ABSTRACT
Introducción: La prótesis ocular es un medio artificial con fines funcional y estético, que posibilita la rehabilitación física, psíquica y social de pacientes con defectos en los ojos. Objetivo: Describir la evolución de los pacientes con prótesis ocular según signos de infección en las cavidades oculares rehabilitadas, factores de riesgos asociados, así como modificaciones en la forma de la cavidad y/o en la prótesis ocular. Métodos: Se realizó un estudio observacional, longitudinal y prospectivo de 74 pacientes aquejados por defectos oculares, que recibieron tratamiento protésico en el período de 2018 a 2019 en la Clínica de Rehabilitación Bucomaxilofacial de Santiago de Cuba, los cuales fueron evaluados a través de una encuesta y un examen clínico en tres momentos durante un año de evolución. Para establecer la asociación entre variables, se emplearon la prueba de la Χ2 de Pearson y la exacta de Fisher de acuerdo con el cumplimiento de supuestos. Resultados: De los 222 exámenes efectuados a las cavidades oculares rehabilitadas, 31 revelaron la presencia de secreciones en 23 pacientes, con recurrencia en 8 de ellos; dicho signo clínico se manifestó de manera similar a la hipercoloración de la conjuntiva en cuanto al momento del hallazgo y al grupo etario afectado, con mayores porcentajes al año de evolución y una incidencia superior en los pacientes de 60 y más años de edad. Asimismo, se constató una asociación estadísticamente significativa de las variables higiene diaria de la cavidad y de la prótesis con la existencia de secreciones, para un intervalo de confianza de 95 %. Conclusiones: Se demostró la ventaja del aseo semanal de la cavidad ocular y de la prótesis en sus portadores, pues con ello se disminuye la frecuencia de los signos inflamatorios e infecciosos de la mucosa, lo que debe observarse con mayor rigurosidad en los ancianos, quienes resultan ser los más afectados.
Introduction: Ocular prosthesis is an artificial means with functional and cosmetic ends that facilitates the physical, psychic and social rehabilitation of patients with eyes defects. Objective: To describe the evolution of patients with ocular prosthesis according to infection signs in the rehabilitated ocular cavities, associated risk factors, as well as modifications in the form of the cavity and/or in the ocular prosthesis Methods: An observational, longitudinal and prospective study of 74 patients suffering from eye defects that received prosthetist treatment from 2018 to 2019 in the oral maxillofacial Rehabilitation Clinic was carried out in Santiago de Cuba, who were evaluated through a survey and a clinical exam in three moments during a year of evolution. To establish the association between variables, the Pearson chi-square and Fisher exact tests were used with the fulfillment of suppositions. Results: Of the 222 exams made to the rehabilitated ocular cavities, 31 revealed the presence of secretions in 23 patients, with recurrence in 8 of them; this clinical sign became evident in a similar way to the hypercoloring of the conjunctiva as for the moment of the finding and the age group affected, with higher percentages at the year of evolution and a higher incidence in the patients of 60 years and over. Also, an association statistically significant of the daily hygiene of the cavity and prosthesis variables with the existence of secretions was verified, for a confidence interval of 95 %. Conclusions: The advantage of the ocular cavity and prosthesis weekly personal cleanliness was demonstrated, because with it the frequency of the inflammatory and infectious signs of the mucous is reduced, what should be strictly observed in elderly, who are the most affected.
Subject(s)
Eye, Artificial , Visual ProsthesisABSTRACT
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. @*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. @*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. @*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.
Subject(s)
Eye , Eye, Artificial , Social Determinants of HealthABSTRACT
El trauma ocular constituye la causa de pérdida ocular más frecuente a nivel mundial y puede presentarse en cualquier etapa de vida, con mayor incidencia en la niñez. El manejo puede ser quirúrgico, quirúrgico-protésico o protésico. A continuación, se presenta un caso clínico que describe la rehabilitación protésica individualizada posterior a una evisceración en una lesión ocular unilateral traumática de hace aproximadamente 56 años, que presenta ptosis del párpado superior, colapso y atrofia muscular debido a la falta de función. Se describe la técnica de confección de los conformadores oculares para corregir la ptosis del párpado superior y lograr la expansión gradual de la cavidad, así como la confección de la prótesis ocular individualizada, con el objetivo de alcanzar los requerimientos funcionales y estéticos esperados. (AU)
Ocular trauma is the most frequent cause of eye loss worldwide. It can occur at any stage of life, with a higher incidence in childhood. Management can be surgical, surgical - prosthetic or prosthetic. We describe individualized prosthetic rehabilitation in a clinical case of upper eyelid ptosis, collapse and muscle atrophy due to lack of function following evisceration in a traumatic unilateral ocular injury approximately 56 years previously. We describe the technique for making ocular shapers to correct ptosis of the upper eyelid and achieve gradual expansion of the cavity, as well as the preparation of an ocular prosthesis to fulfill the expected functional and esthetic requirements. (AU)
Subject(s)
Humans , Female , Aged , Eye Evisceration , Eye Evisceration/rehabilitation , Eye, ArtificialABSTRACT
O olho, responsável por um dos nossos cinco sentidos, é considerado a janela das nossas vidas, por onde observamos as paisagens, vivenciamos experiências e registramos as imagens. A ausência parcial ou total desse orgão pode acarretar problemas funcionais, estéticos, pessoais e sociais ao seu portador. Por se encontar na região da face, aréa considerada nobre para a identidade do indivíduo, a deformidade ocular acaba sendo muito constrangedora ao mesmo, dificultando sua interação com o próximo e afetando diretamente seus aspectos psicológicos. O objetivo deste trabalho é apresentar um relato de caso clínico de reabilitação com prótese ocular. Dessa forma foi realizado a seguinte sequência clínica: Moldagem da cavidade ocular, prova e ajustes da esclera artificial, pintura da íris artificial e instalação da prótese finalizada. O tratamento reabilitador possibilitou a restauração da harmonia facial e, com isso, devolveu a autoestima perdida do indivíduo, reinserindo-o à sociedade(AU)
The eye, responsible for one of our five senses, is considered the window of our lives, through which we observe the landscapes, experience and record the images. The partial or total absence of this organ can cause functional, aesthetic, personal and social problems to its bearer. Because it is found in the region of the face, which is considered noble for the identity of the individual, the eye deformity ends up being very embarrassing to it, making it difficult to interact with others and directly affecting their psychological aspects. The aim of this paper is to present a case report of rehabilitation with ocular prosthesis. Thus, the following clinical sequence was performed: Ocular cavity molding, testing and adjustments of the artificial sclera, painting of the artificial iris and installation of the finished prosthesis. The rehabilitative treatment enabled the restoration of facial harmony and, thus, returned the lost selfesteem of the individual, reinserting him to society(AU)
Subject(s)
Humans , Male , Adult , Acrylic Resins , Anophthalmos , Eye, Artificial , EstheticsABSTRACT
PURPOSE: To evaluate and compare the efficacy and sensation of instillation between 0.05% cyclosporine nanoemulsion group and microemulsion group. METHODS: This is a double-blind, prospective randomized clinical trial. Patients had 2 weeks of wash-out period before the study. They were randomly assigned to either nanoemulsion group or microemulsion group and treated with each group's cyclosporine eye drop. Artificial eye drop and topical steroid were used together according to severity of dryness of cornea. We checked every patient's Break-up time (BUT), Schirmer test, Staining Score and Ocular surface disease index (OSDI) on baseline, 1 month and 3 months after. Patients also self-checked frequency of use of artificial eye drop and topical steroid. Sensation of instillation was also checked. RESULTS: Both nanoemulsion eye-drop and microemulsion eye-drop improved BUT, Schirmer test, Staining Score and OSDI throughout 12 weeks. The nanoemulsion type reduced OSDI significantly compared to the microemulsion type. The mean frequency of use of artificial tear and topical steroid was similar in both groups. Foreign body sense score was higher in microemulsion group. CONCLUSIONS: 0.05% cyclosporine nanoemulsion type has simillar efficacy and subjectively less foreign body sensation.
