Ocular Prosthesis Research Articles

Fabrication of a Two-piece Magnet-retained Orbital Prosthesis in a Post-COVID-19 Mucormycosis Case: A Simplified Evidence-based Approach

Fabrication of a Two-piece Magnet-retained Orbital Prosthesis in a Post-COVID-19 Mucormycosis Case: A Simplified Evidence-based Approach

Empirical Impression - An Efficient Alternative for Ocular Rehabilitation: A Case Report

Ocular prostheses have been used since a very long time ago. Success of ocular prosthesis depends upon its adaptation with anopthalmic socket which is best determined by ocular impressions. Various impression techniques and materials have been described in the literature. This case report highlights the use of empirical impression technique for fabrication of ocular prosthesis of a 65-year old male who had undergone enucleation surgery of left eye. The empirical impression technique involves: first a close visual examination of patient’s socket, then a wax shell is designed and modified empirically to a shape that fits the socket; second, an impression is made of the socket, using this wax shell as an impression tray. Reduced treatment time and increased simplicity are the primary advantages of this method. This technique of impression making is not feasible in cases with highly irregular sockets.

Modified impression tray and iris positioning ocular prosthesis of post enucleation socket syndrome: case report

The cosmetic disfigurements which arise due to loss of orbital volume after enucleation of an eye include enophthalmus, superior sulcus deformity, upper eyelid ptosis, and lower eyelid laxity. The treatment can be either conservative or surgical. For patients who does not want to undergo further surgical procedures, the conservative treatment is simple, non-invasive, and appropriate. This case report describes modified impression tray and iris positioning technique of post enucleation socket syndrome to achieve aesthetics and function. A 65-year-old male patient reported to the Dental Hospital Universitas Sumatera Utara with the chief complaint of facial disfigurement due to loss of the right eye. Patient had enucleation 6 months ago and using conformer after surgery. The diagnosis was post enucleation socket syndrome. Clear acrylic sclera as a tray without handgrip will precisely records of the palpebre con- vexity and specified socket. The use of eyebrow ruler helps accurately determine the symmetrical iris position com- pared to only visually determining which is subjective with the possibility of interobserver errors. It was concluded that clear acrylic sclera as a tray and eyebrow ruler to determine the position of iris resulting in patient satisfaction due to aesthetics and function.

Modified functional ocular impression of post-enucleation socket: A case report

Introduction: The disfigurement associated with the loss of an eye can cause significant physical and psychological problems. Therefore, a good ocular prosthesis is needed to restore the patient's quality of life. One of the factors that determine the quality of an ocular prosthesis is accurately impression. In the case of enucleation where the eyes socket has a soft and movable tissue bad will result inaccurate impression. The difficulty of post enuclation impression in such case is the compression of the tissue eyes socket. This case report will discuss the modification in functional impression technique using a modified custom tray. Case: A 39-year-old male patient came to Dental Hospital Universitas Sumatera Utara with chief complaint an unaesthetic and loose left stock eye that had been used for 10 years. Clinical examination shows moderate depth eye socket with soft and movable tissue. Management: The functional impression technique was modified using a self-curing clear acrylic sclera without handle as a custom tray with 2 mm reduction on the intaglio surface and light body polyvinyl siloxane as impression material. Discussion: The aim of this modification is to avoid the tendency of the eye socket to compress during impression taking and to achieve a natural contour of the eyelid convexity because of the absence of the tray handle so the patient can close their eyes. Conclusion: This technique produces an ocular prosthesis that has a good retention with excellent aesthetic result.

Epidemiology of Blindness From Facial Trauma: A Multi-Centre Nigerian Study.

This is a multi-centre retrospective study. To determine the prevalence of blindness and pattern of facial trauma associated with blindness among Nigerians. A multi-centre retrospective study of all patients with facial trauma resulting in blindness, that were co-managed by maxillofacial surgeons and ophthalmologists in 4 Nigerian public tertiary hospitals between January 2010 and December 2019 was undertaken. Data was analysed by IBM SPSS Statistics (version 21.0 for windows, IBM© Inc, Chicago, IL). Of 2070 patients who presented with major facial injuries during the study period, 61 eyes of 56 (2.7%) patients were blind. Blindness was bilateral and unilateral in 5 (8.9%) and 51 (92.1%) patients, respectively. The mean age (SD) at presentation was 36.2 (16.6) years, and 47 (83.9%) of these patients were males. Road traffic accident (n = 27; 48%) was the commonest mechanism of facial trauma, the cheek (n = 18; 40.9%) was the commonest site of associated soft tissue injury and zygomatic complex fracture (n = 19; 24.1%) was the commonest related fracture. Globe rupture (n = 34; 55.7%) was the leading cause of blindness. Enucleation (n = 7; 13.2%) and evisceration (n = 22; 41.5%) were performed on 29 eyes of which 12 (41.4%) patients had ocular prosthesis post-operatively. Blindness was recorded in 2.7% of Nigerians with facial trauma. The commonest mechanism of trauma and cause of blindness in at least one eye were road traffic accident and globe rupture, respectively. Eye removal surgery was necessary in about half of the blind eyes.

