Cavidad anoftálmica en paciente con prótesis ocular. ¿Existe un protocolo basado en la evidencia para su cuidado? / Anophthalmic cavity in patient with prosthetic eye. Is there any evidence-based protocol for its care?

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[Rehabilitation of Anophthalmic Patients with Prosthetic Eyes in Germany Today - Supply Possibilities, Daily Use, Complications and Psychological Aspects]. / Augenprothetische Rehabilitation in Deutschland heute ­ Versorgungsmöglichkeiten, Handhabung, Komplikationen und psychologische Aspekte.

BACKGROUND: A smooth supply with a visually appealing prosthetic eye after enucleation is not just a cosmetic solution, it is also a key factor in successful social and psychological rehabilitation. OBJECTIVES: This article provides an overview of the current state of medical and ocular care regarding prosthetic eyes in Germany. It focuses mainly on the newest clinical results, daily care, complications, and psychological aspects of wearing prosthetic eyes. METHODS: The study is comprised of the newest clinical results and a current PubMed literature review. RESULTS: In Germany, enucleated patients normally get a double-walled, hollow prosthetic eye made of cryolite glass, and patients with a microphthalmic or phthisic eye receive a thin single-walled prosthesis. Anophthalmic patients wearing cryolite glass prosthetic eyes seem to be more satisfied with their appearance and the look of their prostheses than polymethylmethacrylate (PMMA) prosthetic eye wearers. Cryolite glass prosthetic eyes must be renewed at least each year, while PMMA prostheses need to be polished once a year and renewed after five years of wearing. Among children, the fit of the prosthetic eye must be checked, based on growth, semi-annually. A slightly higher risk of breakage of cryolite glass prostheses is, for most patients, not a great disadvantage in everyday life. Ocularists and ophthalmologists should determine an individual cleaning regime, together with the patient, that is dependent on the material of the ocular prosthesis and other external factors. Complications, such as allergic, giant papillary, viral and bacterial conjunctivitis and blepharoconjunctivitis sicca must be treated at an early stage to allow for a prosthetic eye. In the case of inflammation-caused socket shrinkage or post-enucleation socket syndrome, surgical interventions are needed to re-enable the use of a prosthetic eye. Since the health of the remaining eye is the major psychological burden of prosthetic eye wearers, good ophthalmological care and medical screenings are essential elements. CONCLUSIONS: A smooth supply with a prosthetic eye, adequate and early treatment of possible complications and attention to psychological aspects is essential for successful long-term rehabilitation of enucleated patients.

Reabilitação de paciente anoftálmico bilateral por meio de prótese ocular: relato de caso / Rehabilitación de paciente anoftálmico bilateral por medio de prótesis ocular: relato de caso / Rehabilitation of bilateral anoftálmic patient by eye prosthesis: case report

Introdução: A prótese ocular visa à reparação aloplástica das perdas ou deformidades do bulbo ocular, tendo por objetivos recuperar a estética facial; prevenir o colapso e a deformidade palpebral; proteger a cavidade anoftálmica contra agressões por poeira, fumaça ou poluentes; restaurar a direção da secreção lacrimal e prevenir o acúmulo deste fluido na cavidade evitando as alterações assimétricas que progressivamente se instalam. Objetivo: relatar um caso clínico de reabilitação de paciente anoftálmico bilateral por meio de prótese ocular. Material e método: Para a realização do procedimento, a cavidade anoftálmica do paciente foi moldada com alginato. Esse molde foi incluído em mufla para obtenção da esclera artificial em Resina Acrílica Ocular Termicamente Ativada (RAOTA) cor N2. A esclera obtida foi provada no paciente e recebeu os ajustes necessários. Em seguida, foi realizada a centralização da pupila, feito o platô e pintada a íris artificial, que foi colada sobre o platô. Toda a superfície da esclera recebeu caracterização e o conjunto foi recoberto com RAOTA incolor. Por fim, a prótese recebeu acabamento, polimento, e foi instalada. O paciente foi instruído quanto ao uso e higienização. Resultado: Foi observado que após a instalação da prótese, a estética facial do indivíduo foi restaurada, o suporte palpebral restabelecido e o direcionamento lacrimal corrigido, além da reinserção do indivíduo ao convívio social. Conclusão: o tratamento reabilitador atingiu seu objetivo de restaurar a estética facial e foi de grande importância para o paciente, pois o mesmo resgatou a autoestima e pôde retornar ao convívio social sem constrangimentos(AU)

