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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Find a Job Post a Job. The collaboration between surgeon and ocularist is essential in order to provide a natural-looking prosthesis with good motility. Evisceration, enucleation, and exenteration surgery will change the appearance of your eye, making reconstructive surgery necessary.
Evaluation of the Anophthalmic Socket
On the other hand, a too small orbital implant will not restore lost volume leading to enophthalmos and ano;hthalmic of the upper eyelid sulcus. Upper eyelid ptosis is common in the anophthalmic socket.
In addition, harvesting fascia lata is not a simple procedure and it is time consuming with a second operation site in the thigh with its complications. Besides the ptotic right upper eyelid, the patient has poor motility of the prosthesis.
Does the patient have pain with the prosthetic in? For this reason as much ofthe vascular support should be preserved,trauma to the socket reduced and adapts the graft volume to the socket.
We reviewed the medical records of these patients to obtain the following data: In literature the ideal orbital implant is described as: Footnotes Disclosure The authors report no conflicts of interest in this work. There were various types of orbital implants employed in this study: The latter only restores a maximum of 4.
You make a posterior sclerotomy and, after placing the implant in the muscle cone, sclera and conjunctiva are sutured above.
A statistically significant improvement of the postoperative central inferior fornix depth was reported which was marked in anophthalmic subgroup. It offers good orbital volume, very good motility and very good integration.
If the etiology is not clear and persists after prosthetic polishing and lubrication, the patient may need a CT scan to aid in diagnosis.
Six of the seven patients with an intraocular tumor received radiation, and in only three of those cases, the prosthesis could be successfully worn. Patient with anophthalmic socket syndrome having shallow inferior fornix and lax lower eyelid.
It is divided into two areas; the posterior annophthalmic is methyl methacrylate and anterior half of hydroxyapatite, where there are four grooves for suturing the extraocular muscles Fig. The superior sulcus should be checked for deepening and symmetry with the opposite side See Figure 1. Open in a separate window. A transconjunctival inferior fornix fixation is another method of repair of shallow inferior fornix in anophthalmic socket syndrome where the edges of the conjunctival incision are directly sutured to the periosteum with no need for externalized sutures and stents [ 5 ].
The Anophthalmic Socket – Reconstruction Options
We preferred to perform the dermis-fat graft in cases of implant exposure because many of our patients had concurrent infection.
There are situations when, in order to alleviate severe pain, to protect a healthy contralateral eye, to improve aesthetics slcket even to save the life of a patient, the eyeball must be removed. The three main surgical techniques for partial or complete eye removal are:. This is the dilemma we face whenenucleation or evisceration are unavoidable. Unfortunately this orbital implant is an expensive one and it is necessary to have available several sizes during surgery. A Before the eye prosthesis wearing, a year-old male who underwent evisceration with nonporous implant.
Unilateral dermis-fat graft implantation in the pediatric orbit. In contrary to anophthalmic socket syndrome where there is anopthalmic poor lower fornix fixation, the sockrt socket is characterized by inadequate conjunctiva in addition to cicatricial obliteration of the inferior fornix.
Patient Selection All patients attending to the Oculoplastic Unit at El Minia University Hospital who were unable to wear and retain their ocular prosthesis due to shallow or obliterated inferior conjunctival anophthalmjc were examined and 24 male and female adult patients were considered for study enrollment after exclusion of patients with previous surgical correction of shallow inferior conjunctival fornix.
Evisceration seems to have first been performed unintentionally by James Beer in after an soket choroidal hemorrhage; in J. The full terms of the License are available at http: Support Center Support Center. Informed consents were obtained from all patients for the surgery 2. Therefore, a mucous membrane was added to deepen the fornix, and the size of the xocket was measured.
In Ophthalmic Plastic Surgery, 4th Ed. The implant wrapped in Teflon has a high risk of expulsion and infection Fig. In a retrospective study Katreider evaluated the volume replacement afterenucleation by the orbital implant and prosthesis. Postoperatively the inferior fornix was deep and the lower lid societ was corrected. Is there discharge or bleeding from the socket? These changes and the placement of an orbital implant can lead to a variety of complications and management difficulties.
The mean preoperative Anophghalmic was lower in anophthalmic subgroup Table 3 and the difference between the 2 subgroups was statistically significant. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
National Center for Biotechnology InformationU. Postoperatively, inorder improve orbital volume and upper and lower eyelid grooves, hyaluronic acid can be injected into the socket or a fat graft may be used to restore volume wnophthalmic the cavity and of the sulcus, providing a satisfactory aesthetic result.
In conclusion, the dermis-fat graft has been used for anophthalmic socket reconstruction because it can replace the orbital volume, fornix, and conjunctiva.