Embedded 3D printing of porous silicon orbital implants and its surface modification / 南方医科大学学报

OBJECTIVE@#To prepare customized porous silicone orbital implants using embedded 3D printing and assess the effect of surface modification on the properties of the implants.@*METHODS@#The transparency, fluidity and rheological properties of the supporting media were tested to determine the optimal printing parameters of silicone. The morphological changes of silicone after modification were analyzed by scanning electron microscopy, and the hydrophilicity and hydrophobicity of silicone surface were evaluated by measuring the water contact angle. The compression modulus of porous silicone was measured using compression test. Porcine aortic endothelial cells (PAOECs) were co-cultured with porous silicone scaffolds for 1, 3 and 5 days to test the biocompatibility of silicone. The local inflammatory response to subcutaneous porous silicone implants was evaluated in rats.@*RESULTS@#The optimal printing parameters of silicone orbital implants were determined as the following: supporting medium 4% (mass ratio), printing pressure 1.0 bar and printing speed 6 mm/s. Scanning electron microscopy showed that the silicone surface was successfully modified with polydopamine and collagen, which significantly improved hydrophilicity of the silicone surface (P < 0.05) without causing significant changes in the compression modulus (P > 0.05). The modified porous silicone scaffold had no obvious cytotoxicity and obviously promoted adhesion and proliferation of PAOECs (P < 0.05). In rats bearing the subcutaneous implants, no obvious inflammation was observed in the local tissue.@*CONCLUSION@#Poprous silicone orbital implants with uniform pores can be prepared using embedded 3D printing technology, and surface modification obviously improves hydrophilicity and biocompatibility of the silicone implants for potential clinical application.

Infección de cavidad anoftálmica por Scedosporium sp. en paciente inmunocompetente: Reporte de caso / Anophthalmic socket infection caused by Scedosporium sp. in immunocompetent patient: Case Report

Resumen Scedosporium sp. es un género de hongos filamentosos que de forma infrecuente se relaciona a infecciones localizadas o diseminadas en pacientes inmunocom prometidos, o inmunocompetentes con trauma penetrante contaminado. Reportamos el caso de un paciente masculino de 31 años con antecedente de trauma penetrante por arma de fuego requiriendo enucleación de su ojo izquierdo, quien 12 años posterior al trauma inicial presenta necrosis de la cavidad anoftálmica con extrusión del implante y lisis del párpado inferior, finalmente identificando Scedosporium sp. como germen causal, y un mucocele en el seno frontal como reservorio. El paciente recibió tratamiento médico con voriconazol sistémico, desbridamiento quirúrgico amplio, y resección endoscópica del quiste de retención mucoso, con una evolución satisfactoria. Las infecciones micóticas de la cavidad anoftálmica son infrecuentes, requiriendo una alta sospecha diagnóstica y trata miento agresivo para evitar consecuencias potencialmente devastadoras.

Abstract Scedosporium sp. is a genus of filamentous fungi that is infrequently related to localized or disseminated infections in either immunocompromised patients, or immunocompetent patients with penetrating contaminated trauma. We report the case of a 31-year-old patient with a history of penetrating gunshot wound that required enucleation of his left eye, who 12 years after initial trauma presents necrosis of the anophthalmic socket with implant extrusion and lysis of inferior eyelid, finally identifying the causal agent to be Scedosporium sp. The patient received medical treatment with systemic voriconazole, and wide surgical debridement, with a satisfactory evolution. Fungal infections of anophthalmic sockets are infrequent, requiring a high diagnostic suspicion and aggressive treatment to avoid potentially devastating consequences.

