Biopolymeric Innovations in Ophthalmic Surgery: Enhancing Devices and Drug Delivery Systems.

The interface between material science and ophthalmic medicine is witnessing significant advances with the introduction of biopolymers in medical device fabrication. This review discusses the impact of biopolymers on the development of ophthalmic devices, such as intraocular lenses, stents, and various prosthetics. Biopolymers are emerging as superior alternatives due to their biocompatibility, mechanical robustness, and biodegradability, presenting an advance over traditional materials with respect to patient comfort and environmental considerations. We explore the spectrum of biopolymers used in ophthalmic devices and evaluate their physical properties, compatibility with biological tissues, and clinical performances. Specific applications in oculoplastic and orbital surgeries, hydrogel applications in ocular therapeutics, and polymeric drug delivery systems for a range of ophthalmic conditions were reviewed. We also anticipate future directions and identify challenges in the field, advocating for a collaborative approach between material science and ophthalmic practice to foster innovative, patient-focused treatments. This synthesis aims to reinforce the potential of biopolymers to improve ophthalmic device technology and enhance clinical outcomes.

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.

Living with an artificial eye: qualitative insights into patient and family member experiences.

PURPOSE: Artificial eye users (AEUs) can experience a negative impact on psychological and emotional wellbeing, including reduced social functioning, which may be a consequence of living with one eye removed, and/or of having a prosthetic eye. This may have wider consequences for their families. We aimed to explore what it means to live with a prosthetic eye, for both AEUs and their families-and how any quality of life (QoL) issues impact on their day-to-day functioning. METHODS: A subset of AEUs and their family members taking part in a feasibility randomised controlled trial comparing hand-painted to digitally printed artificial eyes were invited for semi-structured interviews. Transcripts were analysed using reflexive thematic analysis. Qualitative results related to trial participation are covered elsewhere. Here, we focus on QoL and day-to-day functioning. RESULTS: Twelve AEUs (eight males) and five spouses (one male) who had worn artificial eyes for 2-65 years took part, and four themes were identified. (1) Impact on day-to-day life: AEUs and their spouses have to adapt to (partial) sight loss, reduced levels of confidence, and social withdrawal. (2) Impact on psychological and emotional wellbeing: distress among AEUs and their spouses can be severe and prolonged, highlight unmet support needs. (3) Challenges with treatment experiences: AEUs experienced negative impact of fragmentation of care and long waiting times. (4) Worries about the future: AEUs mentioned fragility of remaining sight, and concerns around potential need for further treatment. CONCLUSION: Patients and their family members experience negative impact of being an AEU on their everyday lives and quality of life. There is a potential role for psychosocial support services in supporting AEUs and their families even long after eye loss.

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.

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

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

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.

Microbiological evaluation of conjunctival anopthalmic flora after using digital 3D-printed ocular prosthesis compared to conventional one: a randomized clinical trial.

