Contracted Socket Research Articles

Long-Term Outcomes of Enucleation and Secondary Orbital Implantation Surgeries Using Polyester Mesh-Wrapped Acrylic Orbital Implants.

To reveal the long-term outcomes of enucleation and secondary orbital implantation surgeries employing nonabsorbable surgical mesh-wrapped acrylic orbital implants for various reasons. A retrospective interventional study of 48 eyes that underwent primary or late primary enucleation and secondary orbital implantation using polyester mesh-wrapped acrylic orbital implants, between 2012 and 2021. Patient demographics, diagnosis, prior ophthalmic surgery, implant size, follow-up periods, and implant-associated complications were evaluated. The records of 36 patients who underwent primary or late primary enucleation and 12 who underwent secondary orbital implantation due to sphere extrusion were evaluated. Patients' mean age was 38.7 (range: 2-75) and the mean follow-up period was 48.3 months (range: 24-72mo). Major causes for surgeries were trauma and malignancies (54.1% and 33.3%, respectively). No complications, such as conjunctival dehiscence, implant exposure or extrusion, contracted socket, or fornix insufficiency were observed in any patient during the long-term follow-up period postsurgeries. Using polyester mesh-wrapped acrylic orbital implants in enucleation and secondary orbital implantation surgeries proves to be a successful, safe, and cost-effective option.

Autologous Platelet-rich Fibrin as a Three-dimensional Structural Scaffold in the Healing of Contracted Orbital Sockets.

Evaluation of platelet-rich fibrin as an adjuvant in surface healing of contracted orbital sockets. Prospective, interventional, and comparative study of 25 patients with moderate to severe contracted sockets conducted over 2 years (February 2020-February 2022). Group 1 underwent a dermis-fat graft with fornix forming sutures supplemented by a platelet-rich fibrin membrane, while group 2 received a dermis-fat graft with fornix forming sutures only. Patients over 18 years were evaluated as per prefixed inclusion and exclusion criteria. Assessments were conducted at 1, 3, and 12 months postsurgery, focusing on wound evaluation, socket epithelialization, postoperative pain, prosthesis rehabilitation, and complications, if any. Wound evaluation and pain intensity were assessed utilizing the wound evaluation score and visual analog scale, respectively. Socket epithelization was documented clinically at every visit. The study showed a mean age of 38.8 ± 8.8 years, with a 2:1 male-to-female ratio. Group 1 consistently scored higher on wound evaluation score than group 2 at all follow-up points. In group 1, 81.8% achieved a maximum wound evaluation score at 4 weeks and 100% at 3 and 12 months, compared to group 2's 42.8%, 50%, and 57.1%, respectively (p < 0.05). Postoperative contracture occurred in 3 group 2 patients at the final follow-up, with 6 showing unsatisfactory appearance. Group 1 demonstrated significantly lower pain intensity on postoperative day 1 (p = 0.03), and greater epithelization at 4 weeks. platelet-rich fibrin appears to be an effective solution for enhancing wound healing during socket reconstruction, attributed to its sustained release of growth factors and mesenchymal stem cells.

THE EXPRESSION OF ALPHA-SMOOTH MUSCLE ACTIN IN CONTRACTED SOCKET

Abstract&#x0D; Introduction &amp; Objectives : A contracted socket is considered a common complication in anophthalmic patients, with the resulting poor fitting of an ocular prosthesis. In severe cases where patients have had multiple previous reconstructive attempts, further socket contraction may result from fibrosis, leading to eventual surgical failure. Alpha-smooth muscle actin (alpha-SMA) is often used to identify pathologic fibroblasts. It may serve as a reliable marker for myofibroblast cells. The aim of the study was to find alpha-SMA protein expression in myofibroblasts derived from orbital socket contracture.&#x0D; Methods : In this study, we observed five patients with contracted sockets who underwent fornicoplasty and buccal graft surgery from October 2022 to February 2023. Tissue samples were taken from the conjunctival fornix area during the surgery and then examined for alpha-SMA expression.&#x0D; Results : In this study, there were 2 out of 5 (40%) positive alpha-SMA expressions with history of recurrent contraction, 2 (40%) negative expressions with no history of recurrent contraction, and 1 result that could not be assessed due to the limited number of samples containing fibroblasts in patient with history of recurrent contraction.&#x0D; Conclusion : Alpha-SMA levels can be detected in patients with contracted sockets. Patients with a history of recurrently contracted sockets have a tendency to express positive alpha-SMA. This may allow for the need for the administration of antimetabolites in patients with recurrent contracted sockets to avoid recurrence of this contracted socket.