Novel approach in iris shade matching: mobile photography and custom ocular shade guide

Introduction: Custom ocular prosthesis have several advantages such as even distribution of pressure on the eye socket, highly esthetic iris, better comfort and eyelid movements, but this prosthesis requires a long fabrication time. The fabrication step that spent time the most is the iris shade matching. Case: A 19 years-old woman with a defect in her left eye reported to Dental Hospital Universitas Sumatera Utara. The patient revealed history of infection of the left eye due to measles leading to surgical enucleation when she was one year old. Clinical examination shows healthy conjuctiva with no sign of infection or inflammation covering the posterior wall of the anopthalmic socket. Management: The iris shade matching was done using mobile photography and custom ocular shade guide, allowing the fabrication of iris button in the same day with shade matching appointment. The mobile photography eliminated the need for the operator painting skill and save the fabrication time significantly. The custom occular shade guide compensated the color biased during the photo taking procedure. Conclusion: The novel approach using mobile photography and custom ocular shade guide simplified the iris shade matching, provide highly esthetic results, eliminate the needs for operator painting skills, and save a significant amount of time in fabrication.

Iris positioning technique by using face symmetric measurement tool on the custom ocular prosthesis: a case report

Loss of eye can have a major psychological impact on the patient. To overcome this problem, an ocular prosthetic must have been fabricated similar with the natural eye. Various techniques are documented to determine the symme- trical bilateral iris position; these methods can be subjective and have no measurement guidelines. A 20-year-old male patient came to the Prosthodontic Clinic of Dental Hospital Universitas Sumatera Utara with the diagnosis is post enucleation socket syndrome. Determination of the iris position using the face symmetric measurement-tool by focus to the vertical and horizontal lines of the facial symmetry guide. Confirm the alignment of the vertical lines by connecting the trichion–glabella–subnasal–gnathion guide points so that they vertically divide the two sides of the face, then the two horizontal lines by connecting the left-right cheilon with the mesial-distal canthus of the right and left eyes. This tool is like a face mask with vertical and horizontal guidelines connecting the symmetrical guide points of the face accompanied by centimeters and millimetres making it easy to measure distances and sizes of the iris symmetrically. The use of this tool has given good results in determining the position of the iris because its simplicity and can see facial symmetry.

Amplitude of movements with conical or spherical implants in anophthalmic socket

ABSTRACT Purpose: To evaluate the amplitude of movement in anophthalmic sockets reconstructed with conical or spherical orbital implants with and without an external ocular prosthesis (EOP), and whether the fornix depth could play a role. Methods: Prospective observational study involving unilateral anophthalmic sockets evaluated the amplitude of movement with conical (20 subjects) or spherical (16) non-porous orbital implants, with and without an EOP, having the contralateral eye as the control group. Standardized photographs were obtained in the four gaze directions and measurements were performed using the Image J software. The upper and lower fornix depths were measured using rulers. Results: Compared to the contralateral eye, the median movement amplitude without EOP was smaller with conical implants in supraduction (−0.88 mm, p=0.008), abduction (−2.26 mm, p<0.001) and adduction (−0.91 mm, p=0.008). Spherical implants had reduced movement only in abduction (−2.63 mm, p<0.001). Conical and spherical implants had similar amplitudes of movement in all versions, and were always smaller compared to the control. The median movement amplitude with the EOP was −3.05 mm (p=0.001) than without the EOP in abduction and −2.07 mm (p=0.020) in adduction, regardless of implant format. The fornix depth did not affect the orbital implants or EOP movement amplitude’s median. Conclusion: Conical and spherical implants provide similar amplitude of movement and fornix depth did not have an influence on it. The amplitude of movement was significantly limited compared to the contralateral eye and was even more reduced if the EOP was in place with conical or spherical implant formats.

