Ocular Prosthesis Research Articles

FLEXIBLE SILICONE OCULAR PROSTHESIS

These prostheses are generally produced using two materials, glass or acrylic, and the manufacturing process is currently based only on manual procedures. However, these materials have many disadvantages, such as high hardness and fragility of glass or gradual loss of glossing. All the main disadvantages have been eliminated in the newly developed ocular prosthesis made from silicone. The publication contains the production procedure of an innovative ocular prosthesis based on the use of additive technologies.

Health Services Needs Assessment for Retinoblastoma in Ethiopia.

The aim of this study was to document the available resources and needs for the detection, diagnosis, and treatment of retinoblastoma (RB) in Ethiopia. A health services needs assessment focused on RB care in Ethiopia was conducted. Information was obtained through a web-based survey and field visits. Facilities offering RB service delivery were categorized into three tiers, on the basis of the ability to detect (tier 1) and manage simple (tier 2) or complex (tier 3) patients with RB. Descriptive statistics were performed to quantify human and material resources available at each facility. The web survey received 29 responses from ophthalmologists at 19 health care facilities. Of the 19 units surveyed, seven (36.8%) had an ophthalmologist dedicated to RB treatment, classifying them as either a tier 2 or 3 facility. All tier 3 facilities had an affiliated health facility offering access to off-site pediatric oncology and pathology services. Of the focal therapies offered at tier 3 facilities, none included local chemotherapy or brachytherapy. Enucleation was offered at all tier 2 facilities, but availability of orbital implants and ocular prostheses was variable. None of the health facilities offered genetics services. This study demonstrated that the human and material resources needed for RB care in Ethiopia are constrained. Tier 3 RB facilities are rare and concentrated in urban areas, which could make it difficult for many patients to access. With focused capacity-building efforts, it is possible to increase the efficiency of RB therapy.

Maxillofacial prosthetics and digital technologies: Cross-sectional study of healthcare service provision, patient attitudes, and opinions.

Digital technologies are continuously improving the accuracy and quality of maxillofacial prosthetics, but their impact on patients remains unclear. This cross-sectional study aimed to analyze the impact of facial prosthetics service provision, patients' perception, and digital technology on prostheses construction. All patients who presented for evaluation and management of facial defects between January 2021 and December 2021 at the ENT clinic were eligible for study enrollment. Patients requiring prosthetic reconstruction of their missing facial parts were included in the study. Forty-five questionnaires were delivered, inquiring about the patients' prosthetic demographics, prosthesis manufacture using 3D technologies, and their perceptions and attitudes. A total of 37 patients responded (29 males, eight females; mean age 20.50 years). The congenital cause was the highest among other causes (p = 0.001) with auricular defects being the highest (p = 0.001). A total of 38 prostheses were constructed and 17 prostheses were retained by 36 craniofacial implants (p = 0.014). The auricular and orbital implants success rates were 97% and 25%, respectively. The implant locations were digitally planned pre-operatively. Digital 3D technologies of defect capture, data designing, and 3D modeling were used and perceived as helpful and comfortable (p = 0.001). Patients perceived their prosthesis as easy to handle, suited them, and they felt confident with it (p = 0.001). They wore it for more than 12 h daily (p = 0.001). They were not worried that it would be noticed, and found it comfortable and stable during various activities (p = 0.001). Implant-retained prosthesis patients were more satisfied with it, and found it easy to handle and stable (p = 0.001). Congenital defects are the main cause of facial defects in the study country. The overall acceptance of maxillofacial prostheses was good, showing high patient perception and satisfaction. Ocular and implant-retained silicone prostheses are better handled, more stable, and the latter is more satisfying than traditional adhesive prostheses. Digital technologies save time and effort invested in manufacturing facial prostheses.

Cytotoxicity of cleaning agents for ocular prostheses.

