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A Combined Prosthetic and Surgical Approach
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Hitesh Koria, M. Stephen Dover, Steve Worrollo
The loss or absence of an eye may be caused by a congenital defect, irreparable trauma, tumour, a painful blind eye, sympathetic ophthalmia, or the need for histological confirmation of a suspected diagnosis. Orbital diseases are relatively rare but, considering the anatomy of surrounding structures, they present a very serious disorder. Depending on the severity of the situation, the surgical management may include one of three approaches: evisceration, enucleation or exenteration. The majority of patients requiring orbital prostheses have acquired defects as a result of tumour surgery. These can also include defects into the maxilla and or nasal area. There are three types of surgery for which prosthetics are required (Table 97.2): Evisceration is a surgical procedure wherein the intraocular contents of the globe are removed, leaving the sclera, Tenon’s capsule, conjunctiva, extraocular muscles and optic nerve undisturbed; the cornea may be retained or excised.Enucleation is the surgical removal of the globe and a portion of the optic nerve from the orbit.Orbital exenteration is the removal of the entire orbit, usually involving partial or total removal of the eyelids, and is primarily performed in order to eradicate a malignant orbital tumour. Specific diagnostics is provided by an ocularist; otorhinolaryngologist and dentist examinations are also suitable. Auxiliary imaging methods are also an indispensable part of the diagnostic procedure. These include X-ray images of the skull in dorsoventral, semiaxial and lateral projection. Ultrasonography, CT and nuclear MRI are also frequently employed. According to the specific diagnosis it is possible to establish precisely the extent of the damage to the eye and surrounding structures in the orbital area and to determine a medical treatment. In the treatment of solid tumours, radical surgery is usually the first step despite the risk of possible functional and aesthetic defects.
Digital photographic technique for the production of an artificial eye
Published in Journal of Visual Communication in Medicine, 2021
Timothy Zoltie, Paul Bartlett, Tom Archer, Emma Walshaw, Taras Gout
The most common method of iris reproduction consists of hand painting using oil paint, a technique undertaken by the National Artificial Eye Service (NAES) and regional maxillofacial prosthetic centres by artistry skilled ocularists. The current continued use of hand paint is down to the ease of adaptation, and ultimate control over final colour through colour mixing, but relies in part on the skill of the Ocularist. Other methods have been tested such as monomer-polymer mixture on an artificial iris (Goiato et al., 2010), an inverted painting technique using prefabricated caps as well as photographic reproduction of the patient’s healthy iris (Artopoulou, Montgomery, Wesley, & Lemon, 2006; Walshaw, Zoltie, Bartlett, & Gout, 2018). Currently no viable alternatives to hand painting have been proved scalable. Current NAES turnaround time for receipt of an artificial eye is six weeks, however patients have reported up to a six month wait (Patient and Public Involvement PPI Meeting, 26th February, 2019).
Prevention of Socket Complications in Anophthalmic Patients
Published in Current Eye Research, 2020
Alexander C. Rokohl, Marc Trester, Keith R. Pine, Ludwig M. Heindl
Borelli et al. recommend a fitting of a prosthetic eye 5–8 weeks after socket reconstruction. However, an early ocularistic care is the basis for an optimal social rehabilitation of anophthalmic patients.2,3,5,8,15 Therefore, an earlier ocularistic care is recommended: two weeks after surgery the conformer should be replaced by an appropriate fitting and cosmetic pleasing interim ocular glass prosthesis and 5–6 weeks after socket reconstruction patients can get a fully customized glass prosthetic eye.2,3,5,8 Due to further postoperative changes of anophthalmic sockets already 6 months after surgery, a checkup by an ocularist should be performed once again and if necessary a new customized ocular prosthesis with an improved fit should be manufactured.2,3,5,8 Afterwards, regular ocularistic checkups and renewals of glass prosthetic eyes every 9 to 12 months can be implemented.2,3,5,8
Postoperative Complications of Dermis-Fat Autografts in the Anophthalmic Socket
Published in Seminars in Ophthalmology, 2018
Victoria Starks, Suzanne K. Freitag
Primary dermis-fat grafts completely epithelialize in approximately 8–10 weeks, while secondary grafts or grafts placed in severely traumatized sockets take longer to epithelialize and may require 12–16 weeks.7 Failure to epithelialize or central ulceration is reported in 1.9–25% of cases.4,11,24 It has been suggested that pressure necrosis from the conformer may be partly responsible for failure of the graft to conjunctivalize. Some surgeons use a symblepharon ring with a large central aperture rather than a conformer to minimize this risk and, in some cases, the ring is custom-made by an ocularist.11,21 Other factors thought to contribute to central ulceration include large graft size, previous surgery and contracted sockets, cautery in the recipient bed, and systemic disease affecting wound healing, such as Stevens-Johnson syndrome.4,11 Graft ulceration has been treated by excision of the ulcer and primary closure of the dermis, buccal mucosal membrane grafting, chondro-mucosal grafting, amniotic membrane transplantation, or autologous serum tears.11,27,28 Graft ulceration must be addressed, as a defect in the dermis presents a potential route for infection of the deeper graft. Additionally, chronic inflammation of the conjunctiva may cause contracture and foreshortening of the fornices, preventing comfortable prosthesis wear.