Risk factors for orbital implant exposure after evisceration: A case control study of 93 patients

Purpose: The study aims to analyze risk factors for exposure of orbital implants after evisceration by comparison of patients with and without exposure of implants. Methods: This is a case control study in retrospective interventional case series; Group A- implant exposures after evisceration, Group B - Patients on follow up after evisceration with implant, without exposure, with matched duration of follow up. The sample size is calculated for a power of 80. Results: Group A comprised 32 sockets with implant exposure, presenting at median 18 months after surgery; Group B included 61 eviscerated sockets, without implant exposure, with follow up median 36 months. Odds Ratio (OR) was calculated; infected eyes -OR 1.3, P = 0.6; phthisical eye - OR 1.4, P = 0.43; multiple prior surgeries- OR 1.55, P = 0.33. Group A had 59.3% porous implants, Group B 55.7%, - OR 1.3, P = 0.5. Mean implant size in Group A 19.06 mm, Group B 18.78 mm- showed no statistical difference. Multiple logistic regression analysis showed no significant risk factor for exposure. Surgeon factor was not analyzed since there were multiple surgeons. Conclusion: This is the first study with calculated sample size, comparing implant exposure patients to a control group. Porous implant material, presence of infection, phthisical scleral shell, and prior surgery showed higher trend of exposure (Odds ratio >1), but none was conclusive. Larger size of implant was not a risk factor for exposure. Eliminating the role of several factors in implant exposure allows the surgeon to make better surgical choices: such as place an implant of appropriate size, of a material of surgeon's choice, and do primary placement of implant in a patient with evisceration post-corneal ulcer or endophthalmitis. A hypothesis and a recommendation is that meticulous attention be paid to surgical technique.

Reconstruction of extended orbital floor fracture using an implantation method of gamma-shaped porous polyethylene

BACKGROUND: The conventional surgical method for reconstructing orbital floor fractures involves restoration of orbital continuity by covering an onlay with a thin material under the periorbital region. However, in large orbital floor fractures, the implant after inserting is often dislocated, leading to malposition. This study aimed to propose a novel implanting method and compare it with existing methods. METHODS: Among patients who underwent surgery for large orbital floor fractures, 24 who underwent the conventional onlay implanting method were compared with 21 who underwent the novel γ implanting method that two implant sheets were stacked and bent to resemble the shape of the Greek alphabet γ. When inserting a γ-shaped implant, the posterior ledge of the orbital floor was placed between the two sheets and the bottom sheet was impacted onto the posterior wall of the maxilla to play a fixative role while the top sheet was placed above the residual orbital floor to support orbital contents. Wilcoxon signed-rank test and Mann-Whitney U test were used for data analyses. RESULTS: Compared to the conventional onlay method, the gamma method resulted in better restoration of orbital contents, better improvement of enophthalmos, and fewer revision surgeries. CONCLUSION: Achieving good surgical outcomes for extended orbital floor fractures is known to be difficult. However, better surgical outcomes could be obtained by using the novel implantation method of impacting a γ-shaped porous polyethylene posteriorly.

Treatment of Exposed Hydroxyapatite Orbital Implants Wrapped with a Synthetic Dura Substitute

PURPOSE: To describe cases of exposed hydroxyapatite (HA) implants wrapped with the synthetic dura substitute Neuro-Patch treated via simple Neuro-Patch removal. METHODS: The medical records of seven patients who experienced exposure of their HA implant were reviewed. All patients had been enucleated and implanted with HA wrapped with Neuro-Patch. For treatment, Neuro-Patch was removed to the greatest extent possible. After applying local anesthesia with lidocaine, blunt dissection was performed to separate the conjunctiva and Neuro-Patch via the site of exposure. Pressure was applied to the remaining Neuro-Patch with forceps and removed with scissors. RESULTS: Neuro-Patch was visible at the area of exposure in all patients. No surgery beyond initial Neuro-Patch removal was necessary in six of the seven patients. In five cases, the exposed area began to heal rapidly after Neuro-patch removal without primary closure of the defect. In one case, the Neuro-Patch material and all necrotic tissue was removed aggressively due to inflammation around the orbital implant. Lastly, an infection was noted in one case, prompting complete removal of the Neuro-Patch–wrapped HA implant. CONCLUSIONS: Wrapping material may hinder implant vascularization. Exposure of HA in wrapped implants can be successfully treated by a simple removal procedure if detected and managed early.

