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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Reproduction in whole or in xocket without permission is prohibited. Methods In our study, there were 41 patients who received either primary or secondary dermis-fat graft between August 1, and July 31, at Songklanagarind Hospital. The full terms of the License are available at http: It was later found that this pegging technique involves multiple risks of infection and expulsion and it is now contraindicated in elderly patients, immunosuppressed or after local radiotherapy.
The domed dermis-fat graft orbital implant. Request your next appointment through My Chart! The success rate of the dermis-fat graft alone was All of the four patients who underwent the combined procedure dermis-fat graft with mucous-membrane graft had an inadequate fornix, intraoperatively following the dermis-fat graft.
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The autogenous dermis-fat graft is safe because it is characterized by no foreign-body reaction and disease transmission. Which approach is right? For these reasons it is important that the general ophthalmologist be able to adequately evaluate and treat simple problems of the anophthalmic socket. It is suitable as both a primary and secondary procedure, and is able to overcome the problems related to implant exposure and extrusion. C After the eye prosthesis wearing at 2. The possible reason for the low success rate in the combined procedure may be insufficient blood supply from the base, which is a cause of mucous-membrane graft shrinkage.
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. We reviewed the medical records of these patients to obtain the following data: This procedure has been successful in overcoming some limitations of implant extrusion or exposure in procedures involving other materials.
The only case that failed to retain the prosthesis was a year-old female with severe left contracted socket and later on she required another 2 socket operations for buccal mucosal graft and finally the result was satisfactory for her. Intraoperatively 3 deep skin incisions were made with one end of the fascia strip secured to the periosteum of the inferior orbital margin.
The lip was retracted with two towel clamps and incised with a number blade. History The Chinese possibly first performed enucleation as early as BC, but the first report was by Johannes Lange in Exposed porous orbital implants treated with simultaneous secondary implant and dermis fat graft. Enucleation and evisceration introduce the anophthalmic socket syndrome, which consists of enophthalmos due to orbital tissue shrinkage, deep superior sulcus, and shallow fornix and affects the cosmesis acceptance.
Contracted socket is a condition characterized by fibrosis of the anophthalmic socket where shallow or obliterated fornix is a key finding in different stages of the disease and it occurs secondary to conjunctival shrinkage [ 2 ]. In the Lateral Cutaneous Incision.
Journal of Ophthalmology
We preferred to perform the dermis-fat graft in cases of implant exposure because many of our patients had concurrent infection. Its advantages are manifold Fig. The fat anophthalmif in dermis fat grafts. Does the patient have pain with the prosthetic in?
Eye contact is an important part of interpersonal interaction and thus is essential for the patient to receive a more natural prosthesis. Abstract Keeping the eye is anophthakmic, functionality is lost and aesthetic requirements are high. In our experience, the best results we have obtained with the dermis fat graft or the Guthoff implant, the only criterion to differentiate between the two is, at present, the cost.
Evaluation of the Anophthalmic Socket
To evaluate a new surgical technique using fascia lata to deepen the shallow inferior conjunctival fornix in contracted socket and anophthalmic socket syndrome. The lower eyelid should be evaluated for laxity.
This was a prospective, nonrandomized interventional case series studythat was carried out in the Oculoplastic Unit at Ophthalmology Department, El Minia University Hospital, in the period from February to May Regardless of the implant used and the surgical technique, the goals of the surgeon remain the same; treating the underlying condition, replacing orbital volume, maximizing motility and providing the most comfortable and aesthetically symmetric appearance.
Materials and methods This is a retrospective interventional case series containing data collected between August 1, and July 31, Aesthetic and functional oculofacial plastic problem-solving in the 21st century. Explore our health library for more information about conditions and treatments.
Graft societ can be checked from the first postoperative day by the appearance of small blood stains on the surface of the dermis. Evisceration seems to have first been performed unintentionally by James Beer in after an expulsive choroidal hemorrhage; in J.
Evaluation of the Anophthalmic Socket
Deepening sutures tied over bolsters on the skin surface. These implants are integrated with the orbit soft tissue, and, therefore, the defect can often be repaired leaving the implant in place.
On the other hand, a too small orbital implant will not restore lost volume leading to enophthalmos and deepening of the upper eyelid sulcus. Wocket dermis-fat graft has aniphthalmic used as an orbital implant in primary enucleation, secondary implants, and tissue augmentation in a contracted socket.
Complications of hydroxyapatite orbital implants: As is well known, any orbital surgery, such as volume augmentation, should precede eyelid correction. Primary dermis-fat grafting in children. The median duration between the date of visit and the date of secondary dermis-fat graft surgery was 7.
The three main surgical techniques for partial or complete eye removal are:. In this situation the risk of expulsion diminishes and it provides good volume with good motility. Therefore the disadvantages are mostly aesthetic with no prosthesis motility and difficulties in eyelid closure.
The upper eyelid position should be noted for ptosis, and levator function should be evaluated. Atrophy is greater if the socket has been traumatized, irradiated, infected anophfhalmic scarred. Silicone or soocket bolsters are used when the sutures are tied on the skin surface, anchoring the stent securely in the inferior fornix Figure 8.