Subject(s)
Humans , Cornea , Cyclosporine , Dry Eye Syndromes , Eye, Artificial , Foreign Bodies , Prospective Studies , Sensation , TearsABSTRACT
PURPOSE: We sought to evaluate the outcomes of external dacryocystorhinostomy (DCR) and mono-canalicular intubation in patients with total obstruction of one canalicus. METHODS: Sixteen eyes of 16 patients with nasolacrimal duct obstruction and a single canaliculus obstruction who had undergone external DCR and monocanalicular intubation of the intact canaliculus were retrospectively included in the present study. The monocanalicular tube (Mini Monoka) was left in place for at least two months. Munk epiphora grading for the evaluation of epiphora and irrigation was performed both preoperatively and at 6 months postoperatively. RESULTS: Mean patient age was 46 ± 14.2 (range, 18 to 76) years. The inferior canaliculus was obstructed in nine eyes (group A) and the superior canaliculus was obstructed in seven eyes (group B), respectively. Eight eyes had chronic dacryocystitis and two of these eyes also had a history of acute dacryocystitis attack. Mean preoperative Munk scores were 3.89 in group A and 4.0 in group B. Ocular surface irritation occurred in one eye in group A. Artificial eye drops were prescribed and early tube removal was not performed. Spontaneous tube dislocation was recorded in one eye in group B. No other corneal, punctal, or canalicular complications were found. At six months, irrigation of intact canaliculus was patent in all eyes. Mucoid discharge, conjunctival hyperemia, and chronic conjunctivitis were also resolved. Postoperative Munk scores were 1.11 ± 0.9 in group A and 0.86 ± 0.9 in group B. Of note, preoperative and postoperative Munk scores were significantly different in both groups (group A, p = 0.006; group B, p = 0.017). The postoperative Munk scores were not statistically different between the two groups (p = 0.606). CONCLUSIONS: In patients with nasolacrimal duct obstruction and a total of one canaliculus obstruction, external DCR and monocanalicular intubation of the intact canaliculus is an effective surgical option.
Subject(s)
Humans , Conjunctivitis , Dacryocystitis , Dacryocystorhinostomy , Joint Dislocations , Eye, Artificial , Hyperemia , Intubation , Lacrimal Apparatus Diseases , Lacrimal Duct Obstruction , Nasolacrimal Duct , Retrospective StudiesABSTRACT
O objetivo desse estudo foi avaliar a influência de diferentes ciclos e métodos de polimerização da resina acrílica (RA) branca de próteses oculares sobre a biocompatibilidade de células da conjuntiva humana e resposta inflamatória do tecido subcutâneo de ratos. Para isso, foram confeccionados corpos de prova em RA termopolimerizados em água aquecida (RNAA), por energia de microondas (RNTM) e quimicamente ativados (RNQA). Para a análise in vivo, a resposta inflamatória desses 3 grupos (n=20/grupo) foi avaliada no tecido subcutâneo de 20 ratos Wistar por 7, 15, 30 e 60 dias (d). Células inflamatórias foram contadas no tecido adjacente ao corpo de prova após coloração com hematoxilina e eosina. A análise imunohistoquímica foi realizada para a detecção de IL-1ß, IL-6, TNFα, IL-17 e CCL20. Para a análise in vitro, diferentes ciclos de polimerização para cada método citado foram avaliados, totalizando 11 grupos (n=8/grupo). Foram realizadas análises de grau de conversão (GC), MTT, Alamar Blue, ELISA, RT-PCR em tempo real e dupla marcação de Anexina V e iodeto de propídio. Dados quantitativos foram submetidos à Análise de Variância e ao teste de Tukey com significância de 5%. Os resultados qualitativos foram comparados visualmente. Na análise in vivo, houve infiltrado inflamatório moderado para os grupos RNTM e RNQA e leve para o grupo RNAA após 7 d. O infiltrado inflamatório e a imunomarcação dos alvos testados diminuiu gradativamente ao longo dos 60 d. O grupo RNTM exibiu mais células inflamatórias, com exceção do grupo RNAA, que apresentou mais eosinófilos e linfócitos após 15 d, e do grupo RNQA, onde foi observado mais macrófagos em 15 d e neutrófilos em 60 d. Os grupos RNAA e RNQA apresentaram maior imunomarcação de IL-1ß após 7 d. O grupo RNQA apresentou maior imunomarcação de IL-1ß (15 e 30 d), IL-6 (30 e 60 d), IL-17 (15 e 30 d) e TNF-α (7 d). Os grupos RNAA e RNTM apresentaram maior imunomarcação de TNF-α nos períodos de 15 e 30 d, enquanto o grupo RNTM, aos 60 d. Na análise in vitro, todos os grupos apresentaram proliferação celular maior que 75%. O ciclo longo de polimerização em microondas apresentou menor GC e percentual de proliferação celular no MTT e resultou em grande liberação de IL-2. No ensaio de Alamar Blue, esse grupo apresentou baixo percentual de proliferação celular, assim como o grupo que recebeu ciclo longo de polimerização em água aquecida e grupos submetidos à ativação química. Maior liberação de IL-6 foi observada nos grupos submetidos à ativação química e de IL-23 para o ciclo curto de polimerização em microondas. Maior expressão gênica de TGF ß1 ocorreu para o grupo que recebeu ciclo longo de polimerização em água aquecida seguido de 30 min de armazenamento em água. Maior expressão gênica de CASP9 ocorreu para o grupo ativado quimicamente sobre a bancada. Pode-se concluir que os métodos de polimerização por meio de energia de microondas (ciclos longo e curto) e por ativação química desencadearam uma resposta inflamatória mais intensa. Dentre os métodos de polimerização recomendados pelo fabricante, a polimerização em água aquecida apresentou resultados mais satisfatórios(AU)
