Anophthalmic Patient Research Articles

Ocular Prosthesis: What you need to know and the current challenges in Nigeria

Ocular prosthesis (OP) is the replacement of natural eye by an artificial material following eye removal. OP is also called artificial eye; it gives no vision but improve the quality of life in an anophthalmic patient. OP is mainly used following ocular destructive surgery (evisceration, enucleation and exenteration.). Evisceration is the removal of intraocular content leaving scleral and optic nerve, while enucleation is the removal of the whole eye ball including the optic nerve. Exenteration is the removal of the whole eye including: optic nerve, eye adnexial and part of orbital bone. There are various challenges facing the usage of OP in Nigeria. There is a need to create awareness on the importance of ocular prosthesis, its use, types and production as well as the need to set up school of Ocularistry in Nigeria.

Motility of the Ocular Prosthesis in Anophthalmic Patients: Objective and Patient-perceived Findings

ABSTRACT Aim To study the impact of the prosthesis motility on the Quality of Life (QoL) in anophthalmic patients. Methods Cross-sectional, observational study of 100 anophthalmic patients, of whom 64% had an acryl implant, 6% an Allen implant, 1% a hydroxyapatite implant, 4% a dermis fat graft, 16% no implant, and 9% an unknown implant. We quantitatively assessed the motility of the prosthesis with Kestenbaum glasses and the QoL with a validated questionnaire covering five domains: General functional abilities and care, wearing comfort, physical appearance, psychological and social functioning. Associations between measured prosthetic eye motility, patient-perceived motility, and satisfaction were made. Results Motility of the prosthesis was impaired with an average loss of 76%, and correlated with Cosmetic satisfaction (adduction P = .02, abduction P = .008, elevation P = .04) and Social satisfaction (adduction P = .03, abduction P = .003). The patient-perceived motility of the prosthesis correlated with General functioning abilities (horizontal P = .0004, vertical P = .0004), Comfort (horizontal P = .001, vertical P = .003), Cosmetic satisfaction (horizontal P = .0002, vertical P = .0002), Psychological satisfaction (horizontal P = .001, vertical P = .001), and Social satisfaction (horizontal P = .002, vertical P = .003). Conclusions Ocular prosthetic motility has a significant impact on patient-perceived satisfaction and physical appearance, and predicts coping with the prosthetic condition on the psychosocial level. This highlights the need of introducing patient-reported outcome measures in the prosthetic rehabilitation of the anophthalmic patient.

Should we care about the ocular surface in the anophthalmic patient?

To assess clinical and biomolecular changes of the conjunctival epithelium in anophthalmic patients wearing an ocular prosthesis. Thirty-five unilateral anophthalmic patients were enrolled. Patients with blepharitis, lid abnormalities, and topical/systemic medication affecting the ocular surface were excluded. Symptom Assessment in Dry Eye (SANDE) questionnaire and tear function test (Schirmer Test Type I) were recorded. Conjunctival inflammation and meibomian gland dysfunction (MGD) were graded in the anophthalmic side and fellow eye. Impression cytology sampling of the upper, lower tarsal, and posterior/bulbar conjunctiva from the anophthalmic socket were collected and compared to healthy controls. Patients had significantly higher SANDE (p < 0.001), Schirmer I test (p = 0.004), conjunctival inflammation (p < 0.001), and MGD scores (p < 0.001) on the anophthalmic side compared to the fellow eye. Mucin 5AC, inflammatory markers (MMP-9, ICAM-1) expression (p < 0.001), and response to oxidative stress (NRF2-KEAP1 signaling pathway) (p < 0.05) were significantly upregulated in the posterior conjunctival surface in the anophthalmic socket. Anophthalmic patients complained of more pronounced dry eye symptoms and presented more significant signs of inflammation and MGD on the anophthalmic side. The bulbar conjunctiva, behind the prosthesis, showed more significant hyperexpression of mucins, markers of inflammation, and increased response to oxidative stress compared to the tarsal conjunctiva. Patients wearing ocular prosthesis had signs of inflammation resembling dry eye disease.