Low-cost three-dimensional printed orbital template-assisted patient-specific implants for the correction of spherical orbital implant migration

Purpose: To describe the outcomes of a patient-specific implant (PSI), fabricated using a three-dimensional (3D) printed orbital template and placed in the basin of the inferior orbital fissure to correct inferotemporally migrated spherical orbital implant. Methods: This is a single-center, prospective, consecutive, interventional, case series of six patients, with non-porous, spherical, orbital implant migration that underwent implant recentration surgically with a novel technique. Migration was subclassified either as decentration that did not affect the prosthetic retention or as displacement that affected the prosthetic retention in the eye socket. Only implant displacements were treated. The primary outcome measure was centration of the implant clinically and radiologically, with ability to retain the prosthesis. Results: At a mean follow-up of 21 months, all six orbital spherical implants remained centered. There were no cases of extrusion, exposure, or migration of either implants. There were no cases of PSI displacement. Additional procedures to optimize the aesthetic outcome of the customized ocular prosthesis (COP) required were simultaneous fornix formation suture in three patients, subsequent fornix formation with mucus membrane graft in two patients, and levator resection and sulcus hyaluronic acid gel injection in one patient each. The mean PSI implant weight was 2.66 ± 0.53 g. The mean COP weight was 2.2 ± 0.88 g postoperatively. The median patient satisfaction with the procedure was 9 on 10. Conclusion: A 3D printing-assisted PSI placed in the basin of the inferior orbital fissure allows recentration of the migrated implant over a follow-up of 21 months without complications.

A new method to solve anophthalmic contracted socket in embedding orbital implant in 114 cases / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To perform a new method for orbital implant and contracted socket through one time and its results. ·METHODS:Totally 114 patients 114 eyes, from January 2008 to June 2014, with contracted socket participated in this study. We incised the bulbar conjunctiva horizontally and excised scar tissue, then implanted the hydroxyapatite in the four extraocular muscles and tightly sutured the Tenon ' capsule. After that, we put the superior and inferior conjunctival petals backwards and sutured them to the Tenon ' s capsule. All the patients were divided into four groups according to the vertical diameter length of the conjunctival defect area:GroupⅠ:≤5mm; Group Ⅱ: 6-10mm; Group Ⅲ: 11-15mm; and Group Ⅳ: ≥16mm. These patients were followed up for 6mo to 3y to observe the conjunctival sac shaping and growth of conjunctiva. ·RESULTS:There were 64 cases in GroupⅠ, 31 cases in Group Ⅱ, 16 cases in Group Ⅲ and 3 cases in Group Ⅳ. All patients ' conjunctival defect was covered by new conjunctiva and scar tissue 4 to 6wk after surgeries. Ten cases had contracted socket; 2 cases had orbital implant exposure, requiring reoperation. Of the 114 cases, 8 had contracted socket and could use a smaller conformer, 106 could use a normal size conformer. ·CONCLUSION: When the conjunctival defect was ≤15mm, this new method can address the orbital implant and contracted socket at the same time. While it was ≥16mm, flap transplantation is necessary.

Study on the possible factors leading to complications of hydroxyapatite orbital implantation / 国际眼科杂志(Guoji Yanke Zazhi)

·Hydroxyapatite ( HA ) orbital implant has been widely used since it was developed due to its many advantages. It is one of the ideal materials to fill the orbital volume after enucleation or evicseration. However, it still causes complications, and some complications such as severe eye exposure may require reimplant surgery. The paper reviews the clinical application of HA orbital implant, the possible factors leading to complications of HA orbital implantation and the treatments for several common complications. The review aims to provide some help to readers.

The effects of orbital bone density on the stress distribution of implant-bone surface:A 3D finite element study / 实用口腔医学杂志

Objective:To observe the effects of orbital bone density on the stress distribution of implant-bone surface.Methods:The 3D finite element analysis craniofacial model with eight HU values(300 -1 0 000)was established.A force of 20 N along the im-plant axis was applied on the model.The stress values and distribution were calculated and analyzed.Results:The peak of stress val-ue and displacement discreased as HU value increased.In the range of HU value 800 -1 000 HU,the peak of stress value and dis-placement of bone interface did not significantly change with the increasing of HU value.Conclusion:Orbital bone density is an im-portant factor on orbital implant failure when HU value below 800.

