Anophthalmic Socket Research Articles

Experience of therapeutic eyelid hygiene products use in patients with anophthalmia after eyeball injury

BACKGROUND: One of the purposes of ocular prosthetics is to prevent the progression of pathological processes in the eyelids and conjunctiva of the anophthalmic socket.
 AIM: The aim of this study is to assess the effectiveness of therapeutic eyelid hygiene products: Blepharowipe, Blepharogel cleansing (Geltek-Medica, Russia), used in the late postoperative and long-term rehabilitation periods, in patients with anophthalmia who lost the eyeball as a result of an injury.
 MATERIALS AND METHODS: For the study, 3 main (50 patients) and 3 corresponding control groups (50 patients) were created. The examination of patients included: complaints, medical history; biomicroscopy of the eyelids, the conjunctiva of the anophthalmic socket, and the surface of the ocular prosthesis. In the main groups, therapeutic eyelid hygiene products were used for 8 weeks in combination with regular ocular prosthesis care. In the control groups, eyelid hygiene products were not used. Assessment and analysis of the effectiveness of the products was carried out after 1, 2 and 4 weeks in group I and after 4 and 8 weeks in groups II and III based on the dynamics of patient complaints and objective examination indicators.
 RESULTS: In the main groups I and II, there was a positive dynamics: normalization of the state of the eyelids and the conjunctiva of the anophthalmic socket; increasing comfort of an ocular prosthesis wear. In the main group III and in all control groups, no significant positive dynamics was noted.
 CONCLUSIONS: The results of using the products included in the course of therapeutic hygiene of the eyelids: Blepharowipe, Blepharogel cleansing showed high efficiency, and give reason to recommend them in late postoperative and long-term rehabilitation periods in patients with anophthalmia.

Socket outcomes following enucleation for uveal melanoma: post enucleation socket syndrome can be challenging.

To evaluate socket outcomes of enucleation for uveal melanoma. This study was a retrospective chart review conducted in December 2022 of all patients who underwent enucleation surgery for uveal melanoma between 2010 and 2015 in the Royal Victoria Eye and Ear Hospital, to evaluate socket outcomes including completion of revision surgery, type of surgery, and completion of multiple revision surgeries, and potential associations. Between June 2010 and December 2015, 72 patients underwent enucleation for uveal melanoma in the ocular oncology service, including 25 females and 47 males, mean age 65, range 11-91 years old. There were 68 primary enucleations and 4 secondary enucleations. Complete follow-up data was available for mean 4 years, range 1-11 years. Fourteen patients underwent further surgery, including one exenteration for local recurrence. Oculoplastic surgery (n = 6, 8%), implant exposure repair (n = 3, 6%), and orbit volume expanding surgery (n = 4, 6%) were also performed. Eight patients (11%) underwent one further surgery and five patients (7%) underwent a series of procedures. There was a significant association with younger age at enucleation (age <65) with undergoing further surgery (p = 0.03, Fisher's Exact Test (FET)), and also an association of younger age with undergoing multiple further surgeries (p = 0.02, FET). There was no association found with other predictor variables, including primary versus secondary enucleation status. Most patients (75%) with PESS underwent more than one surgery. Post enucleation surgery 82% of patients did not undergo further surgery, but younger patients were more likely to undergo anophthalmic socket revision or oculoplastic surgery. Management of post enucleation socket syndrome was challenging and usually involved a series of procedures.

Analysis of microbial communities of ocular prostheses and anophthalmic sockets using 16S rRNA gene sequencing

Ocular prostheses are liable to host microbial adhesion, which can favor conjunctival inflammation. Knowing the microbiota of the ocular prosthesis and anophthalmic socket is important for predicting infection-related pathogens. This study evaluated the microbiota of the prostheses and anophthalmic sockets of six individuals by 16S rRNA sequencing. The microbial abundance and diversity were analyzed using the Operational Taxonomic Units at the genus level. Forty-seven phyla, capturing 1,258 named genera, were recorded in the sample set. In both sites, the most frequent genera were Fusobacterium, Staphylococcus, Prevotella, and Streptococcus. The microbial abundance was higher for the anophthalmic socket than for the prosthesis. Alpha diversity showed no significant differences in bacterial richness or diversity between sites. Although the microbial abundance in the anophthalmic socket was higher, both sites had similar microbiota with high diversity and low dominance among the genera.