Polymethylmethacrylate (PMMA) is the most used material for the manufacturing of eye prostheses. To investigate the cytotoxicity of different cleaning agents for ocular prostheses on human conjunctival cells. Six groups of specimens were created (saline, soap, 4% chlorhexidine, hydrogen peroxide, 1% triclosan, and citronella oil). Three specimens were made for each disinfectant at each disinfection period (1, 7, 15, 30, 60, and 90 days), totaling 108 specimens. Thus, the specimens were disinfected, with different disinfectants, for different periods of time. After each disinfection process, the specimens were washed with sterile distilled water. A human conjunctival cell line was grown on the acrylic resin specimens and then cytotoxicity tests (MTT and Neutral Red (NR)) were performed. A negative control (untreated cell cultures) and positive control (Tween 20) were created. Two-way analysis of variance (ANOVA) and Bonferroni test were performed (p < 0.05). For the MTT and NR tests, when there was a significant difference between the disinfectant and negative control, the disinfectant generated a significant reduction in cell proliferation most of the time. All reductions in cell proliferation caused by the disinfectants were clinically acceptable. All disinfectants tested in this study were found to be non-cytotoxic to human conjunctival cells.

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.

EXAMINATION OF THE CONTROL SYSTEM OF AN ARTIFICIAL EYE IMPLANT

Due to various reasons, a person who is missing one eye may experience psychological as well as excruciating suffering. Enucleation and evisceration surgery are the most often used methods to remove a sick or injured eye. The patient is often fitted with a bespoke implant into the orbital tissues after the surgeon removes the eye. In order to keep the socket from looking hollow and depressed, this replaces volume. Once the socket has stabilized, a prosthetic shell—also known as an artificial eye, glass eye, or ocular prosthesis—is placed within. An ocular implant can mechanically replace the lost eye. There have been significant developments in this field. To replace the missing eye, an ocular prosthesis was developed. Physically, the prosthetic seems natural. The eye, however, is stationary or just slightly mobile. development of an independent ocular motor system is the objective of this study in order to give the artificial eye more realistic movement. The detection of natural eye movement is a crucial issue. This study includes an overview of eye movement detecting techniques. Then eye movement detection using the fusion approach is created. The first aspect that is recorded and stored is the eye movement. Then, during the experiment, the sensor array yields the eye movement signal, and the matching rule yields the eye position. The experimental system, fusion technology, and early findings are covered in the majority of this work. Keywords: Sensor array, fusion, artificial eye, orbital implant, and ocular control.

Orbital exenteration reconstruction using a superficial temporalis muscle flap: The “Carpaccio flap”, an innovative approach

Introduction: Malignant orbital diseases may lead surgeons to practice an orbital exenteration associated with chemotherapy and/or radiotherapy to ensure curative treatment. That radical procedure makes physicians consider reconstructive filling in order to allow prothesis wearing and reduce esthetic and social after-effects. We first describe the clinical case of a 6-year-old patient who presented an orbital rhabdomyosarcoma and underwent an orbital exenteration with immediate reconstruction by a superficial temporal pedicled on the middle temporalis muscle flap.Technical note: Through that case-report, we propose an original temporal flap to repair ipsilateral midface defects which may reduce donor site side effects and allow furthers corrections.Discussion: In pediatrics cases, our Carpaccio flap was an available regional tool to rehabilitate an irradiated orbital socket with an appropriate bulking and vascularization effect after subtotal exenteration. Furthermore, we prescribe that flap as a posterior orbital filling, when eyelid and conjunctiva are spared, to prepare orbital prosthesis implementation. A mild sunken temporal fossa appears with our procedure but by preserving the deep layer of the temporalis muscle, autologous reconstruction such as lipofilling are permitted in post-radiotherapy condition to enhance esthetic sequelae.