Facial cosmetic enhancement by secondary implant and ocular prosthesis to avoid camouflaging hair style

Aim: Aim of this study is to access the improvement in psychosocial awareness and self-image of surgical anophthalmic patient after cosmetic rehabilitation with secondary implant followed by ocular prosthesis. Materials and Methods: It was conducted with 15 surgical anophthalmic patients who maintained a special and unnatural hair style to hide the facial deformity from others. These hair styles included growing long hair on a particular side of the head, covering part of the forehead and eyes. This makes other people curious and it does not look normal. Result: After reconstruction of the a anophthalmic socket by secondary ball implant along with scleral graft and followed by fitting of a well matching custom designed ocular prosthesis, the psychological condition, self-confidence of the patients were improved significantly. The follow up photographs of the same patient revealed that they no longer maintained the earlier special type of hair style. They looked confident in normal hair pattern. Conclusion: The study suggest that the psychological well being of those living with facial deformity due to eye loss is related to having a pessimistic outlook and the beliefs a patients has about their appearance and how accepted they feel by the society. Keywords: Contracted socket, Orbital implant, Socket reconstruction, Scleral graft.

Basic principles of rehabilitation for lost eye: A dentist′s perspectives

Various maxillofacial prostheses are made from materials used in dentistry. The treatment of the patient who loses one or both eyes is a challenging task for the clinician. A multidisciplinary approach is required to fulfill the needs and expectations of an anophthalmic patient. Dentists are now playing a major role in this regard as they are more familiar with the materials used for artificial eyes. Ocular prosthesis is an artifi cial replacement of the eye. The article describes the overall management and treatment of an anophthalmic patient, followed by a procedure for an easy fabrication of a custom-fi tocular prosthesis.

Ocular prosthetic obturator: an innovative medical device

The following article describes the methods, materials and techniques used in the long-term management of an anophthalmic patient. Following aggressive surgery to remove a squamous cell carcinoma, the patient had...

Custom Ocular Prosthesis as a Palliative Aid for a Pediatric Patient with a Surgical Enucleation Following Retinoblastoma

Background & Aims: Congenital absence or loss of the ocular globe during childhood not only compromises the normal development of the orbital region, it causes esthetic and psycho-social disturbances as well. Literature demonstrates the necessity of prevention and early detection in order to minimize the sequelae and disturbances in orbital growth. The purpose of this article is to highlight customized scleral shell prosthesis as a simple yet effective treatment modality for opthalmic pediatric patients Methods: For this anophthalmic pediatric patient who reported to us, we decided to fabricate a customized ocular prosthesis by modifying the stock eye prosthesis. Clinical relevance: Fabrication and installation of eye prosthesis is essential to the rehabilitation process especially in a child, so as to produce satisfactory development of the region and for their emotional wellbeing.

Development and Demonstration of a Novel Computer Planning Solution for Predefined Correction of Enophthalmos in Anophthalmic Patients Using Prebended 3D Titanium-Meshes—A Technical Note

Ablative surgery of the orbit is often associated with dramatic changes in facial geometry. Surgical intervention is often necessary to correct the functional and esthetic appearance in those patients who are anophthalmic, having an intact eyelid appearance and an orbital prosthesis. The outcome of the surgical correction depends on the shape of the orbital implants and their adequate placement. In the case of comparatively small rearrangements, the effect of implants on soft tissues can be estimated by surgeons on the basis of their experience. However, large deformities in complex cases (including large deformation of soft tissue or asymmetry) can be hardly predicted on the basis of simple empirical considerations. The purpose of the present technical note was to describe a new procedure of inverse design of customized orbital titanium meshes. To demonstrate this procedure, an anophthalmic patient with superior sulcus deformity and enophthalmos was enrolled. The volume and structure of the extraocular muscles, soft tissue, and bony structure of the orbital walls were examined using high-resolution multislice computed tomography. Next, a geometric model of the patient's anatomy was generated from the tomography data. Afterward, the orbital prosthesis was virtually relocated to a new position. Then, the desired correction of the particular soft tissue regions was performed using virtual sculpturing tools. Next, the deformation of the soft tissues and initial prosthesis boundaries were computed from the predefined displacements of the relocated tissue regions with the help of the Finite Element Method. The differential volume between the initial and designated position of the orbital prosthesis yielded the preferred implant shape required to effect the desired correction of soft tissue. During surgery, the preplanned position of the customized titanium meshes was guided using a navigation system. Although the inverse design of custom-tailored titanium meshes for precision treatment of severe enophthalmos in anophthalmic patients appears to be a promising approach, it has rarely been applied in the past because of the technological complexity and additional time required. With the present study, we have launched a series of clinical evaluations of this novel method. To date, scientific evidence and trials showing a predictable simulation using an inverse finite element approach in the correction of severe enophthalmos in anophthalmic patients with computer-assisted fabricated individual titanium meshes for reconstruction of orbital walls have been rare.

Fabrication of custom made eye prosthesis for anophthalmic paediatric patients: 2 case reports

The loss of an eye is an emotional and psychological setback to the patient. After enucleation, evisceration or exenteration of the eye, the goal is to replace the missing tissues with an artificial prosthesis and restore the facial symmetry and normal appearance of the anophthalmic patient. In case of pediatric patients, the team approach of the ophthalmologist, the maxillofacial prosthodontist and pedodontist are required to rehabilitate the ocular defect, that improves not only the patient's comfort and cosmesis as well as maintain the near symmetrical bony orbital wall and eyelid development. This article illustrates two different cases of pediatric patients where the eye was surgically removed and ocular prosthesis was fabricated.Clinical Relevance to Interdisciplinary Dentistry A few case reports are mentioned in literature for prosthetic rehabilitation of anophthalmic pediatric patients. The presented case reports stressed the use of custom made eye prosthesis than prefabricated one for pediatric patients. As patient grows, the size of eye socket changes, hence periodic enlargement of the prosthesis is necessary for a growing child to aid in the normal development of the lids and the soft tissue lining the orbital bone. The custom made prosthesis can be adjusted whether needed at recall visits. The presented technique is simple and less time consuming. This technique is least depended upon artistic ability of dentist.

Conjunctival sparing Müller's muscle resection for the management of blepharoptosis in the anophthalmic patient

Clinical & Experimental OphthalmologyVolume 39, Issue 5 p. 478-479 Conjunctival sparing Müller's muscle resection for the management of blepharoptosis in the anophthalmic patient Konal Saha MRCOphth, Konal Saha MRCOphth Manchester Royal Eye Hospital, Manchester, UKSearch for more papers by this authorBrian Leatherbarrow FRCOphth, Brian Leatherbarrow FRCOphth Manchester Royal Eye Hospital, Manchester, UKSearch for more papers by this author Konal Saha MRCOphth, Konal Saha MRCOphth Manchester Royal Eye Hospital, Manchester, UKSearch for more papers by this authorBrian Leatherbarrow FRCOphth, Brian Leatherbarrow FRCOphth Manchester Royal Eye Hospital, Manchester, UKSearch for more papers by this author First published: 25 November 2010 https://doi.org/10.1111/j.1442-9071.2010.02478.xCitations: 6Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume39, Issue5July 2011Pages 478-479 RelatedInformation

Concussion in youth ice hockey: It's time to break the cycle

The following article describes the methods, materials and techniques used in the long-term management of an anophthalmic patient. Following aggressive surgery to remove a squamous cell carcinoma, the patient had no orbital implant inserted at the time of surgery and remains reticent in regard to further surgery. She presented with a large orbital socket requiring imaginative and innovative ocular rehabilitation. This paper describes the materials and methods of fabricating this new and innovative medical device.

Correction of Anophthalmic Enophthalmos With Injectable Calcium Hydroxylapatite (Radiesse)

A 66-year-old man who presented with anophthalmic enophthalmos desired improvement in his appearance without invasive surgery. A nonincisional technique for volume augmentation in the anophthalmic socket with injectable calcium hydroxylapatite was performed. Clinical improvement was determined by comparison of preoperative and 6-month postoperative exophthalmometry values and photographs. Injectable calcium hydroxylapatite successfully increased orbital volume in this anophthalmic patient.

Secondary Orbital Implant Insertion in an Anophthalmic Patient after Orbital Reconstruction

The authors report the case of a 20-year-old man who underwent enucleation of his right eye with teratoma when he was an infant, without volume replacement by an implant. As a result, an underdeveloped shallow bony orbit finally occurred. Also, a contracted socket was present with shallow lower fornix, making ophthalmic prosthesis fitting almost impossible. The patient underwent surgical reconstruction of the orbit with expansion of the orbit vertically and horizontally. A secondary implant with an adequate volume was inserted to correct the orbital volume deficit. The previous expansion of the orbit allowed the insertion of an 18 mm-diameter hydroxyapatite implant wrapped in fascia lata. The lower fornix was expanded with a mucosal graft in order to overcome the socket contraction and the conjunctival shortage. The authors conclude that the final result of this approach is satisfactory. Almost 20 years after enucleation of an eye with teratoma, an attempt was made to correct most of the difficult problems dealing with a malformed shallow orbit and a contracted socket. The young patient is now able to wear a fine ophthalmic prosthesis and his appearance is greatly improved.

Digital imaging in the fabrication of ocular prostheses

Several ocular and orbital disorders require surgical intervention that may result in ocular defects. The associated psychological effect of these defects on the patient requires immediate management and rehabilitation intervention by a team of specialists. The role of the maxillofacial prosthodontist in fabricating an ocular prosthesis with acceptable esthetics to restore facial symmetry and normal appearance for the anophthalmic patient becomes essential. This article presents a technique for fabricating ocular prostheses using the advantages of digital photography.

P3-7 Identification des facteurs individuels et des comportements ayant pu influencer la santé des personnes âgées durant la vague de chaleur de 2003

Ablative surgery of the orbit is often associated with dramatic changes in facial geometry. Surgical intervention is often necessary to correct the functional and esthetic appearance in those patients who are anophthalmic, having an intact eyelid appearance and an orbital prosthesis. The outcome of the surgical correction depends on the shape of the orbital implants and their adequate placement. In the case of comparatively small rearrangements, the effect of implants on soft tissues can be estimated by surgeons on the basis of their experience. However, large deformities in complex cases (including large deformation of soft tissue or asymmetry) can be hardly predicted on the basis of simple empirical considerations. The purpose of the present technical note was to describe a new procedure of inverse design of customized orbital titanium meshes. To demonstrate this procedure, an anophthalmic patient with superior sulcus deformity and enophthalmos was enrolled. The volume and structure of the extraocular muscles, soft tissue, and bony structure of the orbital walls were examined using high-resolution multislice computed tomography. Next, a geometric model of the patient's anatomy was generated from the tomography data. Afterward, the orbital prosthesis was virtually relocated to a new position. Then, the desired correction of the particular soft tissue regions was performed using virtual sculpturing tools. Next, the deformation of the soft tissues and initial prosthesis boundaries were computed from the predefined displacements of the relocated tissue regions with the help of the Finite Element Method. The differential volume between the initial and designated position of the orbital prosthesis yielded the preferred implant shape required to effect the desired correction of soft tissue. During surgery, the preplanned position of the customized titanium meshes was guided using a navigation system. Although the inverse design of custom-tailored titanium meshes for precision treatment of severe enophthalmos in anophthalmic patients appears to be a promising approach, it has rarely been applied in the past because of the technological complexity and additional time required. With the present study, we have launched a series of clinical evaluations of this novel method. To date, scientific evidence and trials showing a predictable simulation using an inverse finite element approach in the correction of severe enophthalmos in anophthalmic patients with computer-assisted fabricated individual titanium meshes for reconstruction of orbital walls have been rare.

A novel sensing and control system of artificial eye-implant

The aim of this paper is to let the anophthalmic patient has a natural movement of his artificial eye. The loss of an eye can be solved by the ocular implant. The artificial eye can be made like the real eye. But the problem is that it is static, and doesn't have the natural movement. Present study is to design a small automatic control system to let the. artificial eye has the same natural movement as the real eye. How to detect the eye movement is an important issue. The review of the eye movement detection methods is included in this paper. Main part of this paper deals with the experimental system and the further considerations.

A study of the hydroxyapatite orbital implant drilling procedure.