Anophthalmic socket syndrome: Management and cosmetic outcome

To describe the management strategy and evaluate the outcome of Anophthalmic socket syndrome. This retrospective case study includes 40 patients with anophthalmic socket syndrome who attended the orbit and ocular oncology department of Ispahani Islamia Eye Hospital from January 1, 2018, to June 31, 2021 were included in this study. All the information regarding age, gender, initial pathology, type of initial surgery, implant, degree of contraction, the procedure of socket reconstruction, the management outcome and complication were recorded and analyzed correctly. 17 males (42.5%) and 23 females (57.5%) with a mean age of 24.47 years were included in the study. Trauma (30%) and Tumour (25%) were the main reasons for initial eye removal. Enucleation performed in 24 (60%) cases was the most common initial surgery. The primary implant was not done in 20 (50%) cases. Mild socket contraction (grade 1) was recorded in 10 (25%) cases. Moderate contraction (grade 2 and 3) in 25(62.5%) cases and severe contraction (grade 4) in 5(12.5%) cases were recorded. Only fornix forming suture was done in 10 (25%) cases, mucous membrane graft (MMG) was done in 27 (67.5%) cases and dermis fat graft was done in 3 (7.5%) cases. All the patients were followed up routinely for six months. The outcome was good in 16 (40%) cases, acceptable in 20 (50%), and poor in 4 (10%) cases. A common complication was infection (5%) and fat atrophy (5%).: Anophthalmic socket syndrome remains a challenging entity for the oculoplastic surgeon. Multiple factors help to determine the overall prognosis of socket reconstruction. The goal of management is to provide a socket that can maintain a cosmetically acceptable prosthesis. Timely detection, proper correction of the underlying pathology and a high level of care directly correlate with expected surgical outcomes.

Reconstruction of Anophthalmic Sockets With Pedicled Nasoseptal Flap.

Patients who undergo eye removal often present with orbital soft-tissue insufficiency and contraction of the eye sockets. The most commonly used reconstruction strategy is grafting the orbit with free grafts, which is associated with the drawback of harvesting tissue from an unconnected site. This study describes the use of the vascularized nasoseptal flap in the reconstruction and enlargement of the contracted anophthalmic cavity in patients with severe or recurrent contracted eye sockets and evaluates its efficacy. A sphenopalatine-pedicled flap from the nasal septum was harvested and mobilized into the anophthalmic orbit for the reconstruction, coverage, and enlargement of the socket in 17 patients with anophthalmic socket syndrome. Data regarding the demographics, preoperative status, postoperative findings, follow-up, outcomes, dates of mutilant and reconstructive surgery, and relevant clinical or imaging were collected. Krishna´s classification was used to assess the postoperative outcomes. The final rating improved in all patients at a median follow-up duration of 35 months. A greater impact was observed in patients who underwent reconstructive surgery before nasoseptal flap creation. Two minor complications occurred; however, major surgical intervention was not required. Implant extrusion was observed in 2 patients. The novel strategy of applying nasoseptal flaps in the reconstruction of anophthalmic sockets results in improved socket grading and a low rate of recurrence (socket contracture or implant extrusion), and complications. The vascular nature of the flap makes it suitable for use in complex cases.

Ocular Prosthesis: A Next Generation Cosmetic Management by an Eye for an Eye

An ocular prosthesis is an artificial eye that replaces an absent natural eye following an enucleation, evisceration or orbital exenteration. The prosthesis fits over an orbital implant and under the eyelids that covers the structures in the eye socket. It is a non-optical device designed only to improve the cosmesis of an individual with anophthalmic socket or disfigured eye. A normal facial appearance is one of the inherent human traits, if any changed or lost challenges physical, social, mental well-being, self-confidence and psychological influence on the affected people. The loss of an eye is a severe psychological trauma with negative impact on the quality of life of the patient. It is quite challenging to restore the normal look of the patient for bringing him to normality in society. In this view, an ocular prosthetic eye helps to improve the quality of life, satisfaction and appearance of affected eye to any injury or disease of the patient. It is given to uplift the patient’s behavioral, mental status and improve the confidence especially in children. Today, most artificial eyes are made of medical grade plastic acrylate (polymethyl methacrylate material) with an average life of about 2-3years depending upon the way that people use it. It is commonly known as “Device or Scleral Shell or Glass Eye or Fake Eye”. The children require more frequent replacement of the prosthetic eye due to rapid growth changes in the eye. The construction of an ocular prosthesis in the case of congenital and acquired anophthalmia differs in etiology but many concepts of management for a child are the same as for an adult. An early intervention with ocular prosthesis can stimulate orbital growth and prevent facial asymmetry.