Introduction: The ocular prosthesis aims at the alloplastic repair of the losses or deformities of the ocular bulb, aiming to recover the facial esthetics; prevent collapse and eyelid deformity; protect the anophthalmic cavity against aggression from dust, smoke or pollutants; restore the direction of lacrimal secretion and prevent the accumulation of this fluid in the cavity avoiding the asymmetric changes that progressively install. Objective: to report a clinical case of rehabilitation of bilateral anophthalmic patient by ocular prosthesis. Material and method: To perform the procedure, the patient's anophthalmic cavity was cast with alginate. This template was included in muffle to obtain artificial sclera in thermally activated ocular acrylic resin (RAOTA) color N2. The obtained sclera was tested on the patient and received the necessary adjustments. Afterwards, the pupil was centralized, made the plateau and painted the artificial iris, which was glued on the plateau. The entire surface of the sclera was characterized and the whole was covered with colorless RAOTA. Finally, the prosthesis was finished, polished, and installed. The patient was instructed in the use and hygiene. Results: It was observed that after the installation of the prosthesis, the individual's facial aesthetics were restored, the eyelid support was restored and the corrected lacrimal targeting was performed, as well as the reinsertion of the individual into social interaction. Conclusion: the rehabilitation treatment reached its goal of restoring the facial aesthetics and was of great importance for the patient, since it rescued the self-esteem and was able to return to the social life without constraints(AU)

Introducción: La prótesis ocular se refiere a la reparación aloplástica de las pérdidas o deformidades del bulbo ocular, teniendo como objetivo recuperar la estética facial; prevenir el colapso y la deformidad palpebral; proteger la cavidad anoftálmica contra agresiones por polvo, humo o contaminantes; restaurar la dirección de la secreción lagrimal y prevenir la acumulación de este fluido en la cavidad evitando los cambios asimétricos que progresivamente se instalan. Objetivo: relatar un caso clínico de rehabilitación de paciente anoftálmico bilateral por medio de prótesis oculares. Material y método: Para la realización del procedimiento, la cavidad anoftálmica del paciente fue moldeada con alginato. Este molde fue incluido en mufla para la obtención de la esclera artificial en Resina Acrílica Ocular Termalmente Activada (RAOTA) color N2. La esclera obtenida fue probada en el paciente y recibió los ajustes necesarios. A continuación, se realizó la centralización de la pupila, hecha la meseta y pintada el iris artificial, que fue pegada sobre la meseta. Toda la superficie de la esclera recibió caracterización y el conjunto fue recubierto con RAOTA incoloro. Por último, la prótesis recibió el acabado, pulido, y se instaló. El paciente fue instruido en cuanto al uso e higienización. Resultado: Se observó que después de la instalación de la prótesis, la estética facial del individuo fue restaurada, el soporte palpebral restablecido y el direccionamiento lagrimal corregido, además de la reinserción del individuo a la convivencia social. Conclusión: el tratamiento rehabilitador alcanzó su objetivo de restaurar la estética facial y fue de gran importancia para el paciente, pues el mismo rescató la autoestima y pudo regresar a la convivencia social sin limitaciones(AU)

[The potential of ectoprosthetics in rehabilitation of patients with orbital pathology]. / Vozmozhnosti éktoprotezirovaniia v reabilitatsii patsientov s patologiei orbity.

AIM: rectification of indications and contraindications for ectoprosthetics and exploration of its potential as a modern rehabilitation modality. MATERIAL AND METHODS: Here are summarized the results of 89 cases of facial reconstruction with prosthetic means in trauma patients and those who had had congenital or oncological pathology and in whom other methods of rehabilitation were unable to remedy the defect within the orbital region. RESULTS: The indications and contraindications for facial prosthetics as well as the conditions, under which this type of medical and social rehabilitation can be carried out, were clarified. The authors also explained the process of creating an epiprosthesis and how it should be attached to the orbit to have the maximum effect on the existing defects of both the bone and auxiliary apparatus (including eyelid soft tissues, eyelashes, etc.). Because modern ectoprostheses are made of silicone and held in place with magnets, they provide an optimal cosmetic result, so that, regardless of patient's age, no rough defects can be detected on the affected side at a 2-m distance. CONCLUSION: As the production technology develops, the cosmetic appearance of epiprostheses improves and their use broadens.