The effect of orbital implant load angle on the stress distributions of peri-implant surface / 实用口腔医学杂志

Objective:To observe the effect of orbital implant load angle on the stress distribution of peri-implant surface.Methods:The 3D finite element analysis model of orbital implant with diameter of 3.75 mm and length of 6 mm was established.A force of 20 N was applied on the model at various angles.The stress distribution and displacement of the implant were recorded and analyzed.Results:Under 0°,1 0°,20°,30°,45°and 90°the maximum stress(MPa)on the peri-implant surface was 3.1 73,6.535,1 0.506,1 4.1 68, 1 8.949 and 24.755,the maximum displacement(μm)of the implant was 1 .761 ,3.654,7.665,1 1 .567,1 6.774 and 25.072,respec-tively.Conclusion:The loading angle is an important factor influencing stress and displacement of peri-implant bone.

Comparative analysis of use of porous orbital implant with mucus membrane graft and dermis fat graft as a primary procedure in reconstruction of severely contracted socket.

Purpose: The purpose of our study is to present a surgical technique of primary porous orbital ball implantation with overlying mucus membrane graft (MMG) for reconstruction of severely contracted socket and to evaluate prosthesis retention and motility in comparison to dermis fat graft (DFG). Study Design: Prospective comparative study. Materials and Methods: A total of 24 patients of severe socket contracture (Grade 2‑4 Krishna’s classification) were subdivided into two groups, 12 patients in each group. In Group I, DFG have been used for reconstruction. In Group II, porous polyethylene implant with MMG has been used as a primary procedure for socket reconstruction. In Group I DFG was carried out in usual procedure. In case of Group II, vascularized scar tissues were separated 360° and were fashioned into four strips. A scleral capped porous polyethylene implant was placed in the intraconal space and four strips of scar tissue were secured to the scleral cap and extended part overlapped the implant to make a twofold barrier between the implant and MMG. Patients were followed‑up as per prefixed proforma. Prosthesis motility and retention between the two groups were measured. Results: In Group I, four patients had recurrence of contracture with fall out of prosthesis. In Group II stable reconstruction was achieved in all the patients. In terms of prosthesis motility, maximum in Group I was 39.2% and Group II, was 59.3%. The difference in prosthesis retention (P = 0.001) and motility (P = 0.004) between the two groups was significant. Conclusion: Primary socket reconstruction with porous orbital implant and MMG for severe socket contracture is an effective method in terms of prosthesis motility and prosthesis retention.

Evaluation of bFGF collagen composite sponge promoting vascular ingrowth in orbital implantation by 99Tcm-MDP scan / 中华实验眼科杂志

Background Intraorbital implantation of coralline porous hydroxyapatite (CHA) is a favorable cosmetic method after enucleation.However,the low degree of vascularizatiou in implant results in implant infection and exposure.Studies showed that a collagen composite sponge treated by basic fibroblast growth factor (bFGF/ collagen composite sponge) can promote angiogenesis.However,whether bFGF/collagen composite sponge improves the vascularization of CHA implants is unclear.Objective This study was to investigate the accelerating effect of bFGF collagen composite sponge on vascularization of orbital implant made of CHA using 99Tcm-methylene diphosphate (MDP) scan.Methods Forty-five New Zealand rabbits were randomly assigned to 3 groups.Evisceration of eyeball was performed on the left eyes of rabbits,and naked CHA,collagen composite sponge wrapped CHA and bFGF/collagen composite sponge wrapped CHA were implanted into the orbit respectively in 3 groups.99Tcm-MDP of 3 mCi was injected in the rabbits via ear vein in 2,4,6,8 and 12 weeks,and the vascular enhancement intensity on implants was observed 3 hours after injection.The ratio of average radioactive count from the area of interest with the same size between the left eyes and the right eyes was calculated.The implants were extracted for histopathological examination in the 12 weeks.Results As the lapse of postoperative time,the inflammation response gradually disappeared and no exposure of implants was seen during the 12-week duration.A similar vascular development strength was found in the area of interest among the 3 groups 2 weeks after surgery.However,the vascular development was significantly enhanced in the left eyes compared the right eyes from 4 to 6 weeks,with the highest intensity in the 8th week in the naked CHA group and collagen composite sponge wrapped CHA group.In the bFGF/ collagen composite sponge wrapped CHA group,the strongest image was in the 6th week after operation.The ratios of average radioactive count between the left eyes and the right eyes were significantly higher in the bFGF/collagen somposite sponge wrapped CHA group compared with the naked CHA group and collagen composite sponge wrapped CHA group (all at P＜0.05),and ratios of average radioactive count of the collagen composite sponge wrapped CHA group was significantly higher than that of the naked CHA group (all at P＜0.05).New blood vessels ingrowed toward the center of the implants through the coralline porous under the optical microscope.Conclusions Both bFGF (20 μg)/collagen composite sponge and collagen composite sponge can accelerate the ingrowth of vessel in the CHA,but the promoting effect of bFGF collagen composite sponge is prominent.