The aim of this study was to evaluate the influence of different cycles and methods of white color acrylic resin (AR) for ocular prosthesis on the biocompatibility of human conjunctival cells and on the inflammatory response of rat subcutaneous tissue. For this, AR specimens were prepared in water bath (NRWB), by microwave energy (NRME), and chemically activated (ANR). For in vivo analysis, the inflammatory response of these 3 groups (n=20/group) was assessed in subcutaneous tissue of 20 Wistar rats at 7, 15, 30 and 60 days (d). Inflammatory cells were counted in the tissue adjacent to specimen after staining with hematoxylin and eosin. The immunohistochemical analysis was performed for the detection of IL-1ß, IL-6, TNFα, IL-17, and CCL20. For in vitro analysis, different cycles of polymerization for each method were evaluated, with a total of 11 groups (n=8/group). The degree of conversion (DC), MTT, ELISA, real-time RT-PCR and Annexin V and propidium iodide assays were performed. Quantitative data were submitted to Analysis of Variance and Tukey test with a 5% significance. Qualitative data were submitted to visual comparison. In in vivo analysis, there was a moderate inflammatory infiltrate for groups NRME and ANR, and a light infiltrate for the group NRWB after 7 d. The inflammatory infiltrate and the immunolabeling of tested targets decreased gradually during the 60 d. The group NRME exhibited the highest number of inflammatory cells, except for the group NRWB, which presented a higher number of eosinophils and lymphocytes after 15 d, and for the group ANR, where a higher number of macrophages and neutrophils were observed at 15 d and at 60 d, respectively. Groups NRWB and ANR showed higher IL-1ß immunolabeling after 7 d. The group ANR had the highest immunolabeling of IL-1ß (15 and 30 d), IL-6 (30 and 60 d), IL-17 (15 and 30 d), and TNF-α (7 d). Groups NRWB and NRME showed greater immunolabeling in the periods of 15 and 30 d, while the group NRME had also high results at 60 d. In in vitro analysis, all groups showed cell proliferation higher than 75%. The long cycle of polymerization using microwave energy resulted in lower DC and lower percentage of cell proliferation in the MTT assay and in large release of IL-2. In the Alamar Blue assay, this group had a low percentage of cell proliferation, as well as the group that received a long cycle of polymerization in water bath and groups submitted to chemical activation. A higher release of IL-6 was observed in groups submitted to chemical activation and of IL-23, for the short cycle of polymerization in microwave. Higher TGF ß1 gene expression occurred for the group that received long cycle of polymerization in water bath followed by 30 min of storage in water. Higher CASP 9 gene expression occurred for the chemically activated group on bench. It can be concluded that the polymerization by microwave energy (long and short cycles) and by chemical activation resulted in higher inflammatory response. Among methods recommended by the manufacturer, the water bath polymerization showed more satisfactory results(AU)
Subject(s)
Acrylic Resins , Materials Testing , Eye, Artificial , Biocompatible Materials , Rats, Wistar , Cytotoxicity, Immunologic , PolymerizationABSTRACT
OBJECTIVES: The iris is the part of the eye that is colored, and it is an important feature in making an artificial eye. To address the lack of information about the brown Korean irises, we classified the colors and patterns of the irises of 100 Korean eyes. METHODS: The iris colors were extracted from 100 different digital photographs of each eye using K-mean clustering image analysis. The RGB data of the extracted colors were converted to CIELAB color space data and analyzed to determine the representative color of the iris in each photograph. The color differences were calculated to form groups of similar colors by matching the 100 samples into several groups with minimum color differences among them. The average hue value for each group was calculated, and the corresponding representative color was selected from 2 to 3 colors in one group. RESULTS: The iris colors were classified into seven brown color groups with 2 to 3 colors in each group. The coloration of Koreans' eyes appears to vary in a similar hue with differences in chroma and lightness. In addition, the iris patterns were classified into three basic patterns, namely, crown, sunshine, and flower, as well as three complex patterns that are mixtures of two basic patterns. CONCLUSIONS: We classified Korean iris colors and patterns for application in the design of artificial eyes.