THE EXPRESSION OF ALPHA-SMOOTH MUSCLE ACTIN IN CONTRACTED SOCKET

Purpose: A contracted socket is considered a common complication in anophthalmic patients, with the resulting poor fitting of an ocular prosthesis. In severe cases where patients have had multiple previous reconstructive attempts, further socket contraction may result from fibrosis, leading to eventual surgical failure. Alpha-smooth muscle actin (?-SMA) is often used to identify pathologic fibroblasts. It may serve as a reliable marker for myofibroblast cells. The aim of the study was to find ?-SMA protein expression in myofibroblasts derived from orbital socket contracture. Methods: In this study, we observed five patients with contracted sockets who underwent fornicoplasty and buccal graft surgery from October 2022 to February 2023. Tissue samples were taken from the conjunctival fornix area during the surgery and then examined for ?-SMA expression. Result: In this study, there were 2 out of 5 (40%) positive ?-SMA expressions with history of recurrent contraction, 2 (40%) negative expressions with no history of recurrent contraction, and 1 result that could not be assessed due to the limited number of samples containing fibroblasts. Conclusion: ?-SMA levels can be detected in patients with contracted sockets. Patients with a history of recurrently contracted sockets have a tendency to express positive ?-SMA. This may allow for the need for the administration of antimetabolites in patients with recurrent contracted sockets to avoid recurrence of this contracted socket.

Analysis of Unique Disability Identification Card (UDID) Associated Visual Handicap Certificates at a Tertiary Care Center in Northern Maharashtra

Purpose: To analyze blindness certificates to find causes of visual impairment, low vision, and blindness in a tertiary care hospital in northern Maharashtra. Methods: A retrospective study of all visually impaired patients applying for disability certification between January and June 2023 (6 months period) was performed from the medical record. The demographics, aetiologies, grades and classification of visual impairment according to the new guidelines provided in the Gazette of India published in 2018 of the study subjects were analyzed. Results were compared with data from studies on blindness certificates and population-based studies. Results: A total of 771 patients were included in the study. The mean age was 39.42 ± 19 years (range: 1–85 years). Most patients were in the 41–64 years age group (40.98%). Males were involved more commonly (67.70%). According to the grade and percentage of disability, grade II (30%) was most commonly seen in 35.02% of individuals followed by low vision, grade III a–III e, (40%–80%) seen in 27.37% individuals. Blindness, grade IV a–IV b (90%–100%) was seen in 33.46% individuals. Overall, the most common cause of visual impairment among one-eyed, low-vision and blind individuals was phthisis bulbi/hereditary globe condition/coloboma. Among one.eyed and minimal disability individuals, rest common causes included amblyopia, squint and contracted socket post-evisceration. In patients with low vision and blindness, other common causes included retinitis pigmentosa, optic atrophy and pathological myopia. Conclusion: Analysis of blindness certificates provides valuable information regarding different causes of visual disability and provides an insight into the overall trends in visual disability profile and help in rehabilitation.

Low-level laser therapy combined with scleral graft transplantation in the treatment of contracted socket: a clinical study

ObjectiveTo analyse the efficacy of the therapeutic use of low-level laser therapy (LLLT) on the tissue repair process of allogeneic scleral grafts in patients with contracted sockets by analysing the speed of graft vascularisation and fornice depth of contraction percentage.MethodsA retrospective chart review was performed from April 2015 to April 2021 including 39patients with socket contraction. Allogeneic scleral grafts were used to repair the sockets in all patients. They were randomly enrolled into two groups. The laser group included 18 patients treated with LLLT after the surgery, whereas the control group included 21 patients without LLLT after the surgery who healed naturally. The LLLT equipment used in the research had a wavelength of 650 nm, 10 mW power, and 3.8 J/cm2 dosimetry, and the procedure was performed once daily for 5 min over 7 days, beginning 1 week postoperatively. All patients were followed up over 6 months to examine the changes in the size of the area of the non-vascularised graft and upper and inferior fornice depth.ResultsThe laser group presented a significantly increased speed of conjunctival vascularisation compared with the control group (P = 0.003). The fornice depth of contraction percentage was more apparent in the control group than that in the laser group (P = 0.000).ConclusionLLLT accelerates conjunctival vascularisation, stimulates conjunctival incision healing within a short period, shortens the tissue repair process, reduces the local inflammatory response, and causes no significant shrinkage of the conjunctival sac.

Clinical use of cryopreserved ultra-thick human amniotic membrane for anophthalmic socket contracture.

To study the use of ultra-thick human amniotic membrane for management anophthalmic socket contracture. A prospective study done at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Thirty-six patients (45 eyelids) were involved. Contracted socket caused by trauma, previous surgery or radiotherapy, delay in use of prosthesis, Congenital Anophthalmia/Microphthalmia, and Anophthalmia secondary to Enucleation/Evisceration were included in the study. Thirty-three patients (42 eyelids) underwent fornix reconstruction with cryopreserved ultra-thick human amniotic membrane. Mean ± SD age at surgery was (40.90 ± 17.32) years. Mean follow up was 10.5 months. Grade II fornix contracture was the most common type in 23 (54.8%) eyelids. The most common involved primary diagnosis was Anophthalmia secondary to Enucleation/Evisceration (n = 13). The incidence of pyogenic granuloma (PG) after surgery was seen in 8 eyelids (19.0%). Anophthalmic contracted socket secondary to significant history of multiple PG excision (> 5 times) and secondary to enucleation/evisceration were associated with good surgical outcome. Cryopreserved ultra-thick human amniotic membrane is an ideal material for the management of anophthalmic socket contracture.

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.

Individual impression technique by using functional method on the custom ocular prosthesis: a case report

Enucleation leads to contracture of orbital tissue accompanied by reduction in volume and forniceal depth, which results in an inability to sustain a prosthesis. Shallow inferior fornix in contracted eye socket compromises adaptati-on, retention, stabilization and duplication of palpebral opening similar to natural eye in terms of size, support, con-tour and convexity make fabrication of custom ocular prosthesis become challenging. Hence, the present article describes the use of ocular prosthesis as conformer to obtain better appearance and enlarge orbital dimension in contracted socket. A 21-year-old male came to Dental Hospital Universitas Sumatera Utara with a complaint of un-aesthetic face appearance due to enucleation of left eye in the last 5 years old subsequent to trauma by sharp blades. The patient had already used an ocular prosthesis but lost it 6 years ago and didn’t used it until now. In cli-nical examination, the anopthalmic socket had good posterior wall mobility and absence of infection but, mild con-tracted socket (Grade 1) with shallow inferior fornix depth was examined. In this case, ocular prosthesis provides aesthetics as well as expanding the lid anteriorly, conjunctiva and fornix posteriorly that were successfully obtain-ed by performing functional impression using imprinted waxed up. This results in a favorable peripheral eye seal.

The effect of fibrin glue on suppressing Transforming Growth Factor-β (TGF-β) expression compared to Mitomycin-C (MMC) and Triamcinolone Acetonide (TCA) as antifibrotic agents in contracted socket prevention

Background: Post-evisceration fibrosis remains the leading cause of contracted socket. The application of fibrin glue is considered an alternative adjuvant therapy in suppressing profibrotic factor (TGF-β) expression following evisceration surgery to prevent contracted socket. This study aimed to know the role of fibrin glue in suppressing the TGF-β expression following evisceration surgery. Methods: An in vivo experimental study with a randomized post-test-only control group using twenty New Zealand rabbits were conducted. The sample was divided into four groups, each consisting of five rabbits, and one healthy eye was selected randomly for evisceration. Each rabbit in the study group was given a subconjunctival injection of agents corresponding to each study group, namely: Group I (control [no injection]), Group II (0.1 ml MMC 0.4 mg/ml), Group III (0.1 ml TCA 40 mg/ml), and Group 4 (0.1 ml fibrin glue) at the inferior fornix. Following a 14-day observation period, the animals were euthanized, and tenon conjunctiva in inferior fornix samples was collected for immunohistochemistry (IHC) staining examination. The pathologist calculates the immunoreactive scores (IRS) for each specimen. The differences in TGF-β expression were statistically analyzed with a significant p&lt;0.05. Data were analyzed using SPSS version 26 for Windows. Result: The highest TGF-β expression was found in the control group (I), and the lowest was in the mitomycin-C group (III), followed by the triamcinolone group (IV) and fibrin glue group (II). There were significant differences in TGF-β expression among the four groups (p=0.004). The difference between fibrin glue, MMC, and triamcinolone acetonide groups was insignificant (p&gt;0.05). Conclusion: As an alternative to mitomycin-C and triamcinolone acetonide, fibrin glue can be used as adjuvant therapy to prevent constricted sockets after evisceration.

Fibrin glue: an anti-fibrotic agent for contracted socket

Background: The contracted socket is caused by fibrosis leading to the shortening of the orbital tissue. Vascular endothelial growth factor (VEGF) is a profibrotic factor in postoperative wound healing. The novel option to prevent fibrosis is the use of fibrin glue. This study aims to evaluate the role of fibrin glue in reducing the VEGF expression in cells that cause post-socket surgery scar. Methods: An in vivo experimental study using an animal model was conducted. We used twenty eyes of white rabbit species as the study sample. The evisceration was carried out and distributed to the animals in four experimental groups consisting of the control group, the MMC group (0.1 ml of mitomycin-C (MMC) 0.4 mg/ml), the triamcinolone acetonide (TCA) group (0.1 ml of TCA 40 mg/ml), and the fibrin glue group (0,1 ml of fibrin glue). The treatment was performed through injection of the subconjunctival. After 14 days, rabbits were euthanized, and conjunctiva samples were cut. Immunoreactivity scores (IRS) were used to analyze the expression of VEGF in epithelia conjunctiva with a significant level of p &lt;0.05. Data were analyzed using SPSS version 26 for Windows. Results: All groups showed a statistically significant difference in VEGF expression with a p-value 0,000 (p&lt;0,05). The VEGF level was significantly lower in the three treatment groups compared with the control group. The VEGF expression was highest for the control group, followed by fibrin glue, TCA and MMC group. We found significant differences between the control group and the three treatment groups; the MMC group (p=0.001), the TCA group (p=0.002), and the fibrin glue group (p=0.005). While differences in VEGF expression between the three treatment groups could not be proven statistically. Conclusion: Fibrin glue is proven to reduce VEGF expression as a marker of fibrosis; thus, fibrin glue can be an alternative anti-fibrotic agent.

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.

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.

The Effect of The Mitomycin C on Anophthalmic Contracted Socket (Literature Review)

This study aims to provide information about the effect of the Mitomycin C on contracted sockets surgery so that Mitomycin C can inhibit migration of fibroblast and synthesis of collagen thus causing reduce fibrosis in vitro and in vivo and a significant reduction of scarring. The literature study used is the literature of the last 10 years in 2021. Literature searches were used from the Science Direct, PubMed, and Google Scholar electronic databases. The initial stage obtained 43 national and international articles that are considered relevant. The search for articles using the keywords “anophthalmic socket and mitomycin c”, and “contracted socket and mitomycin c” then continued at the screening stage, which in the end obtained 5 articles that matched the object to be discussed.. The results of this study explain that the Mitomycin C has an effect in a decrease fibroblast in contracted socket surgery and has been successful in reducing recurrence by inhibiting fibrosis.

Evaluation of Topical Mitomycin-C Eye Drops After Reconstructive Surgery for Anophthalmic Contracted Socket.

PurposeTo report the outcomes of using topical mitomycin-C (MMC) after reconstructive surgery for contracted socket and to compare the results with those of the conventional postoperative treatment.Patients and MethodsThe medical records of patients who underwent reconstructive surgery for contracted anophthalmic socket were retrospectively reviewed. Based on the postoperative treatment protocol, two groups of patients were identified; group I (15 patients) who received topical MMC drops (0.02%) 4 times daily for 6 weeks and group II (15 patients) who received the conventional treatment (topical antibiotic-steroid combination). Preoperative data were extracted for age, gender, cause and timing of anophthalmia, history of previous surgeries, preoperative forniceal depth and socket volume (SV). The main postoperative outcome measures were superior fornix depth (SFD), inferior fornix depth (IFD) and SV at the end of 6th postoperative month. Prosthesis fitting and complications were also considered for analysis.ResultsThe mean preoperative IFD was 1.67±0.04 mm in group I and 1.58±0.37 mm in group II, by the end of the 6th postoperative month it increased to 6.1 ±0.27 mm and 5.12 ±0.25mm, respectively. The mean preoperative SFD in group I was 8.3±0.9 mm and 8.9±1.1 mm in group II, by the end of the 6th postoperative month SFD became 13.4±1.2 mm and 10.2±1.4 mm in groups I and II, respectively. The mean SV measured six months postoperatively was 1.9±0.2 mL and 1.3±0.09 mL in groups I and II, respectively. These differences in the postoperative SFD, IFD and SV between both groups were statistically significant. More cases reported successful fitting in group I than in group II but this difference was not statistically significant.ConclusionPostoperative use of topical MMC is associated with higher forniceal depth and greater SV when compared to the conventional treatment in socket reconstructive surgeries with amniotic membrane graft (AMG).

Anophthalmic Socket Syndrome: Prevalence, Impact and Management Strategies.

Anophthalmic socket syndrome determines functional deficits and facial deformities, and may lead to poor psychological outcomes. This review aims to comprehensively evaluate the features of the syndrome, based on literature review and authors’ clinical and surgical experience. An electronic database (PubMed,MEDLINE and Google Scholar) search of all articles written in English and non-English language with abstract translated to English on anophthalmic socket syndrome was performed. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. Different types of orbital implants were evaluated; the management of implant exposure was examined; different orbital volume enhancement procedures such as secondary implantation, subperiosteal implants and the use of fillers in anophthalmic patients were described; the problems related to socket contraction were outlined; the treatment options for chronic anophthalmic socket pain and phantom eye syndrome were assessed; the most recent advances in the management of congenital anophthalmia were described. Current clinical evidence does not support a specific orbital implant; late exposure of porous implants may be due to pegging, which currently is seldom used; filler absorption in the orbit appears to be faster than in the dermis, and repeated treatments could be a potential source of inflammation; socket contraction results in significant functional and psychological disability, and management is challenging. Patients affected by anophthalmic socket pain and phantom eye syndrome need specific counseling. It is auspicable to use a standardized protocol to treat children affected by clinical congenital anophthalmia; dermis fat graft is a suitable option in these patients as it helps continued socket expansion. Dermis fat graft can also address the volume deficit in case of explantation of exposed implants and in contracted sockets in both children and adults. Appropriate clinical care is essential, as adequate prosthesis wearing improves the quality of life of anophthalmic patients.

Evaluation of Multistage Oral Mucosal Grafting From Single Donor Site in Reconstruction of Severely Contracted Ocular Socket

Background: Management of severely contracted ocular socket with inability to retain ocular prosthesis is one of the most difficult problems to tackle. This study aimed to evaluate feasibility, cosmetic outcome and donor site complications of multistage Mucous Membrane Grafting (MMG) from single donor site. Methods: In this prospective, non-randomized study, 07 patients with severely contracted ocular socket (grade 3-5 Gopal Krishna classification) underwent repair with oral MMG in multiple stages under general anaesthesia. Graft harvested from single donor site from inner aspect of lower lip at every surgery. Subsequent surgery was done 08 weeks later after healing of donor site and reassessment of residual socket contraction. All patients were given customised ocular prosthesis. Patients evaluated for ability to retain the prosthesis and cosmetic outcome. Results: Mean age of patients was 43.5 years. Majority of patients were grade 4 socket contraction. Majority required 2 stages of MMG surgery. While 2 patient required 3 stages of MMG. One patient with grade 5 contraction unable to achieve satisfactory retention of prosthesis even after 3 stages of MMG. Rest all patients had adequate expansion of surface and were able to retain customised ocular prosthesis with satisfactory cosmetic outcome. No patient developed donor site infection or contracture. Conclusion: MMG from single donor site in multiple stages for repair of severely contracted ocular socket is effective technique in terms of ease of surgery, cost effectiveness, ability to retain prosthesis and cosmetic outcome. Keywords: contracted socket, mucous membrane graft, buccal mucosa, ocular prosthesis.

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.

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

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.

Anophthalmic socket- A cosmetic dilemma

Anophthalmos is the absence of the globe and ocular tissues from the orbit. It can be congenital or acquired which is produced by destructive procedures like enucleation and evisceration. It affects the cosmetic appearance of the patient and can be particularly devastating psychologically. The anophthalmic socket has been associated with many complications such as discharge, entropion, ectropion, exposure or extrusion of the orbital implant, infection, migration of the orbital implant, contracted socket and ptosis. This article emphasises on the management of an anophthalmic socket and its complications such as a contracted socket in grownups. Keywords Anophthalmic socket, Buccal mucosa, Contracted socket, Dermis fat graft, Implants.