An Innovative Technique of Iris Positioning Using Digital Photographs for Custom Ocular Prosthesis: A Case Report.

Trauma, cancer, and congenital abnormalities are the three main causes of eye loss. A person's personal and professional life is left with functional, aesthetic, and psychological problems when they lose one eye. A customized ocular prosthesis made of heat-cured polymethylmethacrylate can be used to restore an eye defect. Fabrication of the customized ocular prosthesis has multiple steps including scleral plank fabrication, iris positioning, and characterization. This article's primary goal is to explain a novel method for iris positioning for better cosmetic outcomes.

A Case Report on Iris Disk Positioning on a Custom-Made Ocular Prosthesis Using an Adjustable Trial Frame.

Trauma, cancer, and congenital defects may all result in the loss of an eye. This leads to significant emotional and physical challenges in an individual's life. In such cases, cautious preoperative, surgical, and prosthetic planning employing a multidisciplinary approach is essential for effective rehabilitation. Iris positioning is one of the crucial steps in the fabrication of a customized ocular prosthesis. Iris positioning is a technique-sensitive process, hence visual evaluation by itself could not provide reliable results. This case report illustrates a method of iris disk positioning on a custom-made ocular prosthesis using an adjustable trial frame. The advantage of the adjustable mechanism of the adjustable trial frame was utilized here to position the iris on the scleral blank. Since the iris disk on the ocular prosthesis was positioned in symmetry with that of the natural eye, the patient's aesthetics were restored.

Construction of Custom Ocular Prosthesis With Reduced Number of Visits: A Case Report.

Construction of an ocular or eye prosthesis can be challenging, as it is a cosmetic device. It needs good communication between dentists and maxillofacial technicians. The construction process normally requires multiple appointments, which involve at least four visits starting with ocular impression to insertion of the prosthesis. This article will outline the clinical step and propose a clinical technique to reduce the number of appointments from four to three appointments, which would benefit both the patient and practitioner.

Revolutionizing Maxillofacial Rehabilitation for Ocular Defects: The Impact of Three-Dimensional Printing and Sublimation Transfer Technique on Changing Horizons.

An absence or any disfigurement to the eye leads to psychological handicap for the patient. An ocular defect is a defect of an eye because of a cyst, road traffic accident, or enucleation of an eye due to infection. While correcting this type of defect, maxillofacial prosthodontists should consider all aspects such as esthetics, comfort, and functions of the ocular prosthesis, which gives a lifelike appearance to the prosthesis. A prosthetic eye wearer patient complained of asymmetry and opaque appearance of the ocular prosthesis. The patient had lost his eye in a road traffic accident and has been wearing a prosthesis for 8-12 months but is not pleased with how the prosthesis looks. A novel prosthesis created by the use of sublimation transfer technology and three-dimensional printing to improve the esthetics exactly replicates the contralateral normal eye. In a proposed case report, an algorithm for the fabrication of customized ocular prostheses was improved. A smooth blend of conventional as well as digital methods is used to optimize the results.

New Devitalized Freeze-Dried Human Umbilical Cord Amniotic Membrane as an Innovative Treatment of Ocular Surface Defects: Preclinical Results.

A preclinical study was performed to investigate the efficacy and safety of a new viral inactivated, devitalized, freeze-dried and gamma-sterilized human umbilical cord amniotic membrane (lhUC-AM) for the treatment of deep scleral and corneal defects with or without perforation. Firstly, lhUC-AM was investigated on experimental deep sclerectomy in rabbit eyes (n = 12) and compared to autograft (n = 4) on cross section histology. Secondly, lhUC-AM was studied on a selected series of uncontrolled cases of corneal defects (n = 18) with or without perforation, in dogs and cats. lhUC-AM tolerance, reconstruction of the deep corneal lesion and recovery of the structural aspect of the tissue were followed post-surgery. In experimental deep sclerectomy, histology showed that the lhUC-AM was well tolerated and degraded completely in 45 days while allowing an overall quality and kinetic of scleral regeneration, similar to autograft. In the clinical situations, lhUC-AM was well tolerated, with ocular inflammatory signs quickly decreasing after surgery. Mean follow-up was 16.40 ± 11.43 months. In 15 out of 18 cases, lhUC-AM allowed ocular surface wound healing. The ocular surface was fully reconstructed three months after surgery. This study suggests a good safety and efficacy profile of lhUC-AM in the treatment of deep corneal or scleral defect in animals. This new tissue should now facilitate the treatment of severe ocular surface diseases in humans.