Subject(s)
Humans , Asian People , Classification , Crowns , Eye, Artificial , Flowers , Iris , SunlightABSTRACT
La constante evolución de la Implantología en los últimos años, ha logrado que el implante oseointegrado, sea un medio de anclaje eficaz y seguro, para las prótesis buco-maxilo-faciales. Los altos índices de éxito, que surgen de los estudios clínicos, confirman que los implantes oseointegrados son el tratamiento de elección para determinados pacientes1. El objetivo de este trabajo es la presentación de un caso clínico, en el que se instalaron implantes orales, para anclaje de una prótesis orbitaria. El paciente fue atendido en la Facultad de Odontología de la Universidad de la República, en el Servicio de Prótesis Buco Maxilo Facial, conjuntamente con el Departamento de Implantología Oral y MaxiloFacial
The constant evolution of implantology in recent years has made osseointegrated implants an effective and safe anchorage tool for oral-maxillofacial prostheses. High success rates in clinical studies confirm that osseointegrated implants are the treatment of choice for certain patients. The aim of this paper is to present a clinical case in which oral implants were placed to anchor an orbital prosthesis. The patient was treated at the School of Dentistry of Universidad de la República, at the Oral-Maxillofacial Prostheses Service, jointly with the Department of Oral and Maxillofacial Implantology
Subject(s)
Humans , Maxillofacial Prosthesis Implantation , Orbital Implants , Eye, ArtificialABSTRACT
Anoftalmia es la ausencia de un ojo, puede ser unilateral o bilateral y su prevalencia es baja. Resulta de la detención del desarrollo del globo ocular durante la organogénesis. Pacientes de 25, 23 y 22 años, hermanas, presentan anoftalmia congénita unilateral derecha, bilateral y unilateral izquierda respectivamente. Único antecedente mórbido familiar es que su bisabuelo paterno también padecía anoftalmia congénita unilateral derecha. Fueron remitidas desde el Hospital Clínico Regional a la Clínica de Traumatología y Prótesis Máxilo Facial de la Universidad de Concepción para tratarlas desde sus primeros meses de vida. El tratamiento incluyó el uso de conformadores secuenciales para expandir las cavidades oculares y posteriormente se confeccionaron prótesis oculares individuales. La rehabilitación de la anoftalmia congénita es todo un desafío. La intervención temprana, como lo fue el caso de estas pacientes, hace una gran diferencia en el desarrollo general del paciente y el bienestar emocional de la familia
Anophthalmia is the absence of an eye. This may be unilateral or bilateral and its prevalence is low. It results from developmental arrest of the globe during organogenesis. Three patients aged 22, 23 and 25, sisters, have congenital unilateral right-sided, bilateral and unilateral left-sided anophthalmia respectively. The only family history element is that their paternal great-grandfather also suffered from congenital unilateral right-sided anophthalmia. They were sent from the Regional Clinical Hospital to the Clinic of Trauma and Maxillofacial Prosthetics at Universidad de Concepción to be treated from their first months of life. The treatment included the use of sequential conformers to expand the eye sockets, and then individual ocular prostheses were prepared and installed. The rehabilitation of congenital anophthalmia is a major challenge. Early intervention, as was the case with these patients, makes a significant difference on the overall development of the patient and on the emotional well-being of the family
Subject(s)
Adult , Anophthalmos , Eye, ArtificialABSTRACT
O controle da formação de biofilme é essencial para manter a saúde da cavidade anoftálmica dos portadores de prótese ocular. As propriedades físicas da resina acrílica, como a sua rugosidade, podem interferir na adesão de microrganismos nas próteses e na formação de biofilmes. Sendo assim, é necessário utilizar soluções de limpeza eficazes e que não causem irritação tecidual na conjuntiva ocular. O objetivo desse trabalho foi verificar a influência da rugosidade de superfície da resina acrílica utilizada na confecção de próteses oculares na formação de biofilme bacteriano, bem como avaliar a eficácia antimicrobiana e citotoxicidade de diferentes soluções para desinfecção de próteses oculares. Para a análise da rugosidade, corpos de prova de resina acrílica foram confeccionados e divididos em 5 grupos de acordo com a granulação de lixa de polimento utilizada: 120, 400, 800, 1200 e 1200S (lixa + sílica). A rugosidade dos corpos de prova foi mensurada por meio de perfilômetro e imagens de Microscopia de Força Atômica foram obtidas para cada grupo. O crescimento das espécies Staphylococcus aureus e Staphylococcus epidermidis sobre os corpos de prova foi avaliado após 4 e 24h, por meio da contagem das Unidades Formadoras de Colônia (UFC)/mL. O efeito dos seguintes tratamentos: soro fisiológico, sabão neutro, clorexidina 4%, pastilhas efervescentes Efferdent®, triclosan 1% e citronela sobre biofilme formado sobre os corpos de prova de resina acrílica também foi avaliado por meio da determinação do número de UFC/mL. A citotoxicidade dos agentes antimicrobianos foi avaliada por meio dos testes de MTT e Neutral Red, após tratamento dos corpos de prova, diariamente, por 1, 7, 15, 30, 60 e 90 dias com as soluções já citadas, sendo avaliados ao fim de cada período. Os dados obtidos foram submetidos à análise estatística adequada, considerando se provinham de dados paramétricos ou não paramétricos. Os resultados demonstraram que os menores valores de rugosidade foram encontrados no grupo 800, 1200 e 1200S. A contagem microbiana foi menor no grupo 1200S e esta diferiu estatisticamente (p>0,05) do controle para ambos os tempos de avaliação e bactérias. Na análise da ação antimicrobiana das soluções para desinfecção, todos os protocolos promoveram redução do crescimento dos microrganismos testados comparados ao controle (crescimento sem a presença do antimicrobiano), sendo que os grupos submetidos ao tratamento com clorexidina 4%, pastilhas efervescentes Efferdent® e triclosan 1% eliminaram o biofilme (p>0,01). Ainda nos ensaios de citotoxicidade, em todos os grupos foi observada proliferação celular das células da conjuntiva acima de 84% (p>0,05). Dessa forma, conclui-se que a rugosidade não interfere significativamente na adesão bacteriana e formação de biofilme, exceto para o grupo 1200S, e que os protocolos de limpeza com imersão em clorexidina 4%, pastilhas efervescentes Efferdent® e triclosan 1% são totalmente eficazes na desinfecção e não apresentam citotoxicidade para com as células da conjuntiva humana, sugerindo sua indicação para desinfecção de próteses oculares(AU)
