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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In case we are dealing with a severely contracted socket where extraocular muscles cannot be recovered there is the option of placing a conformer wrapped in a skin graft within the socket to restore the orbital volume. View our phone directory or find a patient care location. Dermis-fat orbital implantation and complex socket deformities. Anophthalmic socket syndrome encompasses several anomalies including shallow lower fornix.
For these reasons it is important that the general ophthalmologist be able to adequately evaluate and treat simple problems of the anophthalmic socket.
The results confirmed infection by coagulase-negative Staphylococcus in two cases and Pseudomonas aeruginosa in one case, and the culture for the other one resulted in no growth.
The improvement in mean postoperative CIFD was higher in anophthalmic than in contracted subgroup Table 3 and the difference between the 2 subgroups was significant. Author information Copyright and License information Disclaimer.
Introduction 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.
The ultimate goal of socket surgery is to fit the patient with a prosthesis that would simulate as much as possible to his or her normal fellow eye [ 6 ]. Age of the patients ranged between 14 and 63 years with the mean age of The superior sulcus should be checked for deepening and symmetry with the opposite side See Figure 1.
Whether anophthalmi crossing the country anophthalmkc the globe, we make it easy to access world-class care at Johns Hopkins. Ophthalmol Clin North Am.
After the tissue graft has been sutured to the conjunctival edges, maintaining the graft in its bed and deepening of the inferior fornix can be achieved by various techniques including deepening sutures [ 3 ], slightly larger conformer with temporary tarsorrhaphy [ 12 ] or without tarsorrhaphy [ 13 ], or wire suturing of a custom conformer to anophthqlmic bone of the upper and lower orbital rim [ 14 ].
In literature the ideal orbital implant is described as: To evaluate a new surgical technique using fascia lata to deepen the shallow inferior conjunctival fornix in contracted socket and anophthalmic socket syndrome. The most recent published survey anophthalmiv reported spherical porous polyethylene to be the most commonly used implant.
Find a Job Post a Job. 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.
Indications and results in anophthalmic socket reconstruction using dermis-fat graft
The patient loses binocular vision with reduced visual field but suffers also changes in the perception of self that can lead to anxiety and depression. Ophthal Plast Reconstr Surg. Is the patient happy with the cosmesis and movement of the prosthetic? Is there discharge or bleeding from anpphthalmic socket?
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. A prospective controlled study in which 24 sockets of 24 patients who were unable to wear sovket retain their ocular prosthesis due to shallow inferior fornix were enrolled and categorized into anophthalmic socket syndromes 9 patients and contracted sockets 15 patients.
Author information Copyright and License information Disclaimer. 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 | Oculoplastic Surgery at Wilmer Eye Institute
The 9 cases with anophthalmic socket syndrome had preoperative lax lower lids Figure 1 which were spontaneously corrected after the fascia lata technique without need for lateral tarsal strip Figure 6. Our oculoplastic surgeons will help determine if partial eye removal will be more beneficial, or if removing the entire eye is the only option. Van Der Meulen and J. The ideal implant restores most of the volume, leaving enough space for the prosthesis. In anophthalmic socket syndrome, the shallow inferior fornix is reformed by deepening sutures that exit at the skin of the lower lid where they are tied over bolsters and left for weeks [ 3 ].
The dermis-fat graft, with perfect biocompatibility, has two components: This is a retrospective interventional case series wnophthalmic data collected between August 1, and July 31, The implant can also be placed within the muscle cone, behind the scleral bag.
C After the eye prosthesis anophthalmiv at 2. Informed consents were obtained from all patients for the surgery 2. 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. But chronic mucoid conjunctival discharge and skin erosion with infection necessitated early removal of the externalized sutures and increased the risk of recurrence [ 4 ] Figure 9.
In this case the implant is placed in the scleral bag, ensuring adequate good volume and motility. Keeping the eye is impossible, functionality is lost and aesthetic requirements are high. That is why the prosthesis will be too thin to create the impression of a deep anterior chamber.
It is divided into two areas; the posterior half is methyl methacrylate and anterior half of hydroxyapatite, where there are four grooves sockte suturing the extraocular muscles Fig. The mucosal surface of the lip was marked and injected by a 1: Sockey methacrylate sphere The methyl methacrylate sphere is part of the non-porous orbital implants and is most commonly used to restore volume lost after evisceration.
Ssocket to Table of Contents Alerts. Early skin necrosis as a complication of deepening sutures.
It is suitable as both a primary and secondary procedure, and is able to overcome the problems related soccket implant exposure and extrusion. Central depth of the inferior fornix was measured preoperatively and postoperatively. You make a posterior sclerotomy anophhalmic, after placing the implant in the muscle cone, sclera and conjunctiva are sutured above. The graft was sutured into the defect of the fornix using interrupted and continuous-running 6—0 polyglactin sutures. The most common indications for a dermis-fat graft were extrusion and large exposure.
Figure B shows an exposed, porous implant. Dermis fat grafts as primary and secondary orbital implants.