Clinical lessons learned in constitutional hypopituitarism from two decades of experience in a large international cohort.

CONTEXT: The international GENHYPOPIT network collects phenotypical data and screens genetic causes of non-acquired hypopituitarism. AIMS: To describe main phenotype patterns and their evolution through life. DESIGN: Patients were screened according to their phenotype for coding sequence variations in 8 genes: HESX1, LHX3, LHX4, PROP1, POU1F1, TBX19, OTX2 and PROKR2. RESULTS: Among 1213 patients (1143 index cases), the age of diagnosis of hypopituitarism was congenital (24%), in childhood (28%), at puberty (32%), in adulthood (7.2%) or not available (8.8%). Noteworthy, pituitary hormonal deficiencies kept on evolving during adulthood in 49 of patients. Growth Hormone deficiency (GHD) affected 85.8% of patients and was often the first diagnosed deficiency. AdrenoCorticoTropic Hormone deficiency rarely preceded GHD, but usually followed it by over 10 years. Pituitary Magnetic Resonance Imaging (MRI) abnormalities were common (79.7%), with 39.4% pituitary stalk interruption syndrome (PSIS). The most frequently associated extrapituitary malformations were ophthalmological abnormalities (16.1%). Prevalence of identified mutations was 7.3% of index cases (84/1143) and 29.5% in familial cases (n = 146). Genetic analysis in 449 patients without extrapituitary phenotype revealed 36 PROP1, 2 POU1F1 and 17 TBX19 mutations. CONCLUSION: This large international cohort highlights atypical phenotypic presentation of constitutional hypopituitarism, such as post pubertal presentation or adult progression of hormonal deficiencies. These results justify long-term follow-up, and the need for systematic evaluation of associated abnormalities. Genetic defects were rarely identified, mainly PROP1 mutations in pure endocrine phenotypes.

Custom-made ocular prosthesis for rehabilitation of missing parts of the face: A case report

Background@#Eyes are an important component of the face and vital organs of vision. Eye loss can be caused by congenital defects, trauma, or tumor. Loss of an eye produces physical abnormalities that pose a psychological burden on the patient, as well as visual function damage. An ocular prosthesis is an artificial maxillofacial prosthesis to replace the lost eye. @*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.

Fabrication of ocular prosthesis with a digital customization technique - A case report.

Loss of an eye can be caused by cancer, trauma, or congenital defects. A loss of eye creates functional, esthetic, and psychological lacunae in individual's personal and professional life. Rehabilitation of ocular defect can be done by a custom ocular prosthesis fabricated with heat cure polymethylmethacrylate. The custom-made prosthesis provides a better fit, is more comfortable to use and gives better cosmetic results than a stock prosthesis. The main objective of this article is to describe a new technique of customization using digital photograph of the patient's iris made using a digital camera to give excellent cosmetic results to the patient.

A comparative assessment of prosthetic outcome on enucleation and evisceration in three different etiological eye defects: A case series.

Enucleation and evisceration are the most common surgical procedures that are performed to manage tumor, trauma, and infection. Given the consequences of surgical intervention, the conditions of the remaining eye socket may affect future prosthetic rehabilitation. A custom-made ocular prosthesis can be used to help restore the esthetics and functional defects and to improve the quality of life of patients with such conditions. An assessment must be performed on the prosthetic outcome before rehabilitation. The etiology of defect, type of surgery, condition of the remaining socket, and patient's age should all be considered. This report discusses three different etiological eye defects that have undergone enucleation and evisceration and describes the factors that have a significant role in the esthetic and functional outcome of the prosthesis. This report should serve as a helpful aid for maxillofacial prosthodontists to understand the primary objective of rehabilitating each eye defect and to meet patient expectations.

A simplified approach to rehabilitate an ocular defect: Ocular prosthesis.

A 42-year-old male patient complaint with missing right eye was referred to the Department of Prosthodontics and Crown and Bridge. This patient was seeking artificial eye replacement. On careful clinical examination, a defect with a shrunken orbit and intact tissue bed was found in the patient. As the patient was economically very poor, modified stock ocular prosthesis was advised. To rehabilitate this ocular defect, "single" appointment technique with clinically available material was adopted, which is discussed in the present communication.

Prevalence of ocular defects among patients visiting in an institutionalized hospital setting: A cross-sectional study.