The control of biofilm formation is essential to maintain the health of anophthalmic cavity of ocular prosthesis wearers. The physical properties of the acrylic resin, such as surface roughness, may interfere with the adhesion of microorganisms to the prostheses. Therefore, it is necessary to use cleaning solutions that are effective and do not cause tissue irritation in ocular conjunctiva. The aim of this study was to verify the influence of surface roughness of the acrylic resin used in the preparation of ocular prosthesis in the formation of bacterial biofilm, as well as to evaluate the antimicrobial efficacy and cytotoxicity of different disinfectants in ocular prostheses. For roughness analysis, acrylic resin samples were prepared and divided into 5 groups according to the granulation of polishing sandpaper used: 120, 400, 800, 1200 and 1200S (sandpaper + silica). The roughness of the samples was measured using a profilometer and Atomic Force Microscopy images were obtained for each group. The microbial growth for Staphylococcus aureus and Staphylococcus epidermidis on the samples was evaluated after 4 and 24 h by counting the Colony Forming Units (CFU)/mL. The effect of the following solutions was also evaluated by CFU/mL: non treated group (immersed in saline solution), neutral soap, 4% chlorhexidine, Efferdent® effervescent tablets, 1% triclosan and citronella. The cytotoxicity of the solutions was evaluated by MTT and Neutral Red after treating the samples daily for 1, 7, 15, 30, 60 and 90 days with the solutions already mentioned, being evaluated at the end of each period. Data were submitted to proper statistical analysis, considering whether data were parametric or non-parametric. The results showed that the lowest roughness values were found in groups 800, 1200 and 1200S. 1200S group also presented the lowest values of microbial growth statistically different from control group (p>0,05), for both periods and bacteria evaluated. In the analysis of the solutions, compared to the control group (microbial growth without the presence of the antimicrobial), all protocols promoted a reduction in the growth of the microorganisms, and the groups submitted to disinfection with 4% chlorhexidine, Efferdent® effervescent tablets and 1% triclosan eliminated the biofilm (p>0,01). In addition, all groups showed cell proliferation of conjunctival cells above 84% in the cytotoxicity assays (p>0,05). Thus, it was concluded that the roughness does not significantly interfere in the adhesion of the microorganisms, except for group 1200S, and that the cleaning protocols with 4% chlorhexidine, Efferdent® effervescent tablets and 1% triclosan are totally effective in the disinfection and do not present cytoxicitiy with human conjunctive cells, what suggests their indication for cleaning of ocular prosthesis(AU)
Subject(s)
Acrylic Resins , Biofilms , Disinfection , Eye, Artificial , Surface Properties , ToxicityABSTRACT
The purpose of this study was to evaluate acrylonitrile butadiene styrene (ABS) and polyamide implants in rabbits submitted to evisceration at the macroscopic and microstructure level and to assess clinical response and histopathological changes as well. For the experimental study implants of 12mm diameter were prepared by rapid prototyping, weighed and the outer and inner surfaces evaluated macroscopically and by electron microscopy. In addition, a compression test was performed and ultrastructural damage was then determined. After evisceration of the left eyeball, nine New Zealand rabbits received ABS implants and nine others received polyamide implants. The animals were assessed daily for 15 days after surgery and every seven days until the end of the study (90 days). Histopathological evaluation was performed at 15, 45 and 90 days after surgery. The ABS implants weighed approximately 0.44g, while the polyamide ones weighed 0.61g. Scanning electron microscopy demonstrated that the ABS implants had regular-sized, equidistant micropores, while the polyamide ones showed micropores of various sizes. The force required to fracture the ABS implant was 14.39 ±0.60 Mpa, while for the polyamide one, it was 16.80 ±1.05 Mpa. Fifteen days after surgery, we observed centripetal tissue infiltration and scarce inflammatory infiltrate. Implants may be used in the filling of anophthalmic cavities, because they are inert, biocompatible and allow tissue integration.(AU)
Avaliou-se a macroscopia, a microestrutura, a resposta clínica e histopatológica de implantes de acrilonitrila butadieno estireno (ABS) e poliamida em coelhos submetidos à evisceração. Para o estudo experimental, os implantes foram elaborados por meio de prototipagem rápida, com 12mm de diâmetro, pesados e tiveram suas superfícies avaliadas macroscopicamente e por microscopia eletrônica de varredura. Adicionalmente, foi realizado ensaio de compressão para determinar a força necessária para fraturar os implantes. Após a evisceração do olho esquerdo, nove coelhos da raça Nova Zelândia receberam implantes de poliamida e nove outros receberam implantes de ABS. Os animais foram avaliados diariamente nos primeiros 15 dias após a cirurgia e a cada sete dias até o fim do período experimental (90 dias). Avaliação histopatológica foi realizada aos 15, 45 e 90 dias após a cirurgia. Os implantes de ABS pesaram 0,44g, e os de poliamida 0,61g. A microscopia eletrônica de varredura demonstrou que os implantes de ABS eram formados por microporos equidistantes, enquanto os de poliamida apresentavam microporos de vários tamanhos. A força necessária para fraturar os implantes de ABS foi de 14.39±0.60 Mpa, enquanto para os de poliamida foi de 16.80±1.05Mpa. Quinze dias após a cirurgia, foi observada infiltração fibrovascular centrípeta. Os implantes podem ser utilizados para correção de cavidades anoftálmicas por se mostrarem inertes, biocompatíveis e permitirem a infiltração tecidual.(AU)
Subject(s)
Animals , Rabbits , Biocompatible Materials/analysis , Eye Evisceration/veterinary , Eye, Artificial/veterinary , Polymers , Acrylonitrile/analysis , Butadienes/analysis , Microscopy, Electron, Scanning/veterinary , NylonsABSTRACT
Objetivos: Este artigo visa exemplificar uma parceria internacional técnico cientifica por meio da utilização de técnica idealizada e patenteada por pesquisadores brasileiros. Materiais e Métodos: Um grupo de pesquisadores brasileiros idealizou, pesquisou e patenteou uma técnica de obtenção e utilização de íris digitalizada na reabilitação protética ocular. A internacionalização do método foi decorrente do intercâmbio estabelecido entre professores do Brasil e do México.A permanência do pesquisador mexicano, por um período em que especializou e concluiu o curso de mestrado, junto aos colegas brasileiros, pôde oferecer conhecimento e treinamento na aplicação da técnica proposta. Resultados: São apresentados casos clínicos em que a reabilitação protética ocular foi realizada usando a técnica brasileira de íris digitalizada. Conclusão:Pesquisas brasileiras, principalmente na área da saúde, vêm tendo destaque internacional. A preocupação com a melhora da qualidade de vida torna relevantes nossos estudos e técnica sem âmbito mundial.