Prosthetic approach following traumatic evisceration: a case report

A 20-year-old male patient was referred to Prosthodontic Department, Dental Hospital of Hasanuddin University, Makassar with chief complaint of disfiguration of the face. Medical history revealed a significant trauma to the left eye 6 months prior which stayed after evisceration. Patient has never used prosthetic eye afterwards. Examination of the left eye socket revealed a healthy conjunctiva covering the posterior wall of the anophthalmic socket with syn-chronous motions and absence of infection or inflammation signs. Sulcus depth was sufficient enough to retain prosthetic eye. This article presents rehabilitation of the ocular defect with customized acrylic-based ocular prosthe-sis to increase patient’s appearance and to prevent further shrinkage of the eye socket. Preliminary impression was done using customized tray fabricated from modelling wax and hydrocolloid irreversible impression material. An in-traocular custom tray for secondary impression was fabricated with acrylic resin and modified with a syringe that at-tached to the custom tray. Secondary impression of the defect was recorded using polyvinyl siloxane light viscosi-ty material followed by wax pattern fabrication using modelling wax. The wax pattern was tried in patient’s socket and checked for size, comfort, support, fullness, and then packed with tooth colored heat cure acrylic resin. After deter-mining the location and diameter of the iris with an optical vernier pupillary distance ruler, the color of sclera was de-termined by shade guide and confirmed with technician using digital photo. Ocular prosthesis was fabricated after-wards and inserted into the eye socket and evaluated for suitability, aesthetic and also movements with the contra-lateral eye. It is concluded that customized ocular prosthesis was significantly more aesthetic than pre-fabricated one with better contouring, color matching, and coordinated movements with the contralateral eye. This prosthetic ap-proach may restore patient’s appearance, increase their self-esteem, and improve their quality of life.

Complications of anophthalmic orbits-Treatment and aftercare

The possible complications of anophthalmic eye sockets can occur due to many different pathomechanisms. A differentiation is made between allergic, infectious, inflammatory or mechanical causes. This article gives an overview on the different etiologies of socket complications with their pathophysiology and treatment options.

A rare case of severe bilateral Graves' orbitopathy involving an anophthalmic socket.

This is a report of a rare case of Graves' hyperthyroidism associated with severe bilateral Graves' orbitopathy, in a patient with an anophthalmic eye socket. On clinical review her prosthetic eye (left eye) was tilting upwards, along with worsening of Graves' orbitopathy (GO) in the only seeing eye. As she refused IV glucocorticoids, she was offered rituximab which only caused a transient improvement in the clinical activity score of the eye. She had persistent right upper lid retraction of 6 mm, associated with lagophthalmos. To protect her seeing eye from corneal ulceration, the patient received a botulinum toxin injection to the right upper eyelid to induce blepharoptosis as an interim measure prior to right upper eyelid blepharotomy in April 2021. This patient remains biochemically euthyroid on block and replace therapy and her TRAb level is falling over time. Treatment for active GO is ongoing and the patient required a redo blepharotomy for painful corneal exposure in the right eye. Graves' orbitopathy (GO) does not actually primarily affect the eyeball itself but the orbital contents as well. Patients with severe GO in an only seeing-eyed patient should be referred early to a multidisciplinary Joint Thyroid Eye clinic for expert review and management. Patient outcomes including sight loss are likely to be improved by the extended range of medical and surgical treatment modalities available at specialist clinics treating GO, including the use of immunomodulatory drugs like rituximab or teprotumumab.

Acquired Anophthalmic Socket: Clinical Course and Treatment Options.

Acquired Anophthalmic Socket: Clinical Course and Treatment Options.