Custom-made Ocular Prosthesis for Rehabilitation of Missing Parts of the Face: A Case Report

Background. Eyes are an important component of the face and vital organs of vision. Eye loss can be caused by congenital defects, trauma, or tumor. Loss of an eye produces physical abnormalities that pose a psychological burden on the patient, as well as visual function damage. An ocular prosthesis is an artificial maxillofacial prosthesis to replace the lost eye.&#x0D; Case summary. A 54-year-old man consults at the Prosthodontics Specialist Universitas Airlangga Dental Hospital for an eye prosthesis. The patient did not have the right eyeball since birth. Soft tissue around the eye is normal, including the palpebral muscles.&#x0D; Case management. An impression was made using a custom tray and alginate in the defect area, followed by filling the impression with gypsum type 3 to get a working model, from which a wax model is made and adjusted to the patient. After that, sclera and ocular acrylic prostheses are made on the basis of an adjusted wax model. The prosthesis is then polished and colored according to the contralateral eye. Then the prosthesis is delivered to the patient.&#x0D; Conclusion. The hollow custom-made eye prosthesis can be considered in the treatment of anophthalmia. It is able to improve the patient's psychological and emotional status.

Effect of Rehabilitation with a New Ocular Prosthesis on Electromyography of the Occipitofrontalis, Temporal, Masseter, and Sternocleidomastoid.

Objectives The aim of this study was to verify during facial expressions (“happy,” “sad,” “fearful,” “angry,” “surprised,” and “disgusted”) if: (1) there would be difference in the electromyography (EMG) of the occipitofrontalis, temporal, masseter, and sternocleidomastoid muscles on the normal side (NS) compared with the affected side (AS) (without the use of an ocular prosthesis) in individuals with unilateral absence of the eyeball, and (2) the rehabilitation with a new ocular prosthesis would affect the EMG of the muscles studied on the AS in these individuals. Materials and Methods Thirteen individuals, without temporomandibular disorder, with good health, with unilateral absence of the eyeball (the eye must have been removed by evisceration or enucleation), and users or nonusers of an ocular prosthesis were included. EMG of the occipitofrontalis, temporal, masseter, and sternocleidomastoid muscles was performed during rest and facial expressions (“happy,” “sad,” “fearful,” “angry,” “surprised,” and “disgusted”) before (T0) and 90 days after (T1) rehabilitation with a new ocular prosthesis. The analyses were performed in T0 on NS and AS (without the use of an ocular prosthesis), and in T1 on AS with the new ocular prosthesis. Statistical Analysis All data were submitted to the Student's t -test with p < 0.05. Results There was no statistically significant difference comparing the AS with the NS in T0 for all muscles studied, during all facial expressions evaluated ( p > 0.05). There was no statistically significant difference comparing the AS in T0 with itself in T1 for all muscles studied, during all facial expressions evaluated ( p > 0.05). Conclusion Eye loss did not affect the EMG of studied muscles when comparing NS with AS (without the use of an ocular prosthesis). The rehabilitation with ocular prosthesis was not capable of changing the EMG on AS.

Digital Applications of Maxillofacial Reconstruction– A systematic review

Objectives: Many patients with maxillofacial defects require maxillofacial prosthetic rehabilitation due to cancer, trauma, or congenital diseases. Adequate surgical and prosthetic treatment planning is required to achieve satisfactory morphological and functional results. Before computer-aided design/computer-assisted manufacture (CAD/CAM) technology was introduced, conventional methods have been used to reconstruct the facial form, which involved making impressions, obtaining models and fabricating the prosthesis all of which is time consuming and requires multiple visits. A rapid progress has been made with advances in digital technology, such as milling systems, rapid prototyping, three-dimensional (3D) scanning, and 3D printing, which has improved the patients’ expectations, the functional and esthetic treatment outcomes. Materials and methods: An electronic search was conducted in the Cochrane, PubMed (MEDLINE), and ScienceDirect databases between July 2000 and October 2020. A manual search was also performed to cover all digital aspects of the maxillofacial prosthesis. The inclusion criteria were randomized clinical trials, prospective or retrospective cohort, and cross-sectional studies performed on humans with at least 1 year of follow-up and published within the last 20 years. Results: The results showed that the used technologies in a digital workflow of auricular, orbital and nasal prosthesis reduce the manufacturing time and allow the manufacture of high-quality prostheses for missing facial parts. The methodology provides a good position for further development issues and is usable for clinical practice. Conclusion: Utilization of digital technologies in the facial prosthesis manufacturing process can be a good contribution for higher patient comfort and production efficiency but also comes with a higher initial investment and greater demands for experience with software tools.