PURPOSE: The purpose of this study was to analyze the prevalence of ocular defect among different age groups, gender, side involved, and etiology. MATERIALS AND METHODS: A retrospective study was conducted among referred ocular defect patients in a dental college in southern part of India over a 5 years period (2008-2012). Information regarding general identification, gender, age, affected side, and etiology was collected. The collected data were analyzed and grouped according to different age groups, gender, side involved, and etiology. RESULTS: The ocular defects were more frequently observed in the young male population (66%). Trauma (46%) and pathogenic (44%) causes were the main reasons over nonspecific (8%) and congenital (2%) reasons. CONCLUSION: High prevalence of injuries and infections in young adults (mostly males) predominantly causing ocular bulb loss.

Simplified approach for prosthetic rehabilitation of an enucleated ophthalmic socket.

Physical defects that compromise appearance or function, prevents an individual from leading a normal life, prompt the individual to seek treatment that will reinstate an acceptable normalcy. The disfigurement associated with loss of an eye can cause significant physical and emotional problems. The role of maxillofacial prosthodontists in fabricating an ocular prosthesis with acceptable esthetics and restoring normal appearance is essential. This article presents simplified impression technique and fabrication of ocular prosthesis.

Morbilidad por defectos bucomaxilofaciales en las provincias orientales durante el período 2000-2013 / Morbidity due to oral maxillofacial defects in the eastern provinces during the period 2000-2013

Se realizó un estudio descriptivo y retrospectivo de 2441 pacientes, atendidos en el Servicio de Prótesis Bucomaxilofacial de Santiago de Cuba, desde el 2000 hasta el 2013, con vistas a caracterizar la morbilidad por defectos bucomaxilofaciales en los afectados. Hubo un promedio de 200 ingresos y 159 altas anuales de pacientes atendidos. La mayoría de los casos (63,8 %) pertenecieron a la provincia antes citada. Prevalecieron el sexo masculino (63,0 %), el grupo etario de 60 años y más (33,7 %), el nivel escolar primario (32,6 %), los defectos oculares (80,3 %) y el trauma (53,8 %). En los afectados de 0-19 años predominaron los defectos congénitos, en los de 40-59 los traumas, en personas de más de 60 años los oncológicos y por otras causas. Los defectos oculares se produjeron por traumas en 59,0 %, los nasales por causas oncológicas en 100,0 %, los craneales y auriculares por traumas en 78,6 y 76,5 %, respectivamente.

A descriptive and retrospective study of 2441 patients, assisted in the Service of Oral and Maxillofacial Prosthesis in Santiago de Cuba was carried out from the 2000 to 2013, aimed at characterizing the morbidity due to oral and maxillofacial defects in those affected. There was an average of 200 admissions and 159 annual discharges of assisted patients. Most of the cases (63.8%) belonged to the above mentioned province. Male sex (63.0%), the age group 60 years and over (33.7%), the primary school level (32.6%), the ocular defects (80.3%) and trauma (53.8%) prevailed. In the affected age group 0-19 years, the congenital defects prevailed, in the 40-59 years traumas prevailed, in patients over 60 years the oncological causes and others prevailed. Ocular defects were caused by traumas in 59.0%, the nasal defects were caused by oncological causes in 100.0%, the cranial and ears defects were due to traumas in 78.6 and 76.5%, respectively.

Rehabilitation of partially eviscerated eye with custom made ocular prosthesis-a case report.

Human eyes are the most precious gift from nature; presence of a pair of eye not only gives expression to life but also adds dignity to the face. The loss of an eye causes disfigurement of the face and causes anxiety, stress and depression in their life. The rehabilitation of patients with congenital or acquired defects of the eye is a challenging job. The aim of the rehabilitation is to restore the patient's normal appearance, comfort along with reasonable functional eye movements. This case report describes the rehabilitation of partially eviscerated eye of the patient with custom made ocular prosthesis.

A simplified approach for placing the iris disc on a custom made ocular prosthesis: report of four cases.

This case report describes a series of four cases of different age group, in which a simplified approach was applied for positioning the iris disc on a custom made ocular prosthesis. For each of the patient, a pre-fabricated eye was selected; whose iris and pupil closely matched that of the natural eye. This was duplicated for use as a tray in impression procedure. Iris portion of the stock eye was trimmed out and oriented on the cast according to previously transferred pupillary mark. This stock eye-wax pattern combination was tested in the eye socket, modified accordingly and finally cured in transparent heat cured acrylic resin. The technique to fabricate ocular prosthesis in present case reports modifies pre-fabricated eye prosthesis to a custom-made fit and aesthetics. This helped us to overcome the disadvantages of poor fit, inadequate movement and complex painting procedure and technique involved in making a custom-made ocular prosthesis. It can be concluded that close adaptation of the custom-made ocular prosthesis to the tissue bed provides maximum comfort and restores full physiologic function to the accessory organs of the eye.

