Ocular Prosthesis Research Articles

Precision in Prosthetics: Two Case Reports on Transformative Rehabilitation With Custom Ocular and Orbital Prostheses

Precision in Prosthetics: Two Case Reports on Transformative Rehabilitation With Custom Ocular and Orbital Prostheses

A Novel Technique for Fabricating an Ocular Prosthesis: A Case Report

A Novel Technique for Fabricating an Ocular Prosthesis: A Case Report

Integrated miRNA sequencing and experimental validation Unveil that low-level laser enhances vascular endothelial cell proliferation, migration, and lumen formation via miR-90/VEGFA

The hydroxyapatite orbital implantation is widely used to treat orbital malformation, but delayed postoperative angiogenesis can hinder conjunctival wound healing, potentially leading to implant exposure and prolapse. Low-intensity laser therapy (LLLT) is recognized for its ability to promote tissue regeneration, reduce inflammation, and alleviate pain. This study aims to explore the specific mechanism of miRNAs-VEGFA pathway regulation in early vascularization after orbital implant placement induced by LLLT. A hydroxyapatite orbital implant model was established and treated with LLLT. Vascular tissues surrounding the ocular prosthesis were extracted for high-throughput sequencing to identify differentially expressed miRNAs. miRNAs predicted to bind with VEGFA were selected for validation. GO and KEGG analyses were performed to reveal the functional enrichment of target genes regulated by these miRNAs. Dual luciferase assay, qRT-PCR, and Western blotting were used to verify the targeting relationship between miR-90 and VEGFA. The effects of miR-90 on rabbit microvascular endothelial cell function were assessed through CCK-8 assay, scratch test, and tube formation assay. High-throughput sequencing revealed 32 differentially expressed miRNAs, with 8 upregulated and 24 downregulated. miR-90 was predicted to have a high binding score and expression abundance with VEGFA and was confirmed to regulate VEGFA expression. In vitro functional tests showed that miR-90 inhibited rabbit microvascular endothelial cell proliferation, migration, and tube formation. This study is the first to demonstrate that LLLT regulates ocular prosthesis angiogenesis via the miR-90/VEGFA pathway, providing a new target for treating vascular-dependent diseases.

Tear secretion is preserved while the area of meibomian glands is reduced in patients with prosthetic eyes, contributing to the symptoms of dry eye

Background/aimsIt is unclear whether a reduction in tear secretion contributes to the discomfort experienced by those with prosthetic eyes. Tear secretion has hitherto only been measured with the Schirmer test...

Superior rectus/levator complex in acquired anophthalmic socket repaired with spheric implant-a computed tomography scan and topographic study.

To determine whether the levator palpebrae superioris (LPS)/superior rectus (SR) muscle complex, can influence the position of the upper lid and fornix in acquired anophthalmic sockets. This comparative non-randomized and non-interventional study included retrospective data of 21 patients with unilateral acquired anophthalmic sockets repaired with spheric implants. High-resolution computed tomography (CT) measurements of the LPM/SR muscle complex and clinical topographic position of the upper lid, superior and inferior fornix depth in primary gaze position were evaluated. Demographic data were presented as frequency and percentage proportions and quantitative variables comparing the socket measurements with the normal contralateral orbit was statistically analyzed using non-parametric tests considering P<0.05. The anophthalmic orbits had a significantly shorter LPS length (P=0.01) and significantly thicker SR (P=0.02) than the normal orbit. Lagophthalmos was present in anophthalmic sockets but not in normal orbits (P=0.002), while levator function was normal in both (P>0.05, all comparisons). The superior fornix depth was similar in the anophthalmic socket and the contralateral normal orbit (P=0.192) as well the inferior fornix depth (P=0.351). Acquired anophthalmic sockets repaired with spheric implants have shorter LPS, thicker SR, and more lagophthalmos than normal orbits. The relationship of the LPS and SR with other orbital structures, associated with passive or active forces acting in the final position of the lids and external ocular prosthesis should be further investigated.

Rehabilitation of patient with unilateral congenital anophthalmia using custom ocular prosthesis

This case report aims to detail the fabrication and implementation of a custom ocular prosthesis for a patient with unilateral congenital anophthalmia. This study highlights the innovative approach, the procedures undertaken, and the significant outcomes achieved. A detailed assessment of the patient's anophthalmic socket was conducted. A custom impression technique was used to fabricate the prosthesis, ensuring optimal fit and aesthetic appearance. The process included impression making, customized prosthesis design, and fitting sessions.The custom ocular prosthesis achieved excellent aesthetic integration, restoring facial symmetry and enhancing the patient's appearance. Follow-up assessments showed satisfactory prosthesis retention, minimal discomfort, and positive psychosocial impacts, including improved self-esteem and social interactions.This case underscores the importance of individualized prosthetic solutions in managing congenital unilateral anophthalmia.