Prosthodontic Rehabilitation of Ocular Defect Using Customized Ocular Prosthesis

The eyes play an important role in determining a person's facial profile. It causes distress to the patient when his or her eyes are lost. In order to enhance self-esteem and social acceptance, eye prosthesis restores the appearance of the face. There are various materials and techniques used in the fabrication of an ocular prosthesis. Among the advantages of custom ocular prostheses over stock eye prostheses are better eyelid movements, even pressure distribution, which reduces trauma to the tissues, and improved fit, comfort, and aesthetics. An ocular prosthesis can be customized to appear more natural by customizing the size, shape, and color of the iris, pupil, and sclera. This article illustrates the rehabilitation of eyes using custom-made eye cells.

Rehabilitation of pediatric retinoblastoma patients with ocular prostheses and their subsequent modifications: A 15-year retrospective study.

Enucleation is a common treatment modality performed for pediatric retinoblastoma patients, and the resultant defects are reconstructed using an ocular prosthesis. The prostheses are modified or replaced periodically, as the child develops due to orbital growth and patient-error. The purpose of this report is to evaluate the replacement frequency of prostheses in the pediatric oncologic population. A retrospective review was completed by the two senior research investigators, of patients that had ocular prostheses fabricated following enucleation of their retinoblastoma from 2005 to 2019 (n=90). Data collected from the medical records of the patient included the pathology, date of surgery, date of prosthesis delivery, and the replacement schedule of the ocular prosthesis. During the 15-year study period, 78 enucleated observations (ocular prosthesis fabricated) were included for analysis. The median age of the patients at the time of delivery of their first ocular prosthesis was calculated to be 2.6 years (range 0.3-18 years). The median time to the first modification of the prosthesis was calculated to be 6 months. The time to modification of the ocular prosthesis was further stratified by age. Pediatric patients require modification of their ocular prostheses throughout their growth and development period. Ocular prostheses are reliable prostheses with predictable outcomes. This data is helpful to set an expectation among the patient, parent, and provider.

AFFORDABLE REHABILITATION OF A POST-COVID MUCORMYCOSIS ORBITAL DEFECT BY AN ACRYLIC ORBITAL PROSTHESIS: A CASE REPORT

Mucormycosis is a fungal infection caused by inhalation of Mucor and Rhizopus spores in the atmosphere. While healthy individuals are mostly immune to these fungi, immunocompromised patients are susceptible and can develop a severe infection. The Post- Covid Pandemic Indian population had seen many immunocompromised patients suffering from mucormycosis. This was frequently treated with antifungal therapy and surgical excision which often lead to formation of oro-nasal communication and orbital defects. This case report includes rehabilitation of an orbital defect caused as a complication of post- covid mucormycosis by 2-piece magnet and anatomical undercut retained acrylic orbital prosthesis.

IMPRESSION TECHNIQUES FOR OCCULAR PROSTHESIS - REVIEW

Eye is a vital sensory organ have been playing its role from vision to expression. Construction of the ocular prosthesis was never been so easy numerous techniques was implicated for the fabrication of the ocular prosthesis. Depending upon the availability of materials and time the technique for the fabrication it differs from one author to the another based on its esthetic, comfort and longevity of the prosthesis. This article is a review about various methods implicated by the authors over the due course of time for the construction of a prosthesis.

Результаты реконструктивно-восстановительной хирургии после тяжелой сочетанной травмы глаза, век и глазницы

Purpose. Presentation of the clinical result of complex surgical rehabilitation in a patient with combined traumatic injury of the eye, its adnexa and orbit. Material and methods. A clinical case is presented. Described step by step: surgical reconstruction of orbital walls with «Ekoflon» material (Russia), of lacrimal duct by Taumi method, of medial palpebral ligament, of upper eyelid coloboma with free skin graft, evisceration with plastic surgery of the musculoskeletal stump and ocular prosthetics. Results. Evaluation of the results of the surgical treatment performed at the final examination 14 months after the injury showed that the dimensions of the patient’s palpebral fissure had no obvious differences from the healthy side, the mobility of the upper eyelid was restored, and the lacrimal drainage function was preserved. There was a normal position and good mobility of the ocular prosthesis. Conclusion. Complex specialized rehabilitation of patients after a severe concomitant injury of the organ of vision using the achievements of modern reconstructive ophthalmic surgery makes it possible to restore the anatomy and function of the adnexal apparatus of the eye as much as possible, to carry out cosmetic prosthetics with a satisfactory aesthetic outcome. Key words: combined ocular injury, reconstructive and cosmetic eyelid surgery, lacrimal duct reconstruction; periorbital reconstruction; eye prosthesis