Outcomes and complications of evisceration with primary implant: an electronic medical record driven analytics of 1800 cases

ABSTRACT Purpose To describe the surgical outcomes and implant complications in 1,800 patients undergoing evisceration with primary implant Methods An Electronic Medical Record-driven analysis of 1,800 patients undergoing evisceration with primary implant between 2013 and 2019. Implant sizing was performed intra-operatively to place the largest implant without tension on the wound closure. Outcome measures included implant complications, prosthesis measurements, and incidence of a good aesthetic outcome. Good outcome was defined as <2 mm enophthalmos and grade 1 or less superior sulcus deformity with a custom ocular prosthesis. Results Eighteen hundred eyes of 1800 patients were included. The mean age at surgery was 36 ± 21 years (median 32 years). Implants used were poly(methyl methacrylate) (PMMA) in 1737 (97%) and porous polyethylene in 63 (3%) patients. Two-petal sclerotomy was performed in 1512 (88%) and four-petal sclerotomy in 165 (10%) patients. The mean diameter of the implant used was 19.35 ± 1.18 mm (median 20, range 10–22 mm). The implant extrusion rate was 3% (56) and implant displacement was seen in none. The mean prosthesis volume and thickness were 2.22 ± 0.67 ml (median 2, range 1–6.5 ml) and 6 ± 1 mm (median 6, range 2–9 mm). The mean difference in prosthesis projection on Hertel’s exophthalmometer was 0.28 ± 1 mm (median 0, range 0–1 mm). Good outcome was observed in 93%. The mean follow-up period was 351 ± 386 days (median 194). Conclusion Evisceration with empirically selected primary orbital implant placement is associated with minimal implant complications and gives a good aesthetic outcome in 93% of the patients.

Clinical Manifestations in Patients Wearing Ocular Prostheses.

This study aimed to assess upper and lower eyelid shapes and changes in patients wearing ocular prostheses. The authors retrospectively reviewed the clinical records of patients wearing ocular prostheses. Clinical manifestations, including superior sulcus deepening, ptosis, upper and lower eyelid entropion, upper and lower eyelid ectropion, upper and lower eyelid retraction, and upper and lower eyelid socket contracture were investigated. For those patients who underwent evisceration, the most common clinical manifestations of the eyelid were superior sulcus deepening and ptosis (35%, respectively), whereas lower eyelid entropion and lower eyelid retraction were the second most common manifestations (25%, respectively). Among those patients who underwent enucleation, the most common eyelid changes were lower eyelid entropion (45.5%), and ptosis and lower eyelid socket contracture were the second most common alterations (36.4%, respectively). Finally, superior sulcus deepening, upper eyelid entropion, and lower eyelid retraction occurred in 27.3% of patients, respectively. Upper eyelid ptosis, superior sulcus deepening, and lower eyelid entropion and retraction were the most common clinical manifestations in patients wearing ocular prostheses. When following up with patients with ocular prostheses, it is important to check these eyelid changes and consider making appropriate corrections.

Proposed Campus Intellectual Product for Business Development Program “Ocular Prosthesis Consultation and Service Center Second Year”

In relation with the efforts to develop a knowledge-based economy culture, Universitas Sumatera Utara needs access in realizing knowledge and technopark that utilize the knowledge, education, and research results of lecturers. By organizing the Campus Intellectual Product Business Development Program, Universitas Sumatera Utara has the opportunity to obtain income and helps create new entrepreneurs. As one of the study programs at Universitas Sumatera Utara, Prosthodontics Study Programs also wants to participate to develop a knowledge-based economic culture to create new entrepreneurs in accordance with the vision and mission of the Prosthodontics Study Program. For this year, the proposing team wants to continue a business unit for the Consultation Center and Ocular Prosthesis Services. In this second year, many developments were carried out from the first year, especially equipping tools and materials in the eye laboratory and providing clinical services such as consultation and manufacture of ocular prosthesis.

Replacement Time of Custom Ocular Prosthesis in Children: A Review Article

The aim and objective of this article is to analyze the published literature on the replacement time of ocular prostheses in children. A systematic search of Indexed English literature up to November 31, 2020, was conducted. Data from PubMed, Scopus, and Cochrane library were searched for relevant manuscripts. Predefined inclusion and exclusion criteria were used by assessors, who inspected 910 manuscripts and selected 7 manuscripts, after analyzing their full texts. Because of the constant growth of the orbital socket in children, the ocular prosthesis has to be replaced till the growth of the orbit is complete. Custom ocular prosthesis requires recurrent relining or replacement, in growing children. The rate of relining or replacement of the prosthesis varies according to the growth of the orbit. Children with ocular prostheses should be appointed biannually or quarterly for routine examination. Yearly replacement or relining of the prosthesis should be conducted. Various factors, like patient comfort, age, signs, and clinical assessment, should be evaluated before relining or replacing the old prosthesis.How to cite this article: Jain S, Idris KIA, Al Omar NEM, et al. Replacement Time of Custom Ocular Prosthesis in Children: A Review Article. Int J Clin Pediatr Dent 2021;14(4):558–561.