The hydroxyapatite orbital implant has been introduced as a buried, integrated implant for use in the anophthalmic patient. The second stage of the procedure involves drilling the implant and inserting a motility peg that allows direct coupling of the artificial eye to the implant. Other authors have advocated an assessment of implant vascularity by imaging prior to drilling. We aimed to see whether our practice of drilling after a predetermined time interval without assessment of implant vascularity would result in a higher complication rate. We also aimed to determine how successful the drilling procedure was in improving both the motility and the stability of the artificial eye. The notes of 41 consecutive patients who underwent drilling were studied to determine the time interval between implantation with a hydroxyapatite sphere and drilling, the nature of any complications and any further surgical procedures undertaken. A postal questionnaire was sent to all patients asking them to grade the motility of their implant before and after drilling, and to state whether or not there had been any improvement in the stability of their artificial eye. The most frequent complication encountered was extrusion of the motility peg, which occurred in 3 patients. A total of 5 patients required redrilling. There was an 80% response rate to the questionnaire. Ninety-one per cent of patients felt that there had been an improvement in the motility of their artificial eye and 76% felt that the stability of their artificial eye had been improved. Pegging of the hydroxyapatite implant improves both the motility and the stability of the artificial eye in the majority of cases. Complications are infrequent and minor. If sufficient time is allowed after implantation for full implant vascularity to occur, it is not necessary to perform imaging studies. This practice does not result in an increase in complications, and significantly reduces the expense of the procedure.

Cosmetic Conformers

Abstract. The loss of an eye is an emotionally traumatic event. A prosthetic eye is usually not fitted until the socket has healed (about 6 weeks after surgery). This period, during which a clear conformer is fitted, can be particularly traumatic, especially for the newly anophthalmic patient. The authors have designed interim acrylic prosthetic conformers to help patients overcome some of these problems while preserving the necessary characteristics of ideal postoperative conformers. [Ophthalmic Surg Lasers 1997;28: 171-173.]

A clinical study of the hydroxyapatite orbital implant.

The hydroxyapatite orbital implant has been used in the anophthalmic patient to give good motility of the artificial eye and a cosmetic result which matches that of the natural eye. It is thought to reduce the unacceptable complication rate that has been associated with other implants, as its buried, vascularized state deters extrusion and migration of the implant. Eighty consecutive patients were followed, 33 of whom had been referred for primary enucleation or evisceration, and 47 for secondary implant surgery. Thirteen of the secondary patients already had implants in situ. There were 44 males and 36 females in the study. The age range was 2.5 to 72 years with a mean of 36 years. The follow-up time was 2 to 30 months with a mean of 15 months. Twenty patients had been pegged at the time of review. A standardised operative and post-operative protocol was followed. The patients were assessed for the results of the motility of the artificial eye for both smooth pursuit and saccades, and for the cosmetic result. The amount of upper lid sulcus deformity was assessed to give an indication of volume replacement by the implant. The nature of any complications was noted as well as any further surgical procedures undertaken. The results show the hydroxyapatite orbital implant to give good cosmetic results with good motility of the artificial eye and to be associated with a low rate of complications. Drilling of the implant is simple to perform and also not associated with any significant complications. The hydroxyapatite orbital implant can be used successfully not only as a primary but also as a secondary or exchange implant with very few contraindications.

The 'baseball' orbital implant: a prospective study.

The 'baseball' orbital implant was described by Frueh and Felker in 1976. Although this implant was originally described for use as a secondary implant, it has also been widely used as a primary implant at the time of enucleation. This prospective study evaluated the effectiveness of this implant used both primarily and secondarily. Forty-four patients were implanted between April 1990 and May 1991, 19 of the implants being primary and 25 secondary. A standardised operative and post-operative protocol was followed. The mean follow-up time was 31 months (range 24-36 months). The patients were evaluated for the degree of volume replacement, implant and associated prosthesis motility, secondary eyelid and socket problems, patient satisfaction, the need for further surgery and post-operative complications. The overall results achieved by primary implantation were superior to those of secondary implantation. Our results suggest that this implant provides a satisfactory functional and cosmetic rehabilitation of the anophthalmic patient with few complications.