The purpose of this article is to describe the different reconstruction techniques for anophthalmic sockets. In preparing the anopthalmic socket for prosthesis. Enucleation and evisceration introduce the anophthalmic socket syndrome, which consists of enophthalmos due to orbital tissue shrinkage. Following enucleation or evisceration surgery, the anatomy and physiology of the orbit are changed. These changes affect not only the cosmetic appearance of.
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A conformer must be in place all times until prosthesis is custom fitted [ 5 ]. Conformer enveloped in skin graft, hyaluronic acid lower sulcus. Obliterated or shallow lower fornix might occur either in contracted socket with conjunctival scarring and foreshortening or in anophthalmic socket or postenucleation socket syndrome where there is abundant conjunctiva with lacked inferior fornix fixation [ 1 ].
The depth of the inferior conjunctival fornix was measured in mm at the center of the lower eyelid in all participants in the control group and in patient subgroups. Anophthalmic socket syndrome encompasses several anomalies including shallow lower fornix. Therefore the disadvantages are mostly aesthetic with no prosthesis motility and difficulties in eyelid closure.
Evaluation of the Anophthalmic Socket
One month postoperatively the central inferior fornix depth CIFD was measured in mm and anophthalmjc. For these reasons it is important that the general ophthalmologist be able to adequately evaluate and treat simple problems of the anophthalmic socket.
For the above reason, we designed this study to evaluate new surgical technique for deepening the inferior conjunctival fornix using fascia lata in contracted socket and anophthalmic socket syndrome.
Enucleation with a primary dermis-fat graft was performed in six patients — one suffered a blast injury, one a chemical burn, one a severe corneal ulcer with scleral melting, one advanced glaucoma with multiple surgeries, one necrotizing scleritis, and the last one had an unknown cause. Entropion must be carefully evaluated to determine if the etiology is due to horizontal laxity or mild socket contracture.
The dermis fat graft is harvested from the hip or groin area, in an area without hair that can be easily covered by a bathing suit and not located in a region of pressure. Unilateral dermis-fat graft implantation in the pediatric orbit. The orbital implants we use in current practice are methyl methacrylate sphere, hydroxyapatite implant, Guthoff orbital implant, dermis-fat graft and conformer dressed in skin graft. The lip was retracted with two towel clamps and incised with a number blade.
Complications of hydroxyapatite orbital implants: Direct suture fixation of the edges of the conjunctival incision to the periosteum is then achieved.
Orbital volume can be restored with the help of. Two-stage procedure for management of large exposure defects of hydroxyapatite orbital implant. Another considerable advantage at the time was that hydroxyapatite implant allows placing a peg that connects to the prosthesis, offering a very good motility.
Footnotes Disclosure The authors report no conflicts of interest in this work. Indexed in Science Citation Index Expanded. Six patients were on a conformer because four of them experienced chronic discharge and the other two did not present to the hospital to have their eye prosthesis made, and the other five could wear neither the eye prosthesis nor the conformer because of severe socket contraction.
Author information Copyright and License information Disclaimer. Free orbital fat graft to prevent porous polyethylene orbital implant exposure in patients with retinoblastoma. Loss of one eye due to a tumor, trauma or eye disease is devastating for the patient at any age.
Discharge samples from four infected exposure-related implants were sent for culture. Socket dissection should be minimal to reduce the risk of fibrosis and not to undermine future graft vascularization. A total of 30 patients were able to wear the eye prosthesis over a mean follow-up time of Management of exposed hydroxyapatite orbital implant. Support our groundbreaking research to help end blindness and change the way the world sees. The commonest 13 cases clinical presentation to indicate the dermis-fat graft was an exposed implant mean width of 7.
Evaluation of the Anophthalmic Socket
Published online May 4. He could not wear the eye prosthesis because of volume insufficiency. National Center for Biotechnology InformationU. The fascia lata technique is a new, alternative, and effective procedure to correct the shallow inferior fornix in anophthalmic socket syndrome where minimal socket dissection is required and complications of the deepening sutures are to be avoided also in moderate to severe contracted sockets fascia lata technique which is a second alternative to deepening sutures but avoids their complications.
Depicting indications for evisceration and enucleation in patient group. Reproduction in whole or in part without permission is prohibited. Request your next appointment through My Chart! Psychogenic factors, such as drug-seeking behavior, can also lead to pain, but these are diagnoses of exclusion. On the other hand, a too small orbital implant will not restore lost volume leading to enophthalmos and deepening of the upper eyelid sulcus.
Results Forty-one patients underwent dermis-fat grafts; it was a primary procedure in six patients and a secondary one in 35 others. The tissue over the implant should be examined for thinning, fistula or a defect. Atrophy is greater if the socket has been traumatized, irradiated, infected or scarred. Used in enucleation and sometimes in evisceration, the hydroxyapatite anophthxlmic was discovered in by Perry, obtaining approval in In fascia lata technique, the conjunctiva was minimally manipulated in contrary to the long conjunctival incision and deep tissue dissection in conjunctival fixation procedure.
The fornix was sutured in place with 2—3 double-arm 4—0 polyglactin sutures. The domed dermis-fat graft orbital implant. A short history of enucleation. Compared to the unaffected right eye, the left eye socket is sunken superiorly and the left lower eyelid is retracted. Then we dissected and anophthaalmic the scar to create space, especially in the inferior fornix. We included patients who underwent either primary or secondary dermis-fat grafts for the first time.
For this reason as much ofthe vascular support should be preserved,trauma to the socket reduced and adapts the graft volume to the socket. Journal List J Med Life v. Early skin necrosis as a complication of deepening sutures. To present the indications for a dermis-fat graft in anophthalmic socket reconstruction and evaluate the results of this procedure.