Prosthetic Rehabilitation of Ocular Defect resulting from Pediatric Retinoblastoma.

Ocular defects result from tumor, congenital anomaly and external injury not only lead to serious impairment of function and esthetics but also make the patient psychologically disabled. Prosthetic rehabilitation attempts to restore these disfgurements may improve esthetic, level of function, general psychologic improvement and quality of life. This clinical report details an attempt to rehabilitate a pediatric patient who has undergone orbital enucleation resulting from retinoblastoma with the aid of custom ocular prosthesis using commercially available prefabricated eye shell. How to cite this article: Janya S, Gubrellay P, Purwar A, Khanna S. Prosthetic Rehabilitation of Ocular Defect resulting from Pediatric Retinoblastoma. Int J Clin Pediatr Dent 2014; 7(3):209-212.

The Ocular Prosthesis: A Novel Technique Using Digital Photography.

Loss of an eye can cause a significant psychological and emotional disturbance to any patient. An ocular prosthesis helps to re-establish the physical and mental well-being of the patient. This article describes a novel technique along with a case report for fabricating a predictable, esthetic and well-fitting custom-made ocular prosthesis in an attempt to avoid costly and time consuming procedures that may be required in other methods.

A multidisciplinary approach for ocular rehabilitation following surgical treatment of retinoblastoma: One year follow-up.

Retinoblastoma is a highly malignant neoplasm. Most of the cases are usually advanced at the time of detection, requiring enucleation to salvage the child's life. Just treating the patient for cancer is not enough; the cosmetic rehabilitation of these patients is equally important and it should always be an integral part of their treatment, to help them re-integrate in the aesthetic conscious society. Rehabilitating such patients require a multidisciplinary approach involving the combined and timely efforts of an ophthalmologist, paediatric oncologist and a skilled maxillofacial prosthodontist. This paper presents a case of 3½-year-old girl who had enucleation of her right eye due to retinoblastoma along with chemotherapy and radiotherapy at the age of 3 years. The patient was recalled regularly for follow-up at 3 month intervals for ophthalmic examinations and she was rehabilitated cosmetically with customised ocular prosthesis during the various stages of her developmental growth.

A palliative approach for rehabilitation of a pediatric patient with retinoblastoma.

Retinoblastoma is a highly malignant neoplasm. Most of the cases are usually far advanced at the time of detection, requiring enucleation to salvage the child's life. However, the cosmetic rehabilitation of these patients should always be an integral part of their treatment, which helps in their re-integration in the society. This paper presents a case of 5-year-old patient who had undergone enucleation of her left eye due to retinoblastoma. A multidisciplinary approach, including ophthalmologist, psychotherapist, and a prosthodontist, was adopted to meet her physical, psychological, functional, emotional, social, and cosmetic demands. The patient was rehabilitated cosmetically with precisely fabricated ocular prosthesis. An ocular prosthesis is a highly positive and non-invasive approach to improve the cosmetic appearance and psychological well-being of patient.

Prosthetic rehabilitation of a pediatric patient with an ocular defect.

The eye is a vital organ for vision and an important component of facial expression. Loss of an eye has a crippling effect physically and psychologically. Especially, in case of a child where it affects the parent too and the approach toward these special children needs to be very special indeed. The construction of an ocular prosthesis for a child is the same as for an adult. A growing child will require periodic enlargement of the prosthesis in order to accompany the expansion of the anophthalmic cavity and it is the only way to esthetically rebuild the anophthalmic socket. Although implant eye prosthesis has superior outcome, due to economic factors it may not be advisable in all patients. Therefore, an acrylic custom-made ocular prosthesis replacement as soon as possible is a good alternative to promote physical and psychological healing for the patient and to improve social acceptance. A case of a custom fabricated ocular acrylic prosthesis using the advantages of digital photography is presented here, which had acceptable fit, retention and improved esthetics with a certain degree of motility in coordination with the contralateral normal eye. How to cite this article: Nalawade TM, Mallikarjuna RM, Anand BM, Anand M, Shashibhusan KK, Subba Reddy VV. Prosthetic Rehabilitation of a Pediatric Patient with an Ocular Defect. Int J Clin Pediatr Dent 2013;6(1):62-65.