Конъюнктивиты при использовании глазного протеза. Профилактика и выбор эффективной терапии

Abstract

Purpose. To determine the causes of inflammatory processes when using ocular prostheses, to develop recommendations for prevention and treatment of inflammation and contraction of the conjunctival cavity in rehabilitation of persons using ocular prostheses. Methods. We have analyzed treatment effectiveness in 62 adult patients: 26 men and 36 women, aged 18–92 years, who applied for ocular prosthetic care in 2023. Operations preceding prosthetics were performed in different medical institutions. The period after surgery ranged from 6 months to 69 years. The time elapsed after the last prosthetics was from 2 months to 69 years. Resultsand discussion. All the patients underwent routine ophthalmic examination. Prosthetics was performed depending on the duration of prosthesis use, the condition of its surface and the correspondence between the shape of the prosthesis and the cavity: selection and adaptation of a standard ocular prosthesis (12 patients); repair of the prosthesis – grinding and polishing (14 patients); manufacturing of an individual ocular prosthesis according to the shape of the cavity, taking into account all the parameters of the paired eye (36 patients). Depending on the conjunctival cavity condition, drug therapy was prescribed. To objectify the assessment of treatment results, all the patients filled out questionnaires, where satisfaction with the comfort of wearing a prosthesis and their own appearance was recorded on a 5-point scale. Three weeks after the end of treatment, the administrator and the doctor called all the patients to clarify the need for correction of the prosthesis shape and medical treatment. Conclusions. The patient is satisfied with the prosthetics when the prosthesis looks like an eye and the patient does not feel discomfort when using the prosthesis. It is possible to achieve an optimal result if the prosthesis corresponds to the appearance of the paired eye, its shape fills and repeats the conjunctival cavity, the prosthesis has a smooth surface. The discrepancy between size and shape of the prosthesis and size and configuration of the cavity, sharp edges of the prosthesis, irregularities and roughness of its surface cause inflammation of the cavity, which is accompanied by an increase of mucous discharge and infection. Appointment of antibacterial or any other drug therapy without restoring smoothness of the prosthesis gives a temporary effect and promotes selection of resistant microorganisms. An ocular prosthesis in 1 year of use loses smoothness of its surface. With the observance of conjunctival cavity hygiene and careful attitude to the prosthesis – regular (1 time per year) repair of a plastic prosthesis, it is possible to extend the period of use of a plastic prosthesis to 4–5 years without complications and inconveniences. Key words: ocular prosthesis; conjunctivitis; anophthalmos; microphthalmos; subatrophy; preventive repair; timely prosthesis replacement.