Survey of Ocular Prosthetics Rehabilitation in the United Kingdom, Part 2: Anophthalmic Patients' Satisfaction and Acceptance.

AIM: Ocular prostheses are integral for anophthalmic patients. Part 1 of this study reported that patients' aetiology, opinions, and attitudes significantly affected their prosthetic eyes experience. Part 2 investigates the patient satisfaction and acceptance in light of some of the aetiological demographics reported in Part 1. METHODOLOGY: One hundred sixty questionnaires were delivered to anophthalmic patients attending oculoplastic clinic. Etiological aspects presented in the questionnaire were disseminated in part 1. Patient satisfaction was assessed through 8 closed-end statements reflecting aspects concerning patient's views on prosthesis comfort and appearance; patient's expectations, self-esteem, and perception; and cooperation with ocularist. Each statement had 3 categories as agree, moderately agree, and disagree. A total of 126 questionnaires were returned (response rate was 78.8%). Data was analyzed using SPSS software. Association coefficients and correlations between variables were also analyzed. RESULTS: Total number of responses for the 8 statements was 888, averaging of 111 (expected 126) respondent per statement. Overall, 95.4% of our patients agreed with all satisfaction statements presented echoing very high satisfaction rate with their ocular prosthetics. Having an eye replacement that covers the defect is associated with high satisfaction among patients regardless of ocular prosthetic type. Patient acceptance of prosthesis in relation to employment status was high but not the same among the different categories (P > 0.05). High satisfaction with ocular prosthetics was prevalent among both genders, but there were no statistically significant differences in percentages of agreement in all statements (P > 0.05). Satisfaction and acceptance with ocular prosthetics was the same among all age groups of 12 to 85 years old (P > 0.05). CONCLUSIONS: The patient satisfaction is associated with the interplay of different variables that is related to ocular prosthesis design and its ability to disguise disfigurement (ie, prosthesis shape, resemblance to existing contra-lateral eye, etc.); patients themselves (ie, gender, age, occupation, marital status, etc); and psychological well-being and social support provided. Anophthalmic patients of the north west of England are significantly happy with their ocular prosthetic rehabilitation and support they receive from their regional hospital. Ocular prosthetics enhances their psychological well-being and social interaction and factors like patients' sex, age, employment status, and type of ocular prosthesis have no effect on their acceptance and satisfaction.

Survey of Ocular Prosthetics Rehabilitation in the United Kingdom, Part 1: Anophthalmic Patients' Aetiology, Opinions, and Attitudes.

PURPOSE: Ocular prostheses are constructed to aid cosmetic, functional, and psychological rehabilitation of anophthalmic patients. Part-1 of this study aimed to evaluate anophthalmic patients' opinions, attitudes, and experience about aspects related to their postfit ocular prostheses. METHODS: One hundred sixty questionnaires were delivered to anophthalmic patients inquiring about different information such as age, gender, occupation, eye-loss cause, prosthesis type, prosthesis-wearing frequency, prosthesis-cleaning frequency, and problems encountered. A total of 126 questionnaires were returned (response rate was 78.8%). Data was analyzed using SPSS software (P <0.05). RESULTS: The patients were 74 males and 52 females (57.55 years ±â€Š17.57). Almost 50% of the patients lost their eye due to trauma that was the highest among other causes (P <0.05). High proportion clean their prosthesis daily (37.4%) which was the highest among other cleaning regimes (P <0.05). Almost 30.3% experienced having problems with their prosthetic eye. Patients who clean their prosthetic eye every 6 months have experienced more problems (P <0.05). Majority of patients wear their prosthetic eyes 24 hours (92%) (P <0.05). Half of patients who received a prosthetic eye for the first time experienced problems with it (P <0.05) such as excess discharge (45%), infection (25%), and soreness (20%). However, the problems were independent of prosthesis-type (P >0.05). CONCLUSIONS: Trauma is the most common cause of anophthalmic patients in the North-West of England. Anophthalmic patients are likely to experience problems with their prosthetic eye if they have lost their natural eye due to disease; it is their first prosthesis; or if they clean it once every 6 months.