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.

A low-cost prosthetic orbital simulation model for endoscopic anterior ethmoid artery ligation.

This study aimed to develop and evaluate a low-cost orbital prosthesis for simulation of endoscopically assisted intra-orbital anterior ethmoidal artery ligation. A low-cost orbital prosthesis was built and evaluated by ENT surgical trainees. Feedback was given following the assessment in the form of a face validity questionnaire. Results were scored on a Likert scale of 1-7 (low to high). Trainees had limited exposure to the procedure (40 per cent) and predominantly low levels of confidence (mean, 3.67) that correlated with a lack of first-hand experience. The anatomy and likeness to human tissue of the prosthesis were both ranked highly, with mean scores of 5.0 and 4.93, respectively. The results of this study support the idea that a simple anatomical prosthesis for the simulation of endoscopic anterior ethmoidal artery ligation can be created with potential value to otolaryngology surgical training. To the authors' knowledge, this is the first documentation of simulated surgical epistaxis management using an artificial anatomical model.

Conjunctival sac microbiome in anophthalmic patients: Flora diversity and the impact of ocular prosthesis materials.

To explore the changes of bacterial flora in anophthalmic patients wearing ocular prosthesis (OP) and the microbiome diversity in conditions of different OP materials. A cross-sectional clinical study was conducted, involving 19 OP patients and 23 healthy subjects. Samples were collected from the upper, lower palpebral, caruncle, and fornix conjunctiva. 16S rRNA sequencing was applied to identify the bacterial flora in the samples. The eye comfort of each OP patient was determined by a questionnaire. In addition, demographics information of each participant was also collected. The diversity and richness of ocular flora in OP patients were significantly higher than that in healthy subjects. The results of flora species analysis also indicated that in OP patients, pathogenic microorganisms such as Escherichia Shigella and Fusobacterium increased significantly, while the resident flora of Lactobacillus and Lactococcus decreased significantly. Within the self-comparison of OP patients, compared with Polymethyl Methacrylate (PMMA), prosthetic material of glass will lead to the increased colonization of opportunistic pathogens such as Alcaligenes, Dermabacter and Spirochaetes, while gender and age have no significant impact on ocular flora. The ocular flora of OP patients was significantly different from that of healthy people. Abundant colonization of pathogenic microorganisms may have an important potential relationship with eye discomfort and eye diseases of OP patients. PMMA, as an artificial eye material, demonstrated potential advantages in reducing the colonization of opportunistic pathogens.

Effect of spatial arrangement and clinical service lifetime simulation on the retention of magnetic units used in implant-anchored orbital prostheses