The Surgical Results of Isolated Orbital Blowout Fractures Using Bioresorbable Poly L-/DL-Lactide 70/30 Implant / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to share our clinical experience on the use of bioresorbable poly L-/DL-lactide 70/30 implant to repair blow out fracture. SUBJECTS AND METHOD: The medical records of 130 patients with orbital fractures that were treated surgically from June 2006 to February 2011 were reviewed retrospectively. Patients who had diplopia or limited extraocular motion, significant Enophthalmos (>2 mm), or a large orbital wall fracture on a computed tomographic scan were enrolled for the study. We investigated diplopia, limited extraoacular motion, enophthalmos before and after surgery. RESULTS: The mean postoperative follow-up was 28 months. There was no evidence of sinus infection related to the implant. However, six patients showed dislocation of orbital implant in the nasal cavity. After six postoperative months, diplopia was seen in 1 (2%) patient, and significant enophthalmos was seen 2 (2%) patients. We carried out re-operation on six cases and the main cause was incomplete reduction or over reduction. CONCLUSION: Bioresorbable poly L-/DL-lactide 70/30 implants are safe and reliable for the reduction for blowout fracture.

The effects of orbital implant shrink range on the stress distributions in bone-implant interface / 实用口腔医学杂志

Objective:To observe the effect of orbital implant shrink range on the stress distribution in bone-implant interface. Methods:The 3D finite element analysis of craniofacial and orbital implant models with the implant length of 3,4,6 and 10 mm,and with the shrink range of0.05,0.1 and 0.15 mm were established respectively.The stress in the bone-implant interface were calculat-ed and analyzed.Results:The stress increased with the increase of implant shrink range.The stress produced by the implant with 0.15 mm shrink range decreased.The stress of the implant of 10 mm was lower than that of other implants with the shrink range of 0.1 and 0.15 mm.Conclusion:The maximal implant shrink range of 0.1 mm in the model can meet the clinical requirements in orbital implant planning.

Three-Dimensional Pre-Bent Titanium Implant for Concomitant Orbital Floor and Medial Wall Fractures in an East Asian Population

BACKGROUND: The objective of this article is to evaluate clinical outcomes of combined orbital floor and medial wall fracture repair using a three-dimensional pre-bent titanium implant in an East Asian population. METHODS: Clinical and radiologic data were analyzed for 11 patients with concomitant orbital floor and medial wall fractures. A combined transcaruncular and inferior fornix approach with lateral canthotomy was used for the exposure of fractures. An appropriate three-dimensional preformed titanium implant was selected and inserted according to the characteristics of a given defect. RESULTS: Follow-up time ranged from 2 to 6 months (median, 4.07 months). All patients had a successful treatment outcome without any complications. Clinically significant enophthalmos was not observed after treatment. CONCLUSIONS: Three-dimensional pre-bent titanium implants are appropriate for use in the East Asian population, with a high success rate of anatomic restoration of the orbital volume and prevention of enophthalmos in combined orbital floor and medial wall fracture cases.