BACKGROUND: This study aims to assess the influence of using 3D-printed acrylic resin versus conventional Poly-methyl methacrylate (PMMA) for fabricating ocular prostheses on the biofilm and microbial flora of anophthalmic socket. METHODS: A randomized controlled trial was designed as a parallel group study. Participants were allocated randomly into two groups: the control group, which received conventionally fabricated ocular prostheses (CG, n = 11), and the test group, which received digitally 3D-printed ocular prostheses (DG, n = 11). Microbiological analysis was conducted before prosthesis insertion and three months after using the ocular prosthesis. Swab samples were inoculated on blood agar, MacConkey's agar, and Sabouraud's dextrose agar (SDA) for isolating Gram-positive, Gram-negative, and fungal organisms, respectively. Subsequently, the plates were incubated at 37 degrees Celsius for 48 h. Additionally, a validated questionnaire was used for subjective clinical evaluation, including parameters such as comfort level, socket discharge, lacrimation, and frequency of lubrication for each ocular prosthesis patient in both groups. RESULTS: Test group (DG, n = 11) exhibited a positive, though statistically insignificant, difference (p > 0.001) in microbial growth when compared to the control group (CG, n = 11). A statistically significant difference was observed in comfort levels between the two groups, with more comfort level within group II (test group) patients. While parameters such as discharge amount, discharge location, lacrimation and lubrication frequency displayed statistically insignificant differences between the two groups, all parameters showed improved results after three months of prosthesis use. CONCLUSIONS: The choice of ocular prosthesis fabrication technique did not yield a statistically significant difference in anophthalmic flora. However, the 3D-printed acrylic resin, as an artificial eye material, displayed potential advantages in reducing the colonization of opportunistic pathogens. All subjective clinical evaluation parameters exhibited enhanced outcomes after three months of prosthesis use, emphasizing the need for an adaptation period during which patients complains are alleviated. In comparison with PMMA, 3D-printed acrylic resin showcased a certain degree of anti-colonization ability against pathogenic bacteria, along with a significant level of patient comfort, suggesting its potential as a promising material for ocular prostheses. TRIAL REGISTRATION: This parallel double-blinded RCT has been registered at ClinicalTrials.gov with identification number: NCT05584865, 18/10/2022.

A novel technique for CAD-CAM assisted digital ocular prosthesis.

There are various techniques available for constructing a custom ocular prosthesis. The present technique report describes a digital workflow for constructing an ocular prosthesis using computed tomography integrated with digital technologies. The outer region of the healthy eyeball was segmented to produce the top surface of the prosthesis, while the contour and bottom surface were segmented from the tissue bed of the anophthalmic socket. The iris position was determined by tracing the optical nerve and confirmed by superimposing the patient's facial scan onto the soft tissue model of the computed tomography. Using these parameters, a standard tessellation language file for the ocular prosthesis was generated and 3D printed. The iris was then printed via UV technology using digital photographs of the patient's contralateral eye; characterization of the sclera and the final layer of clear acrylic resin were done conventionally.

Prevalence of anophthalmia etiological factors in patients treated in a reference center: A retrospective study.

Background: Ocular prosthesis rehabilitation has an important social, psychological, esthetic, and functional role. Congenital factors, trauma, and tumors, among others, can cause anophthalmia, and it is essential to identify the etiology to guide its prevention and treatment. Methods: The aim of this study was to retrospectively investigate the records of patients treated from 2013 to 2020 by the Oral and Maxillofacial Prosthesis Group, aiming to identify the prevalence of patients with anophthalmia and the etiology of their anophthalmia. After approval by the Human Research Ethics Committee, two calibrated researchers evaluated 520 records, identifying those from patients with anophthalmia. The inclusion criteria were records with complete and legible information from patients with anophthalmia and a description of their etiology. Descriptive statistics were performed, and etiological factors were categorized into trauma, congenital cause, end-stage eye disease, and tumor. Spearman's correlation was performed to verify the relation between gender and anophthalmia etiology, with a 5% significance level. Seventy-two records were included in the study. Results: It was observed that 33.4% of patients were women and 66.6% were men. The etiologies were physical trauma (52.4%), tumor (21.8%), end-stage eye disease (16.6%), and congenital cause (9.2%), and there was no correlation between gender and these etiologies (p = .301). Conclusion: Most of the cases identified were of traumatic origin, which allows the establishment of preventive and educational measures to avoid new cases of anophthalmia.

Long-term follow-up in a pediatric patient with Ligneous Conjunctivitis due to PLG gene mutation in topical plasminogen treatment after successful use of ocular prosthesis for aesthetic rehabilitation: a case report.