Systematic Review of Clinical Applications of CAD/CAM Technology for Craniofacial Implants Placement and Manufacturing of Orbital Prostheses.

This systematic review was aimed at gathering technical and clinical applications of CAD/CAM technology for the preoperative planning of craniofacial implants placement, designing of molds and substructures and fabrication of orbital prostheses. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, an electronic search was executed. Human studies that utilized digital planning systems for the prosthetic rehabilitation of orbital defects were included. A total of 16 studies of 30 clinical cases, which were virtually planned through various digital planning and designing software, were included. The most common preoperative data required for digital planning were CT scans in 15 cases, the 3DSS-STD-II scanning system in 5 cases, an Artec Color 3D scanner in 3 cases and a NextEngine Desktop 3D laser scanner in 2 cases. Meanwhile, the digital designing software were Ease Orbital Implant Planning EOIPlan software in eight cases, Geomagic software in eight cases, Simplant software in four cases and Artec Studio 12 Professional in three cases. Surgical templates were fabricated for 12 cases to place 41 craniofacial implants in the orbital defect area. An image-guided surgical navigation system was utilized for the placement of five orbital implants in two cases. Digital designing and printing systems were reported for the preoperative planning of craniofacial implants placement, designing of molds and substructures and fabrication of orbital prostheses. The studies concluded that the digital planning, designing and fabrication of orbital prostheses reduce the clinical and laboratory times, reduces patient visits and provide a satisfactory outcome; however, technical skills and equipment costs are posing limitations on the use of these digital systems.

Three-Dimensional Computer-Aided Design of a Full-Color Ocular Prosthesis with Textured Iris and Sclera Manufactured in One Single Print Job.

Three-dimensional (3D) printing of ocular prosthesis has been scarcely described in medical literature. Although ocular prostheses have been 3D printed successfully, iris colors are often manually added to the final product afterward. The objective was to produce a 3D-printed ocular prosthesis with textured iris and sclera in one single print job. We designed an average 3D model of an ocular prosthesis in 3D software, and took a high-resolution digital photograph of a human eye, which was processed in graphical software. By using functions called “displacement mapping” and “UV mapping” on the 3D model, the extent of height displacement was used to digitally produce a textured and colored iris and sclera on the 3D model. By using a polyjet 3D printer, different colors and materials could be used for different prosthesis components. We were able to design and 3D print a lifelike ocular prosthesis with realistic iris and sclera texture. The process took less than 4 h, of which 2.5 h are “printing time,” reducing labor time compared with conventional methods. This proof-of-concept adds valuable knowledge to the future manufacture of 3D-printed ocular prostheses, which has several benefits over the conventional production method: 3D printing is much faster, reproducible, and prostheses can easily be digitally adjusted and reprinted. This study is an important step in the development of a full-fledged 3D workflow to produce lifelike custom eye prostheses.

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.

Clinical Study of Hydroxyapatite-Based Eye Socket Filler in Surgery

An irreversible injury of the eyeball requires patients to undergo enucleation or enucleation of the contents of the eyeball. Due to the absence of organs in the eye socket, its collapse, the drooping of the upper eyelid, and possibility of an eyeball excision syndrome make severe facial deformity frequently occurs. To analyze the effect of applying hydroxyapatite (HA) materials in an eye socket filling surgery, patients requiring the surgery were recruited in this study and divided into two groups according to different eye prostheses selected by patients. Nano-HA orbital implantation was selected in the HA group, and porous high-density polyethylene was selected in the PE group. The activity of the artificial eye platform and Visual Analogue Scale scores were significant difference in both groups. Nevertheless, in the HA group, the total complication rate was lower, and the postoperative facial satisfaction was higher, all P &lt; 0.05. Therefore, it is speculated that the use of nano-HA as an eye socket filling material in an eye socket filling surgery reduces postoperative complications, improves the appearance to a certain extent, and has clinical application value.

FABRICATION OF OCULAR PROSTHESIS IN A SINGLE APPOINTMENT USING A CUSTOM PAINTED IRIS- A CASE REPORT.

Loss of any facial structure can have a deep social, physical and psychological impact on the patient. Rehabilitation of such patients with ocular prosthesis helps to overcome not only their psychological trauma but also social acceptance by restoring the lost facial structure and aesthetics of patient. The present article describes a method of fabricating ocular prosthesis in a single appointment by using conventional materials for acceptable t and optimum aesthetic treatment outcome