Objectives: This article aims to illustrate a scientific technical international relation ship through the use of technique created and patented by Brazilian researchers. Materials and Methods: A group of Brazilian researchers devised, researched and patented a technique of obtaining and using scanned iris in ocular prosthetic rehabilitation. The internationalization of the technique was due to technical and scientific partner ship between Brazilian and Mexican researchers. A Mexican researcher remained for a period in which he specialized and completed his masters course with the Brazilian team that was able to transfer knowledge and offer atraining in the application of the technique. Results: Three cases are shown, two Brazilian an done Mexican. Ocular Prosthetic rehabilitation of these cases was performed using the Brazilian technique of scanned iris. Conclusion: Brazilian research, especially in health, comes with international relevance. The concern with improving life quality makes our technical studies relevant world wide.
Subject(s)
Humans , Male , Female , Iris/metabolism , Eye, Artificial/adverse effects , Eye, Artificial/standards , Eye, Artificial , Rehabilitation/ethics , Rehabilitation/instrumentation , Rehabilitation/methods , Rehabilitation , Rehabilitation/trendsABSTRACT
RESUMO Objetivo: Avaliar a biocompatibilidade da Nanoskin para reposição de volume em cavidades enucleadas ou evisceradas de coelhos. Métodos: Estudo experimental, utilizando implantes de Nanoskin (Innovatecs®, São Carlos, Brasil), celulose bacteriana produzida pela bactéria Acetobacter xylinum tendo como substrato o chá-verde. Implantes de 10mm de diâmetro/5mm de espessura foram colocados em cavidades enucleadas (G1) ou evisceradas (G2) de 21 coelhos, avaliados clinicamente todos os dias, sacrificados aos 7, 30 e 90 dias após a cirurgia. O material foi removido e preparado para exame de microscopia óptica. Resultados: Sinais flogísticos discretos no pósoperatório imediato, não tendo sido evidenciados sinais infecciosos ou extrusão de nenhum implante. Houve aparente redução do volume ao longo do período experimental. Histologicamente ambos os grupos foram muito semelhantes, apresentando aos 7 dias células inflamatórias (predominantemente monócitos e neutrófilos), rede de fibrina e hemácias. A Nanoskin apresentava-se como pequenas esferas, de cor rósea, com pequenos espaços entre elas, permeados por escassas células inflamatórias. As células inflamatórias se modificaram ao longo de período experimental, sendo possível observar aos 30 dias células gigantes multinucleadas e fibroblastos maduros permeando o implante. Aos 90 dias, a estrutura do implante apresentava-se desorganizada, amorfa, com restos necróticos e com áreas ovoides, revestidas por fina membrana rósea, que pareciam se agrupar, vazias ou preenchidas por material acelular, róseo ou acinzentado. Conclusão: A Nanoskin provocou reação inflamatória que levou à reabsorção e redução do volume do implante. Novas formulações devem ser estudadas a fim de ter um produto que seja permanente para reparo da cavidade anoftálmica.
ABSTRACT Objective: The aim of this study was to evaluate the biocompatibility of Nanoskin for replacing volume in enucleated or eviscerated anophthalmic sockets of rabbits. Methods: An experimental study was carried out using enucleated or eviscerated rabbits, which received Nanoskin implants (Innovatecs®, São Carlos, Brazil), a cellulose produced by a bacteria (Acetobacter xylinum) using green tea as substrate. Implants of 10mm diameter/5mm of thickness were used placed in enucleated (G1) or eviscerated (G2) anophthalmic sockets of 21 rabbits.They were clinically examined daily, sacrificed at 7, 30 and 90 days after surgery and the material was removed and prepared for histological examination. Results: There were discrete signs of inflammation in the immediate postoperative period, with no evidence of infection or extrusion in any animal. However apparent reduction of volume during the trial period occurred. Histologically both groups were similar, with inflammatory cells (mainly monocytes and neutrophils), fibrin and hemaceas at 7 days postoperatively.The Nanoskin was presented as small pink spheres, with small gaps between them and permeated by few inflammatory cells. These cells have changed over the study, at 30 days multinucleated giant cells and mature fibroblasts that permeate the implant were observed. At 90 days, the structure of the implant was disorganized, amorphous, with necrotic debris and ovoid areas covered with thin pink membrane that seemed to cluster, empty or filled with no cellular pink or gray material. Conclusion: Nanoskin caused an inflammatory reaction leading to reabsorption and reduction of implant volume. New formulations should be studied in order to have a permanent product to repair the anophthalmic socket.
Subject(s)
Animals , Eye Enucleation , Eye Evisceration , Prosthesis Implantation , Orbital Implants , Eye, Artificial , Orbit/surgery , Rabbits , Biocompatible Materials , Biopolymers , Materials Testing , Cellulose , Anophthalmos/therapy , NanostructuresABSTRACT
A tentativa do homem em restaurar aloplasicamente a região bucomaxilofacial mutilada é tão antiga quanto a formação das civilizações, tendo em vista a importância do olho como uma das estruturas mais importantes na individualização e harmonia da face. Na atualidade, algumas entidades públicas promovem atendimentos a pacientes mutilados que necessitam de uma reabilitação por meio de Prótese Bucomaxilofacial (PBMF), sendo a maior procura pelas oftalmopróteses devido ao grande número de traumas nessa região da face. A prótese ocular é importante para reconstruir a estética, embelezar o rosto cuja harmonia está comprometida, promover a sustentação e a tonicidade muscular palpebral, proteger a cavidade anoftálmica, evitar atresias, entre outros. Tal reabilitação faz parte dos cuidados necessários e representa uma conquista de melhor qualidade de vida para os pacientes e suas famílias. Neste trabalho, os relatos de dois casos clínicos visam apresentar duas reabilitações com oftalmopróteses individualizadas em pacientes com idades diferentes e etiologia da anoftalmia também distintas que resultaram em estéticas favoráveis. Após a confecção das próteses, foi observado que a reabilitação protética anterior ao desenvolvimento ou agravamento de dificuldades de relações interpessoais tende a melhorar a qualidade de vida, visto que a queixa principal quando inexistente melhora o desenvolvimento psicossocial dos pacientes... (AU)
Mans attempt to restore so alloplastic the maxillofacialregion is as old as the formation of civilizations. Given the importance of the eye as the most significant structure in the individualization and harmony of the face. Nowadays some public entities promote special care to patients who need a mutilated rehabilitation through Maxillofacial Prosthodontics (MFP), the highest demand is for eye prosthesis due to the large number of injuries in this region of the face. The ocular prosthesis aims to reconstruct the aesthetic, beautify the face whose harmony is committed to promote and support the eyelid muscle tone, protect the anophthalmic socket, avoid closure, among others.Such rehabilitation is part of palliative care and is an achievement of better quality of life for patients and their families. In this study, reports of two cases aim to present two eye prosthesis individualized rehabilitation in patients with different ages and different etiology of anophthalmic also resulted in favorable aesthetic. Thus it can be concluded that the prosthetic rehabilitation prior to the development or worsening of interpersonal difficulties relations tends to improve the quality of life of patients, since the main complaint nonexistent improves psychosocial development of these... (AU)
Subject(s)
Humans , Male , Female , Child, Preschool , Middle Aged , Rehabilitation Services , Eye, Artificial , Quality of Life/psychologyABSTRACT
Introdução: A reconstrução de grandes defeitos da face nem sempre é passível de correção cirúrgica, podendo ser restaurados com as próteses faciais. Apesar da prótese óculopalpebral apresentar uma aparência natural, ela é facilmente notada, pois não apresenta os movimentos palpebrais de abertura e fechamento sincronizadas com o olho contralateral, tornando assim a reconstrução protética um grande desafio. Objetivos: Planejar, desenhar, viabilizar e construir um protótipo com recurso mecânico/elétrico possibilitando sincronia dos movimentos palpebrais com o olho sadio para utilização em prótese óculopalpebral. Material e Métodos: Confecção de uma prótese óculopalpebral com um dispositivo de pálpebra móvel em silicone médico capaz de conectar-se a um sistema mecânico-elétrico responsável por realizar movimentos de abertura e fechamento da pálpebra móvel da prótese. Resultados e Discussão: Foi confeccionada uma prótese óculo-palpebral em resina acrílica termicamente ativada, criando-se um nicho para a acomodação de um sistema elétrico e possibilitar a livre movimentação de uma fina pálpebra em silicone interligada ao dispositivo tornando possível a conexão desse sistema com um sensor que capta o movimento palpebral de um olho saudável. Conclusão: No presente estudo um protótipo mecânico - elétrico foi planejado, desenhado e desenvolvido acoplado a uma prótese óculopalpebral estabelecendo e sincronizando seus movimentos palpebrais com o olho sadio.
Introduction: Surgical reconstruction of large facial defects may not be always possible. Extraoral maxillofacial prosthesis are a good restorative option. Even though when the oculopalpebral prosthesis presents a natural appearance, it can be easily noticed because its eyelids do not move. It is desirable for the eyelids to open and close synchronously with contralateral eye. Thus, prosthetic reconstruction of oculopalpebral region is a great challenge. Objectives: To plan, design, enable and build a oculopalpebral prosthesis prototype with mechanical and electric features allowing eyelid motion with synchronization with the sound eye. Material and method: Fabrication of an oculopalpebral prosthesis with a medical grade silicone movable eyelid which has the capability to connect itself to an mechanical-eletrical system responsible to make opening and closing movements on prosthesis movable eyelid. Results and discussion: An oculopalpebral prosthesis was made in thermoactivated acrylic resin. A gap was created to accomodate an electrical system and also allow free motion of a thin silicone eyelid attached to the dispositive. This system can be connected to a sensor which captured the eyelid motion of a sound eye. Conclusion: A mechanical-electrical prototype was planned, designed and developed attached to an oculopalpebral prosthesis stablishing and synchronizing its eyelid movements with the sound eye.
Subject(s)
Humans , Male , Female , Adult , Prosthesis Design/ethics , Prosthesis Design/instrumentation , Prosthesis Design/methods , Eye, Artificial/adverse effects , Eye, Artificial , Maxillofacial Prosthesis/adverse effects , Maxillofacial Prosthesis/trends , Maxillofacial Prosthesis , Rehabilitation/organization & administration , RehabilitationABSTRACT
A Prótese Bucomaxilofacial é a especialidade odontológica responsável pelo estudo clínico e tratamento das malformações congênitas, distúrbios do desenvolvimento e mutilações patológicas ou traumáticas da região intra e extraoral da face. As perdas do globo ocular podem ser reparadas com o auxilio de próteses oculares, confeccionadas de modo individualizado, com características semelhantes ao olho são. O maior desafio é a obtenção da íris protética que deve ser cópia fiel da íris do olho remanescente para que a dissimulação da perda seja completa. Este trabalho, por meio de apresentação de caso clinico, traz um avanço de técnica para a obtenção de íris protética com sua digitalização.
The maxilofacial prosthetics is the dentistry speciality responsible for the clinical study and treatment of congenital malformations, developmental disorders and pathological or traumatic mutilations of intra and extra oral region of the face. The eye loss can be repaired with the help of ocular prostheses, made in a individualized way, with characteristics similar to the healthy eye. The biggest challenge is getting the prosthetic iris that should be a true copy of the remaining one to the loss concealment process is complete. This paper, through a case report, brings a technical advance to obtain prosthetic iris with your scan.