Two Cases of Actinomyces Infection in a Hydroxyapatite Orbital Implant with a Motility Peg

PURPOSE: To report 2 cases of Actinomyces infection in a hydroxyapatite orbital implant with a motility peg. CASE SUMMARY: A 44-year-old male and a 55-year-old male who underwent evisceration and implantation of a hydroxyapatite implant in the left eye 17 and 15 years prior, respectively, presented with a conjunctival sac granuloma with discharge and bleeding of 1 year duration. Both patients had a history of motility peg implantation. A large-area of the hydroxyapatite implant was exposed after removal of the granuloma. The previous orbital implant was removed, and the exposed area was covered with a dermis fat graft in both patients. On histopathological examination, Actinomyces infection in the orbital implant was observed in both patients. CONCLUSIONS: To the best of our knowledge, this is the first case report of actinomycosis of hydroxyapatite orbital implant in Korea. In a patient with a porous orbital implant, the possibility of Actinomyces infection of the orbital implant should be considered after a long-duration and large-area exposure of the implant.

The Effects of Commodified Growth Factor Products on the Fibrovascularization of Porous Polyethylene Orbital Implants

PURPOSE: To investigate the effects of commodified growth factor products used clinically on fibrovascular ingrowth into porous polyethylene orbital implants. METHODS: Porous polyethylene orbital implant sheets (Medpor(R)) soaked with Nepidermin (Easyef(R)), Trafermin (Fiblast(R)), and normal saline were implanted into the backs of 18 Sprague-Dawley rats. The degree of fibrovascular ingrowth as observed using a light microscope was compared 1 and 2 weeks after implantation and was calculated as a percentage of the fibrovascular ingrowth length. RESULTS: One week after implantation, the percentage of fibrovascular ingrowth length was 25.33 +/- 5.43%, 22.56 +/- 5.30%, and 21.78 +/- 4.66% in the Easyef(R)-, Fiblast(R)- and normal saline-soaked groups. The degree of fibrovascularization was higher in the Easyef(R)-soaked group than in the other groups (p = 0.020, 0.012). Two weeks after implantation, the degree of fibrovascularization was 98.33 +/- 5.00%, 100.00 +/- 0.00%, and 95.89 +/- 4.57%, which was significantly higher in the Easyef(R)-, and Fiblast(R)-soaked groups than in normal saline-soaked group (p = 0.019, <0.001). CONCLUSIONS: Commodified growth factor products used in other areas selectively enhanced fibrovascular ingrowth to a greater degree and earlier in ophthalmic plastic and reconstructive surgery.

Repair of Inferomedial Orbital Wall Fractures with Bony Strut Loss by Overlapping Absorbable Copolymer

PURPOSE: To report the results of surgical repairing of inferomedial orbital wall fractures accompanied with loss of bony strut by an overlapping method using Resorb X(R) plates (poly(D,L)-lactic acid). METHODS: To repair inferomedial orbital wall fractures with loss of bony strut, we bent the medial aspect of the plate for floor fracture according to the anatomical structure and then inserted the floor implant, which was supported by anterior, posterior and lateral margins of the floor fracture. Then, the medial implant, which was supported by the bent medial edge of the floor implant, was inserted. Postoperatively, we analyzed the outcomes of 21 patients regarding postoperative enophthalmos, limitation of eye movement (LOM) and diplopia. The diagonal lengths of the orbit in the operated side were compared with the non-traumatized side based on the coronal view of the postoperative CT scans to determine the success or failure of the reconstruction. RESULTS: The average postoperative enophthalmic value was 0.5 mm, and no significant differences between the orbital diagonal lengths of the operated and non-operated eyes were observed. The LOM shown in 7 out of 8 patients was completely resolved during the postoperative follow-up period. All patients with diplopia, including one patient who showed partial remission of LOM, experienced complete symptom resolution. No other complications related to the implant were recorded. CONCLUSIONS: Inferomedial orbital wall fractures with the loss of bony strut can be successfully repaired by the overlapping method using Resorb X(R) implants.