Integrated versus non-integrated orbital implants for treating anophthalmic sockets.

BACKGROUND: Anophthalmia is the absence of one or both eyes, and it can be congenital (i.e. a birth defect) or acquired later in life. There are two main types of orbital implant: integrated, whereby the implant receives a blood supply from the body that allows for the integration of the prosthesis within the tissue; and non-integrated, where the implant remains separate. Despite the remarkable progress in anophthalmic socket reconstruction and in the development of various types of implants, there are still uncertainties about the real roles of integrated (hydroxyapatite (HA), porous polyethylene (PP), composites) and non-integrated (polymethylmethacrylate (PMMA)/acrylic and silicone) orbital implants in anophthalmic socket treatment. OBJECTIVES: To assess the effects of integrated versus non-integrated orbital implants for treating anophthalmic sockets. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to August 2016), Embase (January 1980 to August 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to August 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 8 August 2016. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs of integrated and non-integrated orbital implants for treating anophthalmic sockets. DATA COLLECTION AND ANALYSIS: Two authors independently selected relevant trials, assessed methodological quality and extracted data. MAIN RESULTS: We included three studies with a total of 284 participants (250 included in analysis). The studies were conducted in India, Iran and the Netherlands. The three studies were clinically heterogenous, comparing different materials and using different surgical techniques. None of the included studies used a peg (i.e. a fixing pin used to connect the implant to the prosthesis). In general the trials were poorly reported, and we judged them to be at unclear risk of bias.One trial compared HA using traditional enucleation versus alloplastic implantation using evisceration (N = 100). This trial was probably not masked. The second trial compared PP with scleral cap enucleation versus PMMA with either myoconjunctival or traditional enucleation (N = 150). Although participants were not masked, outcome assessors were. The last trial compared HA and acrylic using the enucleation technique (N = 34) but did not report comparative effectiveness data.In the trial comparing HA versus alloplastic implantation, there was no evidence of any difference between the two groups with respect to the proportion of successful procedures at one year (risk ratio (RR) 1.02, 95% confidence interval (CI) 0.95 to 1.09, N = 100, low-certainty evidence). People receiving HA had slightly worse horizontal implant mobility compared to the alloplastic group (mean difference (MD) -3.35 mm, 95% CI -4.08 to -2.62, very low-certainty evidence) and slightly worse vertical implant motility (MD -2.76 mm, 95% CI -3.45 to -2.07, very low-certainty evidence). As different techniques were used - enucleation versus evisceration - it is not clear whether these differences in implant motility can be attributed solely to the type of material. Investigators did not report adverse events.In the trial comparing PP versus PMMA, there was no evidence of any difference between the two groups with respect to the proportion of successful procedures at one year (RR 0.92, 95% CI 0.84 to 1.01, N = 150, low-certainty evidence). There was very low-certainty evidence of a difference in horizontal implant motility depending on whether PP was compared to PMMA with traditional enucleation (MD 1.96 mm, 95% CI 1.01 to 2.91) or PMMA with myoconjunctival enucleation (-0.57 mm, 95% CI -1.63 to 0.49). Similarly, for vertical implant motility, there was very low-certainty evidence of a difference in the comparison of PP to PMMA traditional (MD 3.12 mm 95% CI 2.36 to 3.88) but no evidence of a difference when comparing PP to PMMA myoconjunctival (MD -0.20 mm 95% CI -1.28 to 0.88). Four people in the PP group (total N = 50) experienced adverse events (i.e. exposures) compared to 6/100 in the PMMA groups (RR 17.82, 95% CI 0.98 to 324.67, N = 150, very low-certainty evidence).None of the studies reported socket sphere size, cosmetic effect or quality of life measures. AUTHORS' CONCLUSIONS: Current very low-certainty evidence from three small published randomised controlled trials did not provide sufficient evidence to assess the effect of integrated and non-integrated material orbital implants for treating anophthalmic sockets. This review underlines the need to conduct further well-designed trials in this field.

Rehabilitation of atrophic anophthalmic cavity with orthostatic ocular prosthesis: A clinical report.