Subject(s)
Humans , Male , Middle Aged , Eye, Artificial , Rehabilitation , IrisABSTRACT
A prótese ocular é utilizada para a reabilitação estética e funcional da ausência ocular. O conhecimento da sua biocompatibilidade é importante para a utilização sem reações danosas aos usuários. O objetivo neste estudo foi avaliar a citotoxicidade de materiais utilizados na confecção de próteses oculares, por meio da análise da proliferação celular e da produção de citocinas pró-inflamatórias e de proteínas de matriz extracelular por células da conjuntiva humana. Inicialmente, foi analisada a influência de diferentes períodos de formação e de exposição dos extratos de resina acrílica branca (N1), termopolimerizada em água aquecida, sobre culturas de células da conjuntiva. Foram confeccionados 24 corpos de prova em resina, sendo 12 para cada período de exposição de células da conjuntiva aos extratos da resina testada (24 e 72 horas). Após a formação dos extratos por 24, 48 e 72 horas de imersão em meio de cultura e, 24 horas em água seguido de 24 horas de imersão em meio, os ensaios propostos foram realizados (n=3). Em seguida, foi avaliado o efeito citotóxico de diferentes métodos de polimerização de resina acrílica N1 em células da conjuntiva. Foram confeccionados 9 corpos de prova em resina (n=3), termopolimerizados em água aquecida, por energia de microondas ou ativados quimicamente, utilizados para a formação dos extratos dessas resinas. Os extratos foram obtidos após 72 horas de imersão dos corpos de prova em meio de cultura e, então, expostos às células da conjuntiva por 72 horas para a realização dos ensaios propostos. Adicionalmente, foi analisada a influência da presença do pigmento acrílico na confecção da prótese de resina acrílica N1, termopolimerizada em água aquecida. Foram confeccionados 9 corpos de prova (n=3): resina N1, resina N1 + pigmento e, pigmento, utilizados para a formação dos extratos desses materiais. Os extratos formaram-se por 72 horas de imersão dos corpos de prova em meio de cultura e, então, foram expostos às células da...
Ocular prosthesis is a treatment option for esthetical and functional rehabilitation of ocular absence. The knowledge of ocular prosthesis materials biocompatibility is important to ensure a safe use in patients. The aim of this study was to evaluate the cytotoxic effect of ocular prosthesis materials, through the analysis of the cell proliferation, and the production of proinflammatory cytokines and extracellular matrix proteins by a human conjunctival cell line. Initially, the influence of different preparation and exposition periods of eluates from heat-polymerized ocular prosthesis N1 color acrylic resin in human conjunctival cell line was evaluated. A total of 24 acrylic resin samples were manufactured and divided into 2 groups, according to the eluate exposition period to conjunctival cell line (24 and 72 hours). Eluates corresponding to 24, 48 and 72 hours of resin sample immersion in medium and, 24 hours of resin sample immersion in water followed by 24 hours of immersion in medium, were prepared (n=3) for the proposed tests. Then, the cytotoxic effect of different polymerization methods of ocular prosthesis N1 color acrylic resin was analyzed. A total of 9 acrylic resin samples were manufactured (n=3), according to the polymerization method: heat-polymerization in water bath, polymerization by microwave energy and auto-polymerization. Eluates corresponding to 72 hours of resin sample immersion in medium were prepared for proposed tests and exposed to conjunctival cell line for 72 hours. Additionally, the influence of pigment incorporation on the cytotoxicity of heat-polymerized ocular prosthesis N1 color acrylic resin was evaluated. A total of 9 samples were manufactured (n=3): N1 color acrylic resin without pigment incorporation, N1 color acrylic resin with pigment incorporation, and acrylic pigment. Eluates corresponding to 72 hours of sample immersion in medium were prepared and exposed to conjunctival cell line for 72 hours. The cytotoxic effect...
Subject(s)
Acrylic Resins , Cytotoxicity, Immunologic , Eye, Artificial , Materials TestingABSTRACT
PURPOSE: To investigate the clinical results of patients who have undergone simultaneous dermo-fat graft and insertion of orbital implants in patients who are unable to put on an ocular prosthesis due to severe conjunctival sac contracture or large orbital implant exposure. METHODS: A retrospective analysis was performed of patients who underwent dermo-fat graft simultaneously with orbital implant insertion for replacement of the conjunctival sac from 2007 to 2012. Eight eyes were enrolled in this study and all patients were followed up for phthisis bulbi or implant exposure. RESULTS: Among the eight eyes, five eyes (62.5%) that were diagnosed with orbital implant exposure underwent orbital implant exchange and dermo-fat graft, and two eyes (25%) were anophthalmic enophthalmic patients and underwent secondary orbital implant insertion and dermo-fat graft. One patient (12.5%) underwent orbital implant insertion and dermo-fat graft simultaneously during the evisceration operation. We followed the progress for 46.3 months. For seven out of eight eyes, the results of the wound healing process were successful. One patient underwent removal and reinsertion of the orbital implant with dermo-fat graft, and the wound in this case healed well. However, after five months, dermo-fat re-graft was performed for orbital implant re-exposure and it was not exposed thereafter. Overall cosmetic appearance was satisfactory in each patient, and all patients were able to comfortably retain a prosthesis. CONCLUSIONS: We found that undergoing dermo-fat graft simultaneously when performing orbital implant insertion is effective for replacement of the conjunctival sac and orbital volume.
Subject(s)
Humans , Anophthalmos , Contracture , Eye, Artificial , Orbit , Orbital Implants , Prostheses and Implants , Retrospective Studies , Transplants , Wound Healing , Wounds and InjuriesABSTRACT
O presente trabalho visa apresentar um caso clínico de perda bilateral do globo ocular, descrevendo a técnica utilizada na confecção de prótese ocular realizada por graduandos em Odontologia da Escola Bahiana de Medicina e Saúde Pública-EBMSP. A face possui enorme valor estético e expressivo para as pessoas bem como para suas relações em sociedade. Alterações na face geradas pela perda ou atrofia ocular decorrente de traumatismo podem estar relacionadas a diferentes causas e apresentar variados graus de severidade. Os autores apresentam um caso de perda ocular bilateral em um adulto de 57 anos de idade, cujo globo ocular direito apresenta-se atrofiado e o esquerdo havia sido enucleado, ambos decorrentes de trauma. Pacientes portadores de deformidade ocular sofrem de distúrbios funcionais, estéticos e psicológicos. A prótese bucomaxilofacial procura minimizar tais distúrbios com a reabilitação protética, além de reintegrar o indivíduo na sociedade.
This study presents a case of bilateral loss of the eyeball, describing the technique used in the production of ocular prostheses made by dental students at the Medicine and Public Health School of Bahia (Brazil)-EBMSP. The face has great aesthetic and expressive value for people and their relations in society. Alterations in the face as a result of loss or atrophy due to ocular trauma have varied degrees of severity and may be related to different causes. The authors present a case of a 57 years old patients whose right eye was atrophied and the left had been enucleated, due to a trauma. Patients with ocular deformity suffer from functional, aesthetic, and psychological disorders. The bucomaxillofacial prosthesis can be considered an alternative to minimize these disorders with prosthetic rehabilitation, and help to reinstate the individual in society.