Statement of problemEvidence for the optimal spatial arrangement of magnetic attachments in implant-supported orbital prostheses is lacking. PurposeThe purpose of this in vitro study was to assess the effect of 6 different spatial arrangements on the retentive force of magnetic attachments following the in vitro simulation of clinical service by insertion-removal test cycles and the contribution of artificial aging to the morphological alterations induced on the magnetic surfaces. Material and methodsNi-Cu-Ni plated disk-shaped neodymium (Nd) magnetic units (d=5 mm, h=1.6 mm) were secured on leveled (50×50×5 mm, n=3) and angled (40×45×40 mm, interior angle=90 degrees, n=3) pairs of test panels in 6 different spatial arrangements: triangular_leveled (TL), triangular_angled (TA), square_leveled (SL), square_angled (SA), circular_leveled (CL), and circular_angled (CA) generating corresponding test assemblies (N=6). TL and TA arrangements included 3 magnetic units (3-magnet groups) and SL, SA, CL, and CA 4 (4-magnet groups). The retentive force (N) was measured at a mean crosshead speed of 10 mm/min (n=10). Each test assembly was subjected to insertion-removal test cycles with a 9-mm amplitude, ν=0.1 Hz, and n=10 consequent retentive force measurements at a crosshead speed of 10 mm/min at 540, 1080, 1620, and 2160 test cycles. Surface roughness alterations following the 2160 test cycles were measured by calculating the Sa, Sz, Sq, Sdr, Sc, and Sv parameters with an optical interferometric profiler with 5 new magnetic units used as a control group. Data were analyzed with 1-way ANOVA and Tukey HSD post hoc tests (α=.05). ResultsThe 4-magnet groups had statistically significantly higher retentive force than the 3-magnet ones at baseline and following the 2160 test cycles (P<.05). In the 4-magnet group, the ranking at baseline was SA<CA<CL<SL (P<.05) and following the test cycles SA=CA<CL<SL (P<.05). No statistically significant differences were found in the surface roughness parameters (Sa, Sz, Sq, Sdr, Sc, and Sv) following the 2160 test cycles among the experimental groups tested (P>.05). ConclusionsFour magnetic attachments placed on an SL spatial arrangement resulted in the highest retention force but presented with the highest force reduction following the in vitro simulation of clinical service by insertion-removal test cycles.

A Case Series of Prosthetic Rehabilitation of Post-COVID Rhinorbitocerebral Mucormycosis Ocular Defects: A Digital and Analog Experience.

Removal of a part of or the entire orbit results in facial defect, causing psychological trauma to the patient, apart from anatomic loss. This case series presents 6 clinical cases of prosthetic rehabilitation of ocular defects related to post-COVID-19 ROCM by both analog and digital workflow. The basic objective of this case series was to achieve a well retained, user-friendly, maxillofacial ocular prosthesis with esthetic accuracy. Unique size and shape of the ocular defect in each case, variety of skin tones, age range of patients and compromised neuromuscular control made each of the six cases challenging. This clinical series apart from proposing a digital & analog algorithm for rehabilitating ocular defects also illustrates analog workflow for 4 cases and digital workflow for 2 cases for fabrication of ocular prosthesis.

An Innovative Technique for Fabricating a CustomMade Ocular Prosthesis in a Pediatric Patient: A Case Report

An Innovative Technique for Fabricating a CustomMade Ocular Prosthesis in a Pediatric Patient: A Case Report

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.

Retentive ocular prosthesis restores post evisceration patients’ physical and psychological

Loss of eye does not only affect facial esthetics but also psychological health of the patient and leads to social disa-bility. A custom-made ocular prosthesis is a good alternative to promote physical, psychological and esthetically plea-sing appearance that can improve social acceptance of the patient. A 5-years-old female patient and 18-years old male patient were reported to Dental Hospital USU with the chief complaint of loss of an eye, making them often in-sulted by schoolmates, while the male patient lost confidence on socializing around. In these cases, ocular prosthe-ses with modification of custom tray was made by using a putty index obtained from wax pattern to produce a better fitting ocular prosthesis so it expected to be retentive as to produce comfort and increase patient confidence. Con-tact between ocular prosthesis and tissue bed is necessary to evenly distribute the pressure obtained with proper im-pression technique. This technique ensures a good fit of the custom tray thereby produce accurate adaptation to the tissue surface can increase the movement of the prosthesis and provide a good natural esthetic outcome. Post evi-sceration patients need psychological support to restore confidence and self-esteem in today's cosmetics challenging world. For these cases, patients’ self-confidence was restored and socializing as before without any embarrassment.