The absence of the eyeball can generate psychosocial and facial harmony changes, such as atrophy of the muscles around it. In these cases, the use of an orthostatic prosthesis with expanding function fosters distension of the tissues for subsequent rehabilitation. This technique consists of making individual ocular prostheses with gradual enlargement of size. The aim of this following clinical report was to describe the technique used in the standing prosthetic rehabilitation of a patient, 73 years old, who underwent enucleation of the right eye as a result of glaucoma. Clinical and laboratory procedures were performed such as impression, adjusting curvature of the sclera, centering the pupil area and processing in heat-cured acrylic resin three prostheses made according to the expansion of the anophthalmic cavity. At the end of treatment, there was a considerable increase of the cavity, allowing for volume replacement similar to that existing in the patient's contralateral orbit, thus generating a satisfactory facial harmony.

[Clinical and anatomical features of congenital microphthalmia and anophthalmia in children and conservative methods of rehabilitation]. / Kliniko-anatomicheskie osobennosti vrozhdennogo mikroftal'ma i anoftal'ma u detei i konservativnye metody reabilitatsii.

AIM: To develop a comprehensive classification system of distinctive clinical and anatomical features of congenital microphthalmia and anophthalmia in children and to specify indications, contraindications, and optimal timing of the primary and subsequent prosthetic treatment. MATERIAL AND METHODS: A total of 70 patients with congenital micro- or anophthalmia aged from 1 month to 12 years were examined. Besides the routine ophthalmic examination, all patients underwent eye and orbit ultrasound (axial length measurement and B-scan), computed tomography of the orbits and skull, and immunological tests for infectious diseases (enzyme-linked immunosorbent assays). RESULTS: Basing on the examination RESULTS: we have determined the common types of congenital micro- and anophthalmia in children. We have also developed a stepwise prosthetic treatment aimed at better cosmetic rehabilitation. Indications and contraindications for the use of ocular prostheses in children with congenital micro- and anophthalmia have been identified. CONCLUSION: The proposed method of stepwise prosthetics is the principal option for conservative rehabilitation of children with congenital micro- or anophthalmia.

Computer-aided design and three-dimensional printing in the manufacturing of an ocular prosthesis.

Restoring the facial appearance in acquired anophthalmos entails precision fitting of a customised ocular prosthesis. The fabrication is an artisanal process, and is primarily based on an impression of the anophthalmic cavity. This is usually achieved by the impression-moulding method, which, however, may introduce errors, resulting in a poorly fitted prosthesis. We developed a new method in the manufacturing of a customised ocular prosthesis based on computer-aided design and computer-aided manufacturing. An ocular prosthesis, based on a three-dimensional (3D) printed impression-free mould of the anophthalmic cavity, was successfully fitted in a 68-year-old male. To the best of our knowledge, this is the first case of a customised ocular prosthesis designed with the aid of 3D printing. TRIAL REGISTRATION NUMBER: B322201628407, Pre-results.

Ocular rehabilitation following socket reconstruction with amniotic membrane transplantation with failed primary hydroxyapatite implant post enucleation.

There are several clinical situations that require enucleation in children, with retinoblastoma being the most common. Intra-orbital implants are routinely placed in children at the time of initial surgery to provide motility and cosmesis in addition to adequate orbital volume. Current practice employs intra-orbital implants made of nonporous silicone, hydroxyapatite, or porous polyethylene. Complications are usually minimal with these implants but they do occur. The purpose of this clinical report is to describe the rehabilitation of a pediatric patient with failed primary intra-orbital coralline hydroxyapatite implant post enucleation, who was successfully fitted with custom ocular prosthesis following secondary socket reconstruction with amniotic membrane transplantation after removal of infected implant.

Psychosocial impact on anophthalmic patients wearing ocular prosthesis.

The aim of this study was to assess the improvement in psychosocial awareness of anophthalmic patients wearing ocular prostheses and its relationship with demographic characteristics, factors of loss/treatment, social activity, and relationship between professional and patient. Surveys including a form for evaluation of psychosocial pattern were conducted with 40 anophthalmic patients rehabilitated with ocular prosthesis at the Center of Oral Oncology in the authors' dental school from January 1998 to November 2010. The improvement in psychosocial awareness was assessed by comparing the perception of some feelings reported in the period of eye loss and currently. Wilcoxon tests were applied for comparison of patients' perception between the periods. χ(2) tests were used to assess the relationship between the improvement in psychosocial awareness and the variables of the study. In addition, the logistic regression model measured this relationship with the measure of odds ratio. The feelings of shame, shyness, preoccupation with hiding it, sadness, insecurity and fear were significant for improvement in psychosocial awareness. It was concluded that the anophthalmic patients wearing an ocular prosthesis has significant improvement in psychosocial awareness after rehabilitation.