Novel point-of-care biomarkers of the dry anophthalmic socket syndrome: tear film osmolarity and matrix metalloproteinase 9 immunoassay

PurposeTo compare tear film osmolarity (TFO) values and matrix metalloproteinase 9 (MMP-9) levels between anophthalmic sockets and healthy fellow eyes and to assess the use of the MMP-9 and TFO as objective biomarkers for the dry anophthalmic socket syndrome (DASS).MethodsIn this prospective single-center study, the anophthalmic sockets and healthy fellow eyes of 98 unilateral anophthalmic patients were assessed using the ocular surface disease index (OSDI) questionnaire, InflammaDry® MMP-9 point-of-care immunoassay, TFO with TearLab™ Osmolarity System, and clinical conjunctival inflammation. MMP-9 concentration and conjunctival inflammation were graded semi-quantitatively. Differences between anophthalmic sockets and the healthy fellow eyes for OSDI scores, MMP-9, TFO values, clinical conjunctival inflammation, and eyelid abnormalities as well as the correlation between these factors and demographic data were evaluated.ResultsPatients had significantly higher OSDI, MMP-9, and TFO values, as well as higher conjunctival inflammation on the anophthalmic side, compared to the healthy side (p ≤ 0.002, respectively). For anophthalmic sockets, there was a significant positive correlation between OSDI scores and TFO values (p = 0.007), between the grade of posterior blepharitis and TFO values (p = 0.026), and between the conjunctival inflammation and MMP-9 values (p < 0.001), as well as between MMP-9 levels and time since eye loss (p = 0.004).ConclusionsMeasuring MMP-9 and TFO may be helpful tools as efficient, quantifiable biomarkers, disease course parameters, or predictors for treatment response in the clinical management of patients with DASS or future therapy studies. Ophthalmologists should consider the updated diagnosis criteria including TFO and the definition for DASS proposed in this study.

Fibrin glue as a novel therapy for contracted socket in comparison to mitomycin-c and triamcinolone acetonide at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Background: Contracted socket is still a major problem for patients with anophthalmia. The main factor for this condition is inflammation and fibrosis, which result in conjunctival shortening. Myofibroblasts that express α-SMA are the primary mediators of anophthalmic socket contraction. Methods: One healthy eye of a New Zealand white rabbit were randomly selected for evisceration and divided into four treatment groups, each with five rabbits. Each rabbit in the group received a single subconjunctival injection of a different agent. Group, I was the control group that received no injection, Group II received MMC 0.4 mg/ml, Group III received TCA 40 mg/ml, and Group 4 received fibrin glue. After 14 days, the animals were euthanized, and conjunctival samples were submitted for histopathological analysis. A monoclonal α-SMA antibody was applied, and pathologists provided the IRS score for each sample. The differences in α-SMA expression were statistically analyzed with a significant level of p &lt;0.05 Result: All groups displayed a statistically significant decrease in α-SMA expression compared to the control group (p&lt;0.05) as sorting as MMC group with p=0.007, TCA group with p=0.007, and fibrin glue with p= 0.009. MMC was the most effective at reducing α-SMA (p=0.004). Surprisingly, there were no statistically significant differences between MMC, TCA, and fibrin glue when they were evaluated independently. Conclusion: A single subconjunctival injection of fibrin glue may be used as a novel treatment to prevent socket contracture in actively healing sockets.

The Inflammation Level and a Microbiological Analysis of the Anophthalmic Cavities of Unilateral Ocular Prosthesis Users: A Blind, Randomized Observational Study.

Irritation and biofilm adhesion are complaints associated with ocular prosthesis use. This study aimed to evaluate the effects of prosthesis repolishing on several conditions of anophthalmic volunteers. Participants were divided into two groups: intervention (IG, n = 10) and nonintervention (NIG, n = 6) groups. The anophthalmic cavity, contralateral eye, and prosthesis surface were evaluated at initial, day 15, and day 30 after repolishing. Microbiological analysis (colony-forming units), exfoliative cytology (conjunctiva inflammatory cells), sensory analysis (quantitative mechanical sensory test), tear production (Schirmer's test), and conjunctival inflammation (clinical evaluation) were performed. Nonparametric tests were used to compare groups in the initial period and to analyze periods for the IG (p &lt; 0.05). More microorganisms were formed in the anophthalmic socket and prosthesis than in the contralateral eye in the initial period. For IG, the anophthalmic cavity exhibited more microorganisms and inflammatory clinical signs in the initial period than at 15 and 30 after repolishing. The prosthesis showed greater accumulations of total bacteria and Candida albicans in the initial period than at 15 and 30 days after repolishing. The anophthalmic cavity had more palpebral inflammation than the contralateral eye. In conclusion, repolishing reduced the number of microorganisms and inflammatory signs over time.