BACKGROUND: Ligneous Conjunctivitis (LC) is the most common clinical manifestation of Type I Plasminogen deficiency (T1PD; OMIM# 217090), and it is characterized by the formation of pseudomembranes (due to deposition of fibrin) on the conjunctivae leading to progressive vision loss. In past times, patients with LC were treated with surgery, topical anti-inflammatory, cytostatic agents, and systemic immunosuppressive drugs with limited results (Blood 108:3021-3026, 2006, Ophthalmology 129:955-957, 2022, Surv Ophthalmol 48:369-388, 2003, Blood 131:1301-1310, 2018). The surgery can also trigger the development of membranes, as observed in patients needing ocular prosthesis (Surv Ophthalmol 48:369-388, 2003). Treatment with topical purified plasminogen is used to prevent pseudomembranes formation (Blood 108:3021-3026, 2006, Ophthalmology 129:955-957, 2022). CASE PRESENTATION: We present the case of a sixteen-year-old girl with LC with severe left eye involvement. We reported the clinical conditions of the patient before and after the use of topical plasminogen eye drops and described the treatment schedule allowing the surgical procedure for the pseudomembranes debulking and the subsequent use of ocular prosthesis for aesthetic rehabilitation. CONCLUSIONS: The patient showed a progressive response to the topical plasminogen, with a complete absence of pseudomembrane formation at a twelve-year follow-up, despite using an ocular prosthesis.

Management of external ocular prosthesis by ocularists: results of an online survey conducted in Brazil and Spain.

PURPOSE: To analyse the ocularist's perspective on the management of the anophthalmic socket and external ocular prosthesis (EOP). METHODS: Ocularists from two countries were invited to participate in an online questionnaire. Data were collected on demographics, anophthalmic socket and EOP management (manufacturing, use, cleaning), complications, follow-up visits and multidisciplinary care. The frequency and proportions of the responses were statistically analysed. RESULTS: The questionnaire was addressed to 20 Brazilian and 17 Spanish ocularists, obtaining a response rate of 65% and 64.7%, respectively. 62.5% of respondents were men. The most common cause of anophthalmia in Brazil (69.2%) and Spain (36.4%) is an eye disease (chi square: p = 0.188). Polymethylmethacrylate (PMMA) is the most commonly used material in EOP manufacture (chi square: p = 0.448), and 70.8% reported using customized EOPs (chi square: p = 0.069). Deposits are frequently observed in both countries (chi square: p = 0.157). Changing the prosthesis is recommended after 5 to 10 years by Brazilian ocularists, and after less than 5 years of use by Spanish ocularists (81.8%) (chi square: p = 0.041). Annual follow-up is recommended by Spanish ocularists (45.5%), while semestral (38.5%) and case-dependent (38.5%) follow-up is recommended by Brazilian ocularists (chi square: p = 0.267). Daily cleaning is advocated by 61.5% of Brazilian ocularists and once a month by 45.5% of Spanish ocularists (chi square: p = 0.098), with 75% of ocularists from both countries not recommending EOP removal at night (Fisher´s exact test: p = 0.166). Good communication between ocularists and ophthalmologists was reported by 87.5% of our responders (chi square: p = 0.642). CONCLUSION: Although there are no unified protocols on the management of EOPs, Brazilian and Spanish ocularists follow similar guidelines. Differences between countries were the patients´ referral and the prosthesis´ useful life.

Prosthetic management of an ocular defect utilizing a novel threaded iris fabrication technique.

The conservative prosthodontic construction of an ocular prosthesis utilizing our novel threaded iris fabrication technique required high time and prosthodontic resource inputs and produced a lifelike aesthetic result. Abstract: Patients with ocular defects frequently present with significant local anatomical deficiencies and complex histories and require extensive time and resource inputs to treat. This case report describes the conservative management of an ocular defect completed in a postgraduate prosthodontics clinical residency program utilizing a novel threaded iris fabrication technique.