[Historical aspects of eye prosthetics].

The article is devoted to the problems of eye prosthetics that develops since ancient times till today. Indications for eye prosthesis and its role in rehabilitation of anophthalmic patients are determined. The process of glass prostheses production is described in details, technology is discussed and illustrated. This article is of great interest for opthalmologists and prosthetic technicians as it is proved that glass prostheses are more physiologic and have a number of advantages compared to plasticones.

[Therapy options for blind microphthalmos and clinical anophthalmos]. / Therapiemöglichkeiten bei funktionslosem Mikrophthalmus und klinischem Anophthalmus.

Children suffering from congenital anophthalmos (absence of eyes) or blind microphthalmos (eyes too small without light perception) show significant smaller eyelids, conjunctival sacs and orbital volume due to the lack of intrauterine growth stimulus. Highly hydrophilic osmotic expanders allow prostheses to be fitted in the first year of life to compensate for the volume deficit and the substantial aesthetic disadvantages and to stimulate lid development.

The psychosocial benefits of secondary hydroxyapatite orbital implant insertion and prosthesis wearing for patients with anophthalmia.

PURPOSE: Anophthalmia is associated with a range of psychosocial difficulties and hydroxyapatite orbital implant insertion and prosthesis wearing is the predominant rehabilitation therapy for anophthalmia. However, few articles have compared preoperative and postoperative psychosocial outcomes using standardized questionnaires. This study aimed to investigate the psychosocial benefits of hydroxyapatite orbital implant insertion and prosthesis wearing in this patient population. METHODS: In all, 36 participants were tested preoperatively and 6-months postoperatively using standardized measures of anxiety and depression (Hospital Anxiety and Depression Scale), social anxiety and social avoidance (Derriford Appearance Scale-Short Form), and quality of life (World Health Organization Quality of Life Scale-Short Form). RESULTS: Before treatment, levels of depression were comparable with population norms; however, levels of general anxiety were slightly raised, levels of social anxiety, social avoidance, and quality of life were significantly poorer than population norms. Treatment resulted in significant improvement in psychosocial adjustment with improvements in all study variables for the participant group as a whole. CONCLUSION: Hydroxyapatite orbital implant insertion and prosthesis wearing offers significant improvements in psychological and physical functioning for patients with anophthalmia.

[Enophtalmos of the anophtalmic socket: incidence of the orbital morphology and therapeutic implications. Clinical study of 86 cases]. / Énophtalmie de la cavité anophtalme : incidence de la morphologie orbitaire et implications thérapeutiques. Étude clinique de 86 cas.

AIM OF THE STUDY: From a light asymmetry to a sunken eye aspect, a great disparity between the results after anophtalmic socket rehabilitation is noticeable: what are the factors involved in the degree of residual enophtalmos following excision of the eye? The litterature's response is based on physiopathological considerations around intraorbital architectural disturbance. We propose a geometrical approach related to the existence of different morphological types of orbit. PATIENTS AND METHOD: Eighty-six records of eviscerated and enucleated patients have been studied and submitted to a statistical analysis. A preliminary study has defined four types of orbit depending on the shape and operture of the orbital "window": two opposite types IA and III, a type II intermediate and a particular one, the type IB. A classification of enophtalmos' degree allows to analyze the parameters chosen and to identify the predictive factors. RESULTS: The statistical analysis confirms the incidence of the orbital morphology on the degree of enophtalmos but do not support the theories based on the intraorbital septal architecture changes. Depending on the orbital shape and the container-content relation, the volume loss is more visible on the whole orbitopalpebral surface of opened and high orbit but remains centered on the anteroposterior position of the implant of a closed and lengthened orbit. At the contrary to the type III, the type IA is not favorable for the anophtalmic patient and predispose to a higher degree of enophtalmos. This new approach has therapeutic implications on primary and secondary surgery for volume loss replacement. CONCLUSION: The success of anophtalmic socket rehabilitation is influenced by the orbital morphological type that has to be considered in the therapeutic strategy.