Custom made orbital prosthesis using digital approach: A case report

Factors that affect a person's quality of life can be influenced by aesthetics. In the case of involving orbits, it is a big problem in aesthetic factors and must be done immediately so as not to affect the quality of life of a person. A 76-year-old male patient came to the prosthodontic dental and oral hospital on a referral from an ophthalmologist to have an eye prosthesis because he wanted to improve his appearance. The patient wants to have an eye prosthesis immediately because of embarrassment. The creation of an eye prosthesis by printing with extraoral scans and orbital contour design is the treatment plan given to the patient. After that, the first visit to the orbital socket is scanned, the color of the eye is selected and the patient can go home. The contour of the orbit of the eye can be designed with 3D software and 3D printed for the working model, as well as the search for a suitable stock eye for the patient. The next visit can be done by selecting colors and trying them out. This speeds up visits, prosthetic comfort and aesthetics.

Near field communication tag to provide a unique identification aid for custom ocular prostheses

This technique describes a smartphone-enabled near field communication tag used as an identification aid for a custom ocular prosthesis for a pediatric patient. Near field communication tags are straightforward to read, can be readily connected to smartphone devices without the need for specialized equipment, store data in a variety of ways, are inexpensive, exceptionally thin, and flexible, and tolerate resin polymerization temperatures, making them suitable as an identification aid for an ocular prosthesis.

CUSTOMISED OCULAR PROSTHESIS FABRICATION - A CASE SERIES

Loss of an eye, whether due to trauma or medical necessity, can lead to significant physical and psychological distress This article delves into the profound impact of ocular prosthetics in alleviating the physical and psychological repercussions of eye loss. Acrylic resin has been identified as an optimal material for its durability, aesthetic fidelity, and biocompatibility in fabricating ocular prostheses. Beyond restoring facial symmetry and enhancing aesthetics, these prostheses significantly bolster patient self-confidence and overall quality of life. The series comprehensively examines four distinct methods for iris positioning and prosthesis characterization, crucial for imparting natural vitality to the prosthetic eye. Each case underscores the importance of personalized care in ocular prosthetics, emphasizing the advantages over standard stock prostheses.

Конъюнктивиты при использовании глазного протеза. Профилактика и выбор эффективной терапии

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

The current alternative for ocular surface and anophthalmic socket reconstruction, cryopreserved umbilical amniotic membrane (cUAM).

This report presents the results of using cryopreserved umbilical amniotic membrane (cUAM) as an alternative mucosal graft for ocular surface reconstruction in cases of anophthalmic socket contracture (ASC), cicatricial entropion (CE), and conjunctival-scleral defects. The study included patients who underwent non-commercial implantation of cUAM grafts (prepared by corneal banking methods) for ASC, CE, conjunctival defect, and scleral melting. The main success criteria for this study were the comfortable fitting of the ocular prosthesis in ASC patients, the natural eyelid position in CE patients, and the degree of conjunctivalisation in melting patients. cUAM transplantation was performed in 2 patients who could not use a prosthetic eye due to conjunctival contracture, 2 patients with CE, and 1 patient with conjunctival defect and 1 patient with conjunctival-scleral melting. The primary outcome was achieved in 83.3% (5/6) of patients. In one patient with CE, partial healing was achieved due to the persistence of CE in the medial upper eyelid. cUAM is a viable alternative to mucosal grafting for reconstructing the bulbar and palpebral conjunctival surface, fornix, and orbit, with reduced donor morbidity and shorter surgical time. Its regenerative ability allows for tissue defect healing and improves cosmetic appearance through epithelialization within weeks.

컴퓨터 설계와 3D 프린팅을 이용한 안와부의 맞춤형 보형물 제작

A facial defect can easily lead to psychological distress and social isolation due to its distinctive characteristics. Therefore, it is important to develop and appropriately offer personalized prostheses, even though the number of recipient may be limited. Since the manufacturing method for prostheses designed for stage or screen characters doesn't fundamentally differ from those personalized for everyday wear, special makeup artists can make a contribution to society as personalized prosthesis workers. This study aimed to investigate the manufacturing process for customized orbital prostheses, which can be produced and provided by special makeup artists, utilizing a digital approach. These prostheses target to address facial defects not covered by health insurance. Unlike traditional methods, this study adopted computer design and 3D printing technologies in restoring and making the prosthesis, ensuring that the results remain consistent regardless of a worker’s skill level. A customized orbital prosthesis may be prone to breakage due to its thinness at the center, and it is mot breathable because it is made of silicone rubber. This study proposed a method to reinforce the silicone to prevent easy breakage by using a reinforcing material and to address sweating by drilling a hole in the mold. The anticipated results are expected to serve as foundational data for developing a training manual aimed at educating personalized prosthesis workers.