Modified Treatment Of Shallow Fornix For Better Retention Of Ocular Prosthesis.

The purpose of this study is to share the experience of a modified surgical technique for treating shallow inferior fornix to enhance the retention of cosmetic ocular prosthesis in a tertiary care hospital. It was a Quasi experimental study, carried out at Khalid Eye Hospital, Karachi, Pakistan from January to December 2018. This study included twenty-five patients between the ages of 20-40 years belonging to either gender having an anophthalmic socket with shallow inferior fornices unable to retain cosmetic ocular prosthesis. Three pieces of Silicone tube were placed deep within the inferior fornix with the help of 2-0 Vicryl suture, taking bite of the inferior orbital rim periosteum. Main outcome measure was deepening of the inferior fornix with better retention of the ocular prosthesis. All the patients were followed up for a period of one year after the surgery. Study dynamics were briefed to all the patients and study approval obtained from the hospital ethical review committee. This study included a total of twenty-five patients of both genders. Mean age was 29.6±6.53 years. By the end of the follow up period, twenty-four (96%) out of the twenty-five patients were satisfied with a proper retention of ocular prosthesis within the fornix along with complete lid closure. One (4%) patient required revision surgery because of extrusion of the silicone tube piece after one month. Mean follow up period was 358.5±16.76 days. This modified technique does not require expensive consumables and proved to be effective in terms of cosmetic and functional outcome.

The anatomic classification of the anophthalmic eye socket (Types 0–V): A high-level taxonomy classification system

Eyelid and orbital deformities caused by various defects, such as tumor resection and trauma, whether congenital or acquired, are extremely complex and atypical. Several classifications systems for these anophthalmic conditions have been developed, but none have proven suitable for determining the ideal reconstructive surgical strategy. We therefore designed a novel system known as the Anatomic Classification of the Anophthalmic Eye Socket (Types 0-V) for optimum reconstruction of anophthalmic socket deformities focusing on eyelid and orbital defects. Type 0 is an eyelid defect type, in which only the eyelid is defective; Type I is a phthisis bulbi type, in which the anatomical eyeball is preserved, but the visual function is lost; Type II is a substitution type involving filling with implant packing after evisceration or enucleation; Type III is an enucleation type involving enucleation of the ophthalmus; Type IV is an exenteration (incomplete) type involving exenteration while saving the eyelids; and Type V is an exenteration (complete) type involving exenteration including eyelid defects. Using this classification system, it will be possible to standardize reconstructive procedures of the anophthalmic socket.

Conjunctival Relaxing Incisions with a Bare Bed: An Overlooked Privilege in Contracted Sockets.

The aim of reconstruction of a contracted socket is to retain a satisfactory prosthesis. Simple procedures to modify the socket architecture as first line options could avoid multiple staged procedures, increased surgical time, harvesting tissues or use of allografts. The objective of this study was to evaluate the outcome of modifying the socket architecture by making conjunctival relaxing incisions leaving it bare to re-epithelialize and compare it to dermis-fat graft. A retrospective review of all socket reconstruction surgeries in our hospital over a period of 10 years (July 2009 to June 2019) was done. The two procedures which were compared were dermis-fat graft (DFG) and conjunctival relaxing incisions (CRI) without a graft. In the latter, the split conjunctiva was left bare under a conformer and temporary tarsorrhaphy. The conjunctiva was allowed to re-epithelialize under cover of topical antibiotic and steroid. The patients included had a mean age of 24 years (n=8) in the DFG group and 36 years (n=10) in the CRI group. The most common cause of anophthalmic socket was enucleation for tumour and evisceration for trauma in the two groups, respectively. Six patients (75%) in the DFG group and six (60%) in the CRI group achieved good prosthesis retention (P = 0.51). None had post-operative infection. Transverse conjunctival relaxing incisions with tissue stretching can be a safe first line option to rehabilitate a contracted socket.