Rehabilitación protésica en defecto ocular provocado por herpes zóster

El herpes zóster es el cuadro clínico constituido por las manifestaciones dermatológicas (erupción vesiculosa) y neurológica (dolor). Es la expresión de la recurrencia del virus varicela-zóster latente en los ganglios sensitivos, su aparición se favorece por el envejecimiento y la inmunosupresión con una prevalencia que se estima en un 20 %. Se describe los pasos clínicos para la confección de una prótesis ocular en el mejoramiento estético a un paciente con defecto ocular en ojo izquierdo provocado por herpes zoster. Se trata de un paciente masculino de piel blanca de 50 años de edad, que acudió a la consulta de prótesis del Policlínico Universitario Julio Antonio Mella de la provincia Camagüey remitido del Servicio de Oculoplastia del Hospital Universitario Manuel Ascunce Domenech con diagnóstico de defecto ocular izquierdo por evisceración como consecuencias de infección por herpes zoster y antecedente de inmunodepresión. El paciente expuso que la pérdida ocular fue por las complicaciones que se fueron sucediendo en la medida que se agravó su cuadro clínico. Además, refirió que presentaba dolor en la zona y que le irradiaba a la cabeza y que le preocupaba su estética. Se determinó la elaboración de una prótesis ocular acrílica para mejorar el aspecto estético, lo cual permitió que el paciente mejorara su autoestima y calidad de vida.

Herpes zoster is the clinical picture constituted by dermatological (vesicular rash) and neurological (pain) manifestations. It is the expression of the recurrence of the latent varicella-zoster virus in the sensitive ganglia, its appearance is favored by aging and immunosuppression with a prevalence estimated at 20%. We describe the clinical steps for the fabrication of an ocular prosthesis for the aesthetic improvement of a patient with ocular defect in the left eye caused by herpes zoster. This is a 50-year-old male patient with white skin, who came to the prosthesis consultation of the Julio Antonio Mella University Polyclinic in Camagüey province, referred from the Oculoplasty Service of the Manuel Ascunce Domenech University Hospital with a diagnosis of left ocular defect due to evisceration as a consequence of herpes zoster infection and a history of immunosuppression. The patient explained that the ocular loss was due to the complications that occurred as his clinical condition worsened. In addition, he reported that he had pain in the area that radiated to the head and that he was concerned about his esthetics. It was decided to make an acrylic ocular prosthesis to improve the esthetic aspect, which allowed the patient to improve his self-esteem and quality of life.

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

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

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

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

A narrative review on techniques of iris replication in an ocular prosthesis.

The disfigurement associated due to the loss of an eye can cause a significant physical and psychological disturbance. Psychological distress among such unfortunate patients can be reduced by providing an artificial eye. Rehabilitating such patients with an ocular defects is the most challenging task for a prosthodontist. The custom-made ocular prostheses are preferred over the prefabricated stock eye shells as it provides intimate contact with the tissue bed, enabling an ideal fit. For an esthetic ocular prosthesis, the precise positioning of an iris is a primary requirement to avoid the squint eye appearance. Various case reports are documented in the literature for centralizing the iris in the prosthetic eye. This review article explores the established methods and techniques for positioning the iris in a custom-made ocular prosthesis.

[Complications of anophthalmic orbits-Treatment and aftercare]. / Komplikationen der anophthalmischen Orbita ­ Therapie und Nachsorge.

The possible complications of anophthalmic eye sockets can occur due to many different pathomechanisms. A differentiation is made between allergic, infectious, inflammatory or mechanical causes. This article gives an overview on the different etiologies of socket complications with their pathophysiology and treatment options.

[Ocular prosthetics in children-Possibilities and challenges]. / Augenprothetik beim Kind ­ Möglichkeiten und Herausforderungen.

One of the greatest challenges for ocularists is prosthetic fitting in children, especially in children with congenital anomalies such as clinical anophthalmia or functionless (blind) microphthalmia. The most frequent reason for prosthetic fitting in children is a condition following enucleation for retinoblastoma, followed by trauma and congenital pathologies. The standard treatment after enucleation or evisceration begins intraoperatively with the selection of an suitable implant and the use of a conformer at the end of the operation to shape the prosthetic cavity. An initial prosthesis can be fitted 4 weