Recurrent contracted sockets treated with personalized, three-dimensionally printed conformers and buccal grafts.

ALW Groot,Roel JHM Kloos,Jelmer S Remmers,Peerooz Saeed,Dyonne T Hartong

doi:10.1177/11206721211000013

ALW Groot, Roel JHM Kloos + Show 3 more

Open Access

https://doi.org/10.1177/11206721211000013

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Abstract

Purpose:Recurrent contracted sockets are complex situations where previous surgeries have failed, disabling the wear of an ocular prosthesis. A combined method of surgery and long-term fixation using custom-made, three-dimensional (3D) printed conformers is evaluated.Methods:Retrospective case series of nine patients with recurrent excessive socket contraction and inability to wear a prosthesis, caused by chemical burns (n = 3), fireworks (n = 3), trauma (n = 2) and enucleation and radiotherapy at childhood due to optic nerve glioma (n = 1) with three average previous socket surgeries (range 2–6). Treatment consisted of a buccal mucosal graft and personalized 3D-printed conformer designed to be fixated to the periosteum and tarsal plates for minimal 2 months. Primary outcome was the retention of an ocular prosthesis. Secondary outcome was the need for additional surgeries.Results:Outcomes were measured at final follow-up between 7 and 36 months postoperatively (mean 20 months). Eight cases were able to wear an ocular prosthesis after 2 months. Three cases initially treated for only the upper or only the lower fornix needed subsequent surgery for the opposite fornix for functional reasons. Two cases had later surgery for cosmetic improvement of upper eyelid position. Despite pre-existing lid abnormalities (scar, entropion, lash deficiency), cosmetic outcome was judged highly acceptable in six cases because of symmetric contour and volume, and reasonably acceptable in the remaining two.Conclusions:Buccal mucosal transplant fixated with a personalized 3D-designed conformer enables retention of a well-fitted ocular prosthesis in previously failed socket surgeries. Initial treatment of both upper and lower fornices is recommended to avoid subsequent surgeries for functional reasons.

Highlights

The goal after ocular evisceration or enucleation is to fit an ocular prosthesis that resembles a natural eye as closely as possible
In this study we describe our experience with nine patients were this method of personalized 3D-printed conformer with long-term mucosal transplant fixation was applied
In eight out of nine patients sufficient fornices were created, which enabled the retention of an ocular prosthesis (Figure 4)

Summary

Introduction

The goal after ocular evisceration or enucleation is to fit an ocular prosthesis that resembles a natural eye as closely as possible. In order to fit an ocular prosthesis, deep eyelid fornices with sufficient conjunctival lining are mandatory. Shortness of conjunctival lining with shallow or absent fornices can occur in various conditions, including previous external beam radiation, multiple previous extrusions of an orbital implant, immunologic diseases such as mucous membrane pemphigoid or Stevens Johnson syndrome, or after chemical or thermal trauma. In a subset of patients these standard procedures fail, and severe recurrent contraction of the socket results in the inability to wear any ocular prosthesis. This situation is referred to as stage 5 contracted socket as defined by Krishna[2], where “there is recurrence of contraction of the socket after repeated trial of reconstruction”

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Conclusion