Rehabilitación quirúrgico-protésica de pacientes con cavidades anoftálmicas atípicas / Surgical-prosthetic rehabilitation of patients with atypical anophthalmic cavities

Se realizó estudio descriptivo y transversal de 377 pacientes con cavidades anoftálmicas atípicas, atendidos en el Departamento de Oculoplastia del Hospital General Dr Juan Bruno Zayas Alfonso y la Clínica de Rehabilitación de Prótesis Bucomaxilofacial del Hospital Provincial Docente Saturnino Lora en Santiago de Cuba, desde enero de 2004 hasta septiembre de 2010, con vistas a evaluar su rehabilitación quirúrgica protésica. Del total de cavidades, 13 eran congénitas y 364 adquiridas: 75 con globos oculares no estéticos y 289 sin ellos; en estos últimos se efectuaron 189 evisceraciones, 98 enucleaciones y 2 exenteraciones. En la casuística, 170 pacientes recibieron implantes orbitarios con hidroxiapatita porosa coralina cubana (HAP 200): 125 primarios y 45 secundarios. La rehabilitación quirúrgica protésica fue buena en 86,0 % de los pacientes sin implante orbital y en la totalidad de los que sí lo recibieron, de donde se concluyó que la rehabilitación quirúrgica no puede separarse de la protésica(AU)

A descriptive and cross-sectional study of 377 patients with atypical anophthalmic cavities, attended in the Oculoplasty Department from Dr Juan Bruno Zayas Alfonso General Hospital and the Rehabilitation Clinic of Oral Maxillofacial Prosthesis from "Saturnino Lora Teaching Provincial Hospital in Santiago de Cuba was carried out from January 2004 to September 2010, aimed at evaluating their surgical prosthetic rehabilitation. From the total of cavities, 13 were congenital and 364 were acquired: 75 with non-aesthetic eyeballs and 289 without them; in the last group 189 eviscerations, 98 enucleations and 2 exenterations were carried out. One hundred and seventy patients had orbital implants with Cuban coral porous hydroxyapatite (HAP 200): 125 primary and 45 secondary in the case material. Surgical prosthetic rehabilitation was good in 86,0% of the patients without orbital implants and in all those who received it, from which it was concluded that surgical rehabilitation cannot be separated from the prosthetic one(AU)

Restoration of an atrophic eye socket with custom made eye prosthesis, utilizing digital photography.

Ocular defects may cause several ocular and orbital disorders, which require surgical intervention. These defects are psychologically disturbing for the patients, and therefore, they require immediate management and rehabilitation by a team of specialist. Ocular prosthesis may be either readymade (stock) or custom made. Fabrication of a custom ocular prosthesis allows for a range of variations during construction. The iris can also be custom made by ocular painting or by digital photography. The optimum cosmetic and functional results of a custom-made prosthesis enhance the patient's rehabilitation to a normal life style. This paper elaborates the technique for fabrication of a custom-made ocular prosthesis for an atrophic eye socket utilizing digital photography.

Congenital anophthalmia: current concepts in management.

PURPOSE OF REVIEW: The introduction of hydrogel socket and orbital expanders has modified the approach towards the rehabilitation of congenital anophthalmia. This study highlights the most recent advances for the treatment of congenital anophthalmia based on personal experience and the review of recent literature. RECENT FINDINGS: Hydrogel socket expanders may be positioned as an out-patient procedure with topical anaesthesia, using cyanoacrylate glue as opposed to temporary tarsorraphy. Increased orbital volume has been confirmed by computed tomography (CT) scan or magnetic resonance imaging (MRI) following early dermis-fat graft in children with congenital anophthalmia. An orbital tissue expander made of an inflatable silicone globe sliding on a titanium T-plate and secured to the lateral orbital rim appears to be effective to stimulate orbital bone growth and development. SUMMARY: Congenital anophthalmia has a complex cause with both genetic and environmental factors involved. The ideal treatment is simultaneous expansion of the eyelids, socket and orbital bones, and it should begin after birth as soon as possible. Socket expansion with self-inflating expanders is a useful technique, although custom-made conformers may produce similar results. Dermis-fat grafts are another reasonable option as an orbital implant, following adequate lid and socket expansion.