A Sandwich-Like Oral Mucosa Graft-Conjunctiva In Situ-Dermis-Fat Graft for Reconstruction of the Anophthalmic Socket with Ocular Infection History.

IntroductionA novel technique of using a sandwich-like structure, namely, an oral mucosa graft (OMG)–conjunctiva in situ–dermis-fat graft (DFG) (OMG-C-DFG), to reconstruct a contracted and low-capacity anophthalmic socket for a patient with ocular infection history was evaluated.MethodsThis was retrospective case study of four patients (cases) who underwent anophthalmic socket reconstruction surgery in which the OMG-C-DFG technique was applied. The procedures were performed in the Department of Ophthalmology at the Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine (Shanghai, China). Postoperative cosmetic appearance, graft outcome, the ability to wear an ocular prosthesis, and postoperative complications were evaluated.ResultsThe median (± standard deviation) age of patients was 41.5 ± 22.1 (range 10–60) years. All patients suffered from contracted and low-capacity anophthalmic sockets. Three patients had a history of orbital implant infection and one patient had a history of enucleation due to exogenous endophthalmitis after globe rupture. The DFG and OMG were harvested from the abdominal region and lower lip, respectively. All four patients achieved a good postoperative appearance, with dermal surfaces appearing pink and smooth, the orbital areas showing good fullness, the ocular prosthesis showing good wearability, and no narrowing of the sockets. There was no lipid secretion, fat lysate outflow, or infection in the graft bed. There were only small amounts of scars and no infection of the donor site.ConclusionThe sandwich-like structure can be effectively used to reconstruct the contracted and low-capacity anophthalmic socket with a history of orbital infection in one stage.

Evisceration Versus Enucleation in Ocular Globe Injury

Evisceration and enucleation have been acceptable therapeutic modalities to treat not only severe ocular trauma but also various ocular conditions, such as intraocular tumors, endophthalmitis, and blind-painful-cosmetically disfiguring eyes, over the last two centuries. Clinical indications and choices of procedure, whether enucleation or evisceration, vary among institutions, surgeon experience, and severity of structure loss. In the past, enucleation has been preferred by most surgeons for various reasons, including the fear of sympathetic ophthalmia (SO) after evisceration. Despite the possibility of causing SO, anophthalmic socket also has complications, including superior sulcus defect, conjunctival surface changes, implant exposure, fornix/socket contraction, and eyelid malposition. This literature review will discuss indication, technique, and decision with regard to enucleation or evisceration after ocular trauma.

Ocular Prosthesis – For Beginners

Background: The Ocular Prosthesis device is very important toprovide the best possible functional &amp; cosmetic results. It is important to have a firm understanding of management of the anophthalmic socket &amp; when to make appropriate referrals to the Ophtahlmic Surgeon. The Objectives In this review, the author will discuss about one of the component of Ocular Prosthesis ie. Orbital implants.Material &amp; Methods:The patients who requires ocular prosthesis are selected as per the need &amp; requirement, also on the basis of types of available implants.Results:One should follow the components&amp; scenario for optimal outcome.Conclusions:An eye care professional should be aware of the entire structure &amp; all the recent development involved in it. They also have to be empathetic and have a creative oulook in management of such conditions by using all the available resources.

Orbital volume changes during growth and development in human children assessed using cone beam computed tomography

ObjectivesTo measure growth-related changes in orbital volume from childhood to the late teenage years using cone-beam computed tomography (CBCT) scans.MethodsThis retrospective cohort study involved 65 (24 male, 41 female) healthy Caucasian children (ages 6–18 years) with existing serial craniofacial CBCT scans. CBCT scans were available for 292 orbits. Each orbit was transformed into a closed space with well-defined boundaries, and orbital volume was measured using manual segmentation. A novel statistical analysis was applied to extract the maximum amount of longitudinal information from the data. Intra- and inter-operator correlation coefficients were calculated from replications performed on a random subset of 10% of the sample.ResultsOrbital volume increased at a rate of 1–2% annually until the late teenage years. Intra- and inter-operator agreement between repeated measurements were >90%.ConclusionsOrbital volume increases by 1–2% per year throughout childhood continuing until the late teenage years. This annual increase is large enough to be clinically relevant as it may lead to less-than-optimal long term surgical outcomes when reconstructive surgery for the pediatric anophthalmic socket is required.