Outcomes of Autogenous Dermis Fat Grafting with Different Donor Sites in Exposed Porous Orbital Implants

PURPOSE: To compare the outcomes of autogenous dermis fat grafting with different donor sites in the treatment of exposed porous orbital implants. METHODS: The present study retrospectively evaluated the medical records of 17 patients (17 anophthalmic eyes) who had undergone autogenous dermis fat grafting based on the diagnosis of exposed porous orbital implants and were regularly followed up for at least 12 months since the surgery from January 2001 to December 2010. The patients were divided into 2 groups (thigh and abdomen) according to the site of the donor grafting. The treatment outcome and complications were compared between the 2 groups. RESULTS: The success rate of thigh dermis fat grafting was 88.9% (8/9) and 100.0% (8/8) in the abdominal dermis fat grafting, and there was no statistically significant difference between the 2 groups (p = 1.000). Regarding ocular complications, graft tissue infection (thigh 11.1%, abdomen 0%) and superior sulcus deformity (thigh 22.2%, abdomen 25.0%) were present. Regarding donor site complications, tenderness (thigh 55.6%, abdomen 25.0%), dehiscence (thigh 22.2%, abdomen 25.0%) and scar formation (thigh 33.3%, abdomen 25.0%) were observed. In the gait associated complications, pain (thigh 55.6%, abdomen 25.0%) and limping (thigh 22.2%, abdomen 12.5%) were observed. The rate of all complications showed no statistically significant difference between the thigh dermis fat grafting and the abdominal dermis fat grafting (all p > 0.05). CONCLUSIONS: Thigh and abdomen can both be considered as an effective donor site for the autogenous dermis fat grafting in the treatment of exposed porous orbital implants.

Rehabilitación quirúrgico-protésica de pacientes con cavidades anoftálmicas atípicas / Surgical-prosthetic rehabilitation of patients with atypical anophthalmic cavities

Se realizó estudio descriptivo y transversal de 377 pacientes con cavidades anoftálmicas atípicas, atendidos en el Departamento de Oculoplastia del Hospital General "Dr. Juan Bruno Zayas Alfonso" y la Clínica de Rehabilitación de Prótesis Bucomaxilofacial del Hospital Provincial Docente "Saturnino Lora" en Santiago de Cuba, desde enero de 2004 hasta septiembre de 2010, con vistas a evaluar su rehabilitación quirúrgica protésica. Del total de cavidades, 13 eran congénitas y 364 adquiridas: 75 con globos oculares no estéticos y 289 sin ellos; en estos últimos se efectuaron 189 evisceraciones, 98 enucleaciones y 2 exenteraciones. En la casuística, 170 pacientes recibieron implantes orbitarios con hidroxiapatita porosa coralina cubana (HAP 200): 125 primarios y 45 secundarios. La rehabilitación quirúrgica protésica fue buena en 86,0 % de los pacientes sin implante orbital y en la totalidad de los que sí lo recibieron, de donde se concluyó que la rehabilitación quirúrgica no puede separarse de la protésica.

A descriptive and cross-sectional study of 377 patients with atypical anophthalmic cavities, attended in the Oculoplasty Department from "Dr Juan Bruno Zayas Alfonso" General Hospital and the Rehabilitation Clinic of Oral Maxillofacial Prosthesis from "Saturnino Lora" Teaching Provincial Hospital in Santiago de Cuba was carried out from January 2004 to September 2010, aimed at evaluating their surgical prosthetic rehabilitation. From the total of cavities, 13 were congenital and 364 were acquired: 75 with non-aesthetic eyeballs and 289 without them; in the last group 189 eviscerations, 98 enucleations and 2 exenterations were carried out. One hundred and seventy patients had orbital implants with Cuban coral porous hydroxyapatite (HAP 200): 125 primary and 45 secondary in the case material. Surgical prosthetic rehabilitation was good in 86,0% of the patients without orbital implants and in all those who received it, from which it was concluded that surgical rehabilitation cannot be separated from the prosthetic one.