Patient-specific implants in orbital reconstruction.

PURPOSE OF REVIEW: Advances in the use of patient-specific implants (PSIs) and virtual surgical planning (VSP) for reconstruction of primary and secondary traumatic orbital defects are explored. RECENT FINDINGS: PSIs and VSP are emerging technologies that promise to make complex orbital reconstructions safer and more predictable for patients. Recent studies highlight principles of implant design, the novel use of multiunit implant constructs, and utility of intraoperative imaging adjuncts to achieve favorable outcomes. SUMMARY: This article summarizes recent developments in PSIs for orbital reconstruction. A complete workflow including presurgical planning, execution in the operating room, postoperative analysis, and avoidance of common pitfalls and implant design errors are reviewed.

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.

Comparison of the outcomes of blowout fracture repair according to the orbital implant.

PURPOSE: The clinical outcomes of blowout fracture repair classified by 2 types of orbital implants (Macropore and Medpor) were compared. PROCEDURES: The medical records of 331 patients with orbital fractures that were treated surgically by 1 surgeon at Gachon University Gil hospital, from March 2007 to March 2009, were reviewed. Patients who had diplopia or limited extraocular motion, significant enophthalmos (>2 mm), or a large fracture on a computed tomographic scan (>50% of the floor area) were enrolled. The clinical outcomes were compared between patients who received surgical repair using Macropore and those who had surgical repair using Medpor. RESULTS: One hundred six patients had surgical repair using Macropore and 225 patients were surgically treated with Medpor. Both the Macropore (n = 106) and the Medpor groups (n = 225) showed significant clinical improvement. The degree of preoperative/postoperative diplopia and limited extraocular motion was not different between the 2 groups. In addition, there was no difference in the preoperative/postoperative enophthalmos between the 2 groups. CONCLUSIONS: Both Macropore and Medpor were associated with equally safe and satisfactory patient outcomes without notable complications.

A technique for fabrication of an interim ocular prosthesis.

Several ocular and orbital disorders require surgical intervention that may result in ocular defects. Immediate intervention is required to preserve the anophthalmic socket size and prevent scar tissue contractures that may follow surgery. Unfortunately, immediate fitting of an anophthalmic socket with an artificial eye may not always be possible, and a delayed prosthesis delivery may result in settling and sinking of the prosthesis into the socket, therefore requiring orbital cavity conformation. This article presents a short review of the most commonly used techniques for processing an ocular prosthesis, while suggesting a practical transition to the application of some of them. A technique for fabricating a custom-made provisional ocular prosthesis using digital imaging technology is described. This technique may be considered in order to avoid costly procedures that might be required as a result of delayed artificial eye insertion. The technique described in this article provides a cost-effective choice for optimal orbital cavity conformation and serves as a diagnostic aid for predicting the patient's compliance to ocular prosthetic treatment. The esthetic advantages and the relative ease of fabrication of this interim prosthesis allow it to be considered a first step in the management of untreated anophthalmic sockets.

[Evaluation of results of enucleations with orbital implant in children and adolescents]. / Ocena wyników operacji usuniecia galki ocznej z wszczepem oczodolowym u dzieci i mlodziezy.

PURPOSE: The aim of the research is the assessment of results of enucleation with orbital implant in children. MATERIAL AND METHODS: Examinations included the group of 99 children between 6 months and 19 years of age. The examined group consisted of 39 boys (39.4%) and 60 girls (60.6%). 96 eyes were removed because of non-regressive retinoblastoma (despite applied treatment), two eyes with buphtalmus (with no light perception), as a result of glaucoma, and one case of medulloepithelioma. The applied implants were: Castroviejo--in 28 patients, Medpor--in 24 patients, Hydroxyapatite--46 patients. In one patient was applied Baush and Lomb orbital implant. RESULTS: In 91 patients (91.9%) no significant complications occurred. In 2 patients (2%), the hemorrhage occurred during the surgery. Postoperative complications included: in 6 patients (6.1%) exposition of orbital implant was observed; in one patient the exposition was enlarging which led to removal of the implant; in 2 patients with implant exposition (2%) inflammatory granuloma occurred on the edge of the exposition. In one patient (1%) cyst of conjunctiva in the postoperative scar area occurred 3 months after operation. CONCLUSIONS: Enucleation with orbital implant enables normal development of the orbit and improves cosmetic effect. The frequency of complications depends on type of applied orbital implant.

Gender differences in corneal thickness values

The aim was to study gender differences in corneal thickness. We analysed the corneal thickness of 100 corneas of 100 healthy subjects (mean age 30.87±7.76 years; range, 19 to 54 years old) with the Orbscan Topography System II (Orbscan, Inc., Salt Lake City, UT. USA). The means of five consecutive measurements of the central and paracentral corneal thickness were obtained. No significant differences in mean corneal thickness between women and men at central (p=0.477), nasal (p=0.247), superonasal (p=0.242), inferonasal (p=0.554), temporal (p=0.538), superotemporal (p=0.524) and inferotemporal (p=0.860) corneal locations were found. In sum, there are no differences in mean central and paracentral corneal thickness values between women and men (AU)

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