“Ice cream cone” design of forearm free flap for orbital exenteration reconstruction

BackgroundsReconstruction post-orbital exenteration serves the dual purpose of expediting healing, laying the groundwork for cosmetic restoration, and minimising complications such as orbitosinusal fistulae. The aim of this study was to introduce a modified "Ice cream cone" (ICC) design of the Radial Forearm Free Flap (RFFF) technique used for reconstruction of orbital exenteration cavity, along with the oncological, functional, and aesthetic outcomes. MethodsThe authors conducted a retrospective study between January 2005 and December 2020. Inclusion criteria encompassed patients treated for orbitosinusal malignancies undergoing exenteration with subsequent ICC design of RFFF reconstruction. ResultsTwenty-two patients underwent exenteration with the ICC design of RFFF. At the follow-up conclusion, 65% of patients regularly used orbital prosthesis. The average waiting time until the prosthesis was 10 months. Quality of life questionnaires yielded average RFFF POSAS scores of 23.5 (SD 13,6), cervical POSAS scores of 8 (SD 13,2), and orbital cavity rehabilitation scores of 5.9 (SD: 3,32). ConclusionsICC design of RFFF is a reliable technique. It can be proposed in cases of extended exenteration with a high risk of cerebrospinal fluid (CSF) but more generally in cases of total exenteration. This technique facilitates optimal postoperative wound healing and accommodates early radiotherapy. Importantly, the bowl-shaped aspect of the orbital socket supports effective prosthetic rehabilitation for patients opting for orbital prosthesis post-surgery.

Custom-made ocular prosthesis: enhancing the iris position of post-evisceration patient

Individuals who have impaired vision as a result of illness or injury may have their appearance improved with the use of a prosthesis eye. To construct realism, symmetry, and a glance that appears natural, it is necessary to duplicate the size and arrangement of the iris with accurate pinpoint accuracy. This is crucial for developing a realistic-looking gaze. Eye loss has a profoundly debilitating impact on the mental state of the person who has suffered it. The ultimate goal of every ocular prosthesis procedure is to facilitate the patient's reintegration into society while preserving their healthy visage and self-esteem. This article provides a clinical report on the rehabilitation of a patient whose left eye had suffered intraocular foreign body damage following evisceration. A closer fit between the prosthesis and the ocular base tissue can be achieved with custom-made acrylic resin ocular prosthesis that are sized and shaped to fit the ocular socket of the patient. This close fit results in a more uniform distribution of pressure compared to factory stock eye prosthesis and is more cost-effective than stock eye prosthesis

Eyes of empowerment: A case study on the impact of custom ocular prosthesis in restoring quality of life

Ocular prostheses serve as invaluable tools in restoring both visual symmetry and psychological well-being for individuals who have experienced ocular defects. This article presents a comprehensive overview of the fabrication and placement of custom acrylic ocular prosthesis in a 39-year-old male patient who suffered left eye loss following a traumatic accident. The patient's history underscores the profound impact of ocular trauma on self-image and quality of life, highlighting the importance of prosthetic rehabilitation. Meticulous attention was paid to every step of the fabrication process, including impression taking, color matching, and fitting, to ensure optimal aesthetic outcome and functionality. The successful placement of the prosthesis resulted in significant improvements in the patient's confidence and overall well-being. This case report emphasizes the approach required for successful ocular prosthetic rehabilitation and underscores the transformative impact of custom ocular prostheses in restoring quality of life for individuals with ocular defects.

Orbital Prosthesis Rehabilitation in Biomedical Engineering by Means of Computer Vision-Photogrammetry and 3D Prototyping

Eye loss may be caused as a result of eye trauma, accidents, or malignant tumors, which leads the patient to undergo surgery to remove the damaged parts. This research examines the potential of computer vision represented by Structure from Motion (SfM) photogrammetry in fabricating the orbital prosthesis as a noninvasive and low-cost technique. A low-cost camera was used to collect the data towards extracting the dense 3D data of the patient facial features following Structure from Motion-Multi View Stereo (SfM-MVS) algorithms. To restore the defective orbital, a Reverse Engineering (RE) based approach has been applied using the similarity RE algorithms based on the opposite healthy eye to rehabilitate the defected orbital precisely. Following quality assurance and best-fitting statistical analysis, the digital model of the restored eye was converted into a physical model using 3D prototyping. This is later used to fabricate the mold for casting medical-grade silicone to obtain the final orbital prosthesis. The results show the power of SfM photogrammetry by offering a high-accuracy model of 0.048 mm and 0.186 mm relative errors acquired in the horizontal and vertical directions, respectively. These results boost the RE implementation in medicine to reconstruct the patient's damaged eye by mirroring the image of the healthy eye using RE algorithms. Therefore, the margin matching results claim perfect data capture settings and successful data processing workflow as designed in the first place. Consequently, one can claim this approach effectively rehabilitates maxillofacial deformities as an alternative to invasive restoration approaches. The presented approach provided a low-cost and safe workflow that avoids the patient the risks of exposure to harmful rays or magnetic fields available in other sensors.

Factors associated with depressive and anxiety symptoms among anophthalmic patients wearing ocular prostheses

This study aimed to investigate the prevalence of anxiety and depression among individuals with ocular prostheses and to identify factors associated with these psychological symptoms. A sample of patients who underwent monocular enucleation and socket implantation participated in the study, responding to digital questionnaires covering demographics, psychosocial factors, and aspects related to their ocular prostheses. Depressive and anxiety symptoms were evaluated using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Optimal scale regression analysis was employed to explore factors linked to psychological symptoms in ocular prosthesis users. Results from 100 valid participants revealed a 51% prevalence of depressive symptoms and a 45% prevalence of anxiety symptoms. The mean PHQ-9 score was 4.91 &amp;plusmn; 1.98, and the mean GAD-7 score was 4.99 &amp;plusmn; 2.15. Factors such as undergoing right eye enucleation, longer duration of ocular prosthesis use, comfort with prosthesis wearing, and greater satisfaction correlated with milder depressive symptoms. In terms of anxiety, those who used ocular prostheses due to trauma or tumors were affected by more severe symptoms, while individuals who were comfortable with their prosthesis or using alumina-based prostheses reported fewer anxiety symptoms. In conclusion, ocular prosthesis users wrestle with significant challenges of depressive and anxiety symptoms. Factors including age, household registration, economic status, enucleation side, cause of anophthalmos, prosthetic material, and satisfaction and duration of prosthesis use were associated with depressive or anxiety symptoms. Long-term comprehensive care targeting these vulnerable individuals is imperative to alleviate depression and anxiety.

Factors affecting anophthalmic socket reconstruction outcomes using autologous oral mucosal graft

BackgroundLimited studies have reported surgical outcomes that are defined by strict criteria following grade 2 or 3 socket reconstruction using an oral mucosal graft (OMG). We aimed to determine factors influencing surgical outcomes of anophthalmic socket reconstruction using OMG in patients with grade 2 or 3 socket contractures.MethodsThirty-seven patients who underwent socket reconstruction with autologous OMG between January 2007 and December 2017 were retrospectively analyzed. The successful outcome was defined as an eye prosthesis wearing without experiencing displacement and the absence of any re-operations or additional surgeries following socket reconstruction. Factors affecting surgical outcomes were identified using multivariate analysis.ResultsA total of 15 male and 22 female patients (mean age: 40.2 ± 17.2 years) were included. The median duration of socket contracture was 21.5 years. Grade 2 and 3 socket contractures, based on Tawfik’s classification, were reported in 20 and 17 patients, respectively. Twenty-eight and eight patients underwent socket reconstruction using OMG alone and OMG combined with a hard palate graft, respectively. The success rates of grades 2 and 3 socket contracture reconstruction were 80.0% and 52.9%, respectively. Multivariate analysis demonstrated that only grade 3 contractures were predictive of worse outcomes. At the final visit (mean follow-up: 6.3 years), 34 patients (91.9%) could wear their eye prostheses.ConclusionsSocket reconstruction using autologous OMG can provide acceptable results in grade 2 and 3 contractures; however, satisfactory results were more significantly reported in grade 2 than in grade 3 contractures.

Evaluation of motility of solid versus hollowed ocular prosthesis. A double blinded cross over randomized clinical trial

Evaluation of motility of solid versus hollowed ocular prosthesis. A double blinded cross over randomized clinical trial

Rehabilitation of an orbital defect using a silicone prosthesis with a custom ocular portion – A case report

ABSTRACT The surgical removal of the orbit can be a psychologically traumatic event that may incapacitate patients. The prosthetic rehabilitation of such defects is complex and artistically driven. This case report describes the aesthetic rehabilitation of a patient who had undergone unilateral orbital exenteration due to COVID-19-associated rhino-orbital mucormycosis. This technique uses commonly available materials in the dental clinic and artists’ colors for the fabrication of a custom ocular portion of the silicone orbital prosthesis that closely matches the natural eye color of the patient.