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Medicina Ambiental , Pólipos Nasales , Procedimientos Quírurgicos Nasales , Otolaringología , Rinitis , Sinusitis , Corticoesteroides/uso terapéutico , Adulto , Alergólogos , Anticuerpos Monoclonales Humanizados , Enfermedad Crónica , Atención a la Salud , Humanos , Pólipos Nasales/terapia , Rinitis/tratamiento farmacológico , Sinusitis/tratamiento farmacológicoRESUMEN
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the nasal and paranasal mucosa. A Type-2 inflammation is described as the most common endotype. Since October 2019 the anti-IL-4/-IL-13 antibody dupilumab has been approved in Germany as an add-on therapy to intranasal corticosteroids for the treatment of adults with severe chronic rhinosinusitis with nasal polyps, when systemic corticosteroids alone or surgery do not provide adequate disease control. While recommendations for the use of dupilumab in CRSwNP exist at both national and international levels, until now it has not been adequately established, how therapy should be monitored and when it should be discontinued in the German Health Care System. METHODS: A literature search was performed analyzing previous data on the treatment of CRSwNP with dupilumab and to determine the available evidence by searching Medline, Pubmed, the national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to 05/2022 were included. RESULTS: Based on international literature and previous experience, recommendations are given by an expert panel for follow-up and possible therapy breaks, therapy intervals or termination of therapy when using dupilumab for the indication CRSwNP in the German health care system based on a documentation form. CONCLUSIONS: Understanding the immunological basis of CRSwNP opens new non-surgical therapy approaches with biologics for patients with severe courses. The authors give recommendations for follow-up, possible therapy breaks, therapy intervals and a termination for dupilumab treatment as add-on therapy with intranasal corticosteroids for the treatment of adult patients with severe CRSwNP that cannot be adequately controlled with systemic corticosteroids and/or surgical intervention.
Asunto(s)
Pólipos Nasales , Rinitis , Sinusitis , Adulto , Humanos , Pólipos Nasales/tratamiento farmacológico , Rinitis/tratamiento farmacológico , Sinusitis/tratamiento farmacológico , Enfermedad Crónica , Corticoesteroides/uso terapéutico , Atención a la Salud , DocumentaciónRESUMEN
Exophthalmos is a common and important symptom in orbital consultation. It can be either uni- or bilateral. A wide spectrum of benign and malignant diseases has to be considered and evaluated for differential diagnosis, in order to maintain complete ocular function and to lead the patient to adequate therapy. Exophthalmos can be accompanied by variable symptoms, ranging from neurogenic or myogenic to corneal alterations. Symptoms at presentation depend on the underlying disease and may manifest systemically. Interdisciplinary teamwork is essential for diagnostics and therapy of exophthalmos. In addition to ophthalmological routine diagnostics, various supplementary examinations are available which are of importance for disease monitoring. Exact radiological imaging is important for the detailed visualisation of the pathology, surgery as well as treatment planning. Magnetic resonance imaging (MRI) and computed tomography (CT) are the standard imaging techniques used. Contrast enhancement and specific sequences can answer specific problems in detail. Combined positron emission tomography (PET) with CT permits evaluation of metabolic and morphological data and is employed in diagnosis of meningioma, lymphoma and metastases. In summary, the reader should learn important differential diagnoses and accompanying symptoms of exophthalmos, thus enabling essential clinical examinations and adequate imaging.
Asunto(s)
Enfermedades de la Córnea/diagnóstico , Diagnóstico por Imagen/métodos , Técnicas de Diagnóstico Oftalmológico , Exoftalmia/diagnóstico , Enfermedades de la Córnea/complicaciones , Diagnóstico Diferencial , Exoftalmia/complicaciones , HumanosRESUMEN
PURPOSE: To compare quality of life (QoL) in patients with uveal melanoma after enucleation and stereotactic radiosurgery to that in an age-matched patient collective. METHODS: QoL was assessed in a cross-sectional survey and compared among 32 uveal melanoma patients after enucleation, 48 patients after stereotactic radiosurgery (CyberKnife(®); Accuray(®) Incorporated, Sunnyvale, CA, USA), and an age-matched control group of 35 patients, using the SF-12 Health Survey. Statistical analysis was performed with Fisher's exact test, Student's t test, one-way ANOVA analysis, Wilcoxon rank-sum (Mann-Whitney test), and ordered logistic regression for multivariate analysis. RESULTS: There was no significant difference in QoL between patients treated by stereotactic radiosurgery and the age-matched control group. After enucleation, patients presented significantly lower values in Physical Functioning (PF), Role Physical (RP), and Role Emotional (RE) compared to the radiosurgery and control group. To control for the overall QoL lowering effect of visual loss, the QoL of the patients who underwent enucleation was compared with the QoL of patients suffering severe functional loss after CyberKnife radiosurgery in a subgroup analysis, which showed no statistically significant difference. The number of comorbidities had a significant impact on QoL in multivariate analysis. CONCLUSIONS: Superior performance in PF, RP, and RE suggests that CyberKnife represents a suitable first-line therapy for uveal melanoma. In cases with painful amaurosis or vast tumor recurrence, enucleation can be performed with an acceptable QoL outcome.
Asunto(s)
Enucleación del Ojo , Melanoma/psicología , Melanoma/terapia , Calidad de Vida/psicología , Radiocirugia , Neoplasias de la Úvea/psicología , Neoplasias de la Úvea/terapia , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Melanoma/radioterapia , Melanoma/cirugía , Persona de Mediana Edad , Estudios Retrospectivos , Perfil de Impacto de Enfermedad , Encuestas y Cuestionarios , Neoplasias de la Úvea/radioterapia , Neoplasias de la Úvea/cirugíaRESUMEN
PURPOSE: In recent years artificial intelligence (AI), as a new segment of computer science, has also become increasingly more important in medicine. The aim of this project was to investigate whether the current version of ChatGPT (ChatGPT 4.0) is able to answer open questions that could be asked in the context of a German board examination in ophthalmology. METHODS: After excluding image-based questions, 10 questions from 15 different chapters/topics were selected from the textbook 1000 questions in ophthalmology (1000 Fragen Augenheilkunde 2nd edition, 2014). ChatGPT was instructed by means of a so-called prompt to assume the role of a board certified ophthalmologist and to concentrate on the essentials when answering. A human expert with considerable expertise in the respective topic, evaluated the answers regarding their correctness, relevance and internal coherence. Additionally, the overall performance was rated by school grades and assessed whether the answers would have been sufficient to pass the ophthalmology board examination. RESULTS: The ChatGPT would have passed the board examination in 12 out of 15 topics. The overall performance, however, was limited with only 53.3% completely correct answers. While the correctness of the results in the different topics was highly variable (uveitis and lens/cataract 100%; optics and refraction 20%), the answers always had a high thematic fit (70%) and internal coherence (71%). CONCLUSION: The fact that ChatGPT 4.0 would have passed the specialist examination in 12 out of 15 topics is remarkable considering the fact that this AI was not specifically trained for medical questions; however, there is a considerable performance variability between the topics, with some serious shortcomings that currently rule out its safe use in clinical practice.
Asunto(s)
Evaluación Educacional , Oftalmología , Consejos de Especialidades , Oftalmología/educación , Evaluación Educacional/métodos , Evaluación Educacional/normas , Alemania , Humanos , Competencia Clínica/normas , Certificación , Inteligencia ArtificialRESUMEN
To determine protrusion assessment via Hertel exophthalmometry in comparison to measurement on Computed Tomography (CT). Retrospective blinded comparison of exophthalmos measurements on axial CT with Hertel exophthalmometry measurements in 113 patients. Descriptive statistics, Pearson's correlation, Kruskal-Wallis and Mann-Whitney-U test were employed for analysis. Mean difference of proptosis between both eyes was 2.4 (SD ± 2.0) mm in CT and 2.2 (SD ± 2.0) mm in Hertel measurements. Proptosis of 0-2 mm was present in 69 (61.1%), and > 2 mm in 42 (38.9%) patients in Hertel measurements (CT 64 (56.6%), and 49 (43.4%) patients). Pearson's coefficient showed a correlation of 0.793 between both methods (p < 0.001). Accuracy of Hertel measurement depended significantly from the examiners' experience (< 5 (group 1), 5-15 (2) and > 25 (3) years, p = 0.042, Kruskal-Wallis analysis; p = 0.086 group 1 vs. 2, p = 0.014 group 1 vs. 3, p = 0.688 group 2 vs. 3, Mann-Whitney-U-test), reflected by levels of Pearson's coefficient (correlation of both methods 0.691 (group 1), 0.837 (2) and 0.831 (3), respectively, p = 0.01). Generally, Hertel exophthalmometry correlates well with CT measurements. Subgroup analysis confirmed a superior quality of Hertel measurements in favour of experienced examiners. Teaching of accurate Hertel exophthalmometry should be improved. Assessment of exophthalmos using standardized criteria should be implemented for imaging reports.
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Exoftalmia , Gorgojos , Animales , Estudios Transversales , Técnicas de Diagnóstico Oftalmológico , Exoftalmia/diagnóstico por imagen , Humanos , Órbita/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: The clinical picture of specific orbital inflammation can be subdivided into infectious diseases and idiopathic as well as autoimmune diseases. OBJECTIVE: This synopsis should help the reader to become acquainted with rare, yet important differential diagnoses of specific orbital inflammations. MATERIAL AND METHODS: A variety of cases of specific orbital inflammation from our interdisciplinary orbital consultation are presented that illustrate examples supported by the medical literature, expert opinions as well as the authors' personal experiences. RESULTS: Orbital symptoms can occur due to infectious pathogens, rheumatic systemic autoimmune diseases or be idiopathic. They mostly manifest by swelling of the lids or lacrimal glands but involvement of deep orbital structures is also possible. CONCLUSION: It is of importance to know the possible clinical ocular manifestations of infectious and rheumatic immunological systemic diseases in order to be able to treat patients adequately and whenever necessary by a multidisciplinary approach.
Asunto(s)
Enfermedades Autoinmunes , Aparato Lagrimal , Enfermedades Orbitales , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/terapia , Humanos , Inflamación , Órbita/diagnóstico por imagen , Enfermedades Orbitales/diagnósticoRESUMEN
An extensive spectrum of differential diagnoses has to be considered when a patient presents with enophthalmos. The most common causes of this presentation include orbital trauma or contraction and atrophy of the orbital contents secondary to scleroderma or radiotherapy. However radiologists also have to consider less common causes of enophthalmos, such as the imploding antrum syndrome or the ethmoid silent sinus syndrome. The latter involves the ethmoidal cells and results in medial orbital wall implosion. Along with the case presentation the pathogenesis, incidence and differential diagnoses of ethmoid silent sinus syndrome are elucidated. In particular the differentiation from normal anatomical variants, such as dehiscent lamina papyracea is discussed.
Asunto(s)
Síndrome de Retracción de Duane/diagnóstico , Enoftalmia/etiología , Sinusitis del Etmoides/diagnóstico , Tomografía Computarizada por Rayos X , Diagnóstico Diferencial , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Persona de Mediana Edad , ProlapsoRESUMEN
BACKGROUND: Upper eyelid blepharoplasty is among the most frequent oculoplastic surgical procedures. It is often performed as one of the first esthetic surgical interventions by surgeons of various disciplines. While there is a high probability of happy and satisfied patients postoperatively, there are important potential surgical complications that should be prevented. This requires a careful preoperative, perioperative and postoperative approach. OBJECTIVE: This synopsis presents the basic considerations concerning upper eyelid blepharoplasty to serve as practical surgical guidelines. MATERIAL AND METHODS: This is a compendium of important preoperative, perioperative and postoperative contemplations derived from the medical literature, expert opinions and the authors' personal experiences. RESULTS: Careful examination and documentation of eyelid and periorbital findings are required in order to identify additional pathologies to dermatochalasis and plan the surgical approach accordingly. There is a trend in the literature and in expert opinions away from large tissue resection and towards volume preserving and volume reconstructing surgical techniques. Correct placement of the skin fold as well as maintaining lid symmetry are crucial points in order to achieve a natural appearance and patient satisfaction. CONCLUSION: Careful and realistic patient information, state of the art surgery including cautious tissue resection and correct symmetrical formation of the skin fold as well as postoperative assistance and availability increase the likelihood of satisfied patients after blepharoplasty.
Asunto(s)
Blefaroplastia , Enfermedades de los Párpados/cirugía , Estética , Párpados , Humanos , Satisfacción del PacienteRESUMEN
Dermofat grafts represent an alternative to alloplastic orbital implants and are used as primary or secondary implants. Advantages are their autologous nature without the risk of foreign body reaction and extrusion or possibly transmission of prions in combination with creating a flat and smooth surface in the socket even under difficult conditions with an excellent motility of the artificial eye. Disadvantages of dermofat grafts are the labor-intensive operative technique with a second operation site and a possible shrinking of the implant. The operation technique is presented in detail in an operation video, which is available online.
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Tejido Adiposo/trasplante , Dermis/trasplante , Enucleación del Ojo/métodos , Implantes Orbitales , Anestesia Endotraqueal , Estudios de Seguimiento , Humanos , Educación del Paciente como Asunto/métodos , Posicionamiento del Paciente , Complicaciones Posoperatorias/cirugía , Reoperación/métodos , Estudios Retrospectivos , Técnicas de Sutura , Recolección de Tejidos y Órganos/métodosRESUMEN
PURPOSE: The aim of this study was to evaluate the role of topical interferon-alpha-2b in the adjuvant treatment of corneal and conjunctival tumors. METHOD: In this noncomparative, prospective, interventional case series, five patients with histologically proven conjunctival intraepithelial neoplasia (CIN) after primary excision and amniotic membrane transplantation were treated with interferon (IFN)-alpha-2b eye drops five times daily over a period of 6 weeks (1 million IU/ml Intron A, Schering). An in situ hybridization technique was used to detect human papillomavirus (HPV) in all specimens. Frequent follow-up was undertaken clinically and photographically for evidence of tumor recurrence. RESULTS: In the follow-up period (13.2+/-4,97 months) no clinical evidence of recurrence with only limited treatment side effects such as mild conjunctival hyperemia were recorded after 6 weeks of interferon. In one CIN specimen HPV 16/18 could be detected. CONCLUSIONS: The combination of excisional biopsy and topical interferon-alpha-2b application seems to be an effective and safe treatment for conjunctival intraepithelial neoplasias. Therefore, we prefer this combined treatment to topical interferon-alpha-2b treatment alone, more destructive approaches such as radiation and cryotherapy, or treatment with antimetabolites such as 5-fluorouracil or mitomycin C.
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Neoplasias de la Conjuntiva/tratamiento farmacológico , Neoplasias de la Conjuntiva/cirugía , Epitelio Corneal/efectos de los fármacos , Epitelio Corneal/cirugía , Interferón-alfa/administración & dosificación , Procedimientos Quirúrgicos Oftalmológicos/métodos , Administración Tópica , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Quimioterapia Adyuvante/métodos , Femenino , Humanos , Interferón alfa-2 , Masculino , Persona de Mediana Edad , Proteínas Recombinantes , Resultado del TratamientoRESUMEN
AIM: To report on a modified technique for upper eyelid lengthening in lid retraction associated with Graves' disease. METHODS: A prospective consecutive interventional case series. 41 patients, 38 women and three men, with a mean age of 55 years (range 32-75 years) were included. Full transsection of the upper eyelid with optional transsection of the lateral horn was performed in 60 lids. A central bridge of conjunctiva was left intact in the pupillary axis. Before and after surgery, the skin crease, palpebral aperture, and scleral show were measured and the contour of the lid margin was assessed. The overall result was graded as "perfect," "acceptable," and "failure." RESULTS: The mean period review was 6 months (range 2-36 months). Preoperatively, upper eyelid retraction varied from 1 mm to 7 mm; mean scleral show was 2 mm in 45 lids, the palpebral aperture was in the desired height (SD 1 mm) in 53 of 60 lids (88%) and was reduced by 3 mm (mean), the skin crease remained unchanged (SD 1 mm) in 44 of 60 lids (73%). The result was considered "perfect" in 43 and "acceptable" in 14 of 60 lids after one or two surgical approaches. In three lids, the surgery had failed. CONCLUSION: In contrast with other surgical techniques the surgical approach presented here is easy to perform and still leads to very satisfying and predictable postoperative results.
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Blefaroplastia/métodos , Enfermedades de los Párpados/cirugía , Enfermedad de Graves/cirugía , Adulto , Anciano , Enfermedades de los Párpados/etiología , Enfermedades de los Párpados/patología , Femenino , Enfermedad de Graves/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Estudios Prospectivos , Reoperación/métodos , Resultado del TratamientoRESUMEN
Groups of 6-15 guinea pigs sensitized to ovalbumin were challenged by repeated inhalations of a constant histamine dose at time 0, 10, 20, 60 and 70 min. Bronchial obstruction was measured by whole body plethysmography. The degree of bronchial obstruction increased from one challenge to the other reaching maximal values after 70 min. This increase of bronchial responsiveness to histamine after repeated histamine challenges was reduced by pretreatment with clemastine (histamine H1-receptor antagonist, 0.12 mg/kg i.p., n = 7, P less than 0.05) and more effectively by combined clemastine/cimetidine pretreatment (combined H1-H2-receptor antagonists, 0.12 resp. 10 mg/kg, n = 7, P less than 0.001); pretreatment with acetylsalicylic acid (10 mg/kg orally) accelerated the increase of bronchial responsiveness to histamine (n = 9, P less than 0.01 at the second challenge), inhalation of prostacyclin (1 microgram) prior to each histamine inhalation prevented the increase of bronchial histamine sensitivity totally (n = 10, P less than 0.001), whereas inhibition of thromboxane biosynthesis (imidazol, 10 mg/kg i.p., n = 6; 4-[2-(1H-imidazol-1-yl)ethoxy]benzoic acid, 10 mg/kg i.p., n = 9; imidazo(1,5-a)pyridine-5-hexanoic acid, 1 mg/kg i.p., n = 8) as well as immunologic platelet depletion were ineffective in our test system. We conclude that prostacyclin inhibits the increase of bronchial responsiveness to histamine after sequential histamine inhalation challenges by a platelet independent mechanism. 1-(3-phenyl-2-propenyl)-1H-imidazol, the fourth type of thromboxane synthetase inhibitor tested (10 mg/kg i.p., n = 15) showed specific effects which may be attributed to antihistamine functions.
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Plaquetas/fisiología , Bronquios/fisiología , Epoprostenol/fisiología , Histamina/fisiología , Tromboxanos/fisiología , Animales , Aspirina/farmacología , Bronquios/efectos de los fármacos , Pruebas de Provocación Bronquial , Fenómenos Químicos , Química , Cimetidina/farmacología , Cobayas , Imidazoles/farmacología , Masculino , Agregación Plaquetaria/efectos de los fármacos , Piridinas/farmacología , Receptores Histamínicos H1/efectos de los fármacos , Receptores Histamínicos H2/efectos de los fármacos , Tromboxano-A Sintasa/antagonistas & inhibidoresRESUMEN
The use of the Mersilene mesh sling brow suspension procedure for the correction of severe blepharoptosis in 76 lids of 54 patients is presented. After a median follow up of 20 months functional and cosmetic results and complications were evaluated. The method is considered to be an alternative for those cases not primarily suitable for autogenous fascia lata brow suspension.
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Blefaroptosis/cirugía , Mallas Quirúrgicas , Adolescente , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Cejas/cirugía , Femenino , Estudios de Seguimiento , Granuloma/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Tereftalatos Polietilenos , Complicaciones Posoperatorias , Prótesis e Implantes , Cirugía Plástica , Resultado del TratamientoRESUMEN
AIM: To analyse the extent of bony orbital volume reduction after enucleation in humans. METHODS: Volumetric studies on bony orbital volumes based on three dimensional reconstructions acquired from high resolution computed tomograph (CT) scans were performed in 29 patients with acquired anophthalmia and four patients before enucleation (controls). Eight patients (follow up 25-52 years) were enucleated in childhood aged between 0.4 and 8 years (group I), 21 in adulthood aged between 15 and 53 years. Fifteen of these patients (group IIa) had long standing anophthalmia (follow up 7-53 years), six patients (group IIb) were enucleated 9 months to 4 years before CT. RESULTS: Bony orbital volumes were reduced in all patients with long standing anophthalmia. The median percentage reduction in enucleated orbits was 7.0% in group I, 3.8% in group IIa, and 1.9% in group IIb. In patients with long standing anophthalmia (I and IIa) the reductions were statistically significantly different (p <0.01) from zero. There was some evidence of a correlation between orbital volume reduction and age at enucleation (rho = 0.36, p = 0.09, Spearman rank correlation coefficient) and a statistically significant correlation between volume reduction and time interval since enucleation (rho = -0.5, p = 0.003). Clinically none of the patients showed significant facial asymmetry. CONCLUSIONS: These data provide strong evidence that enucleation both in children and adults is associated with a reduction of bony orbital volume and that this decrease in volume is associated with increasing time. However, the reduction is smaller than generally assumed and does not cause obvious facial asymmetry. It is more related to the time interval since enucleation than the age at enucleation, which makes a mechanism of volume adaptation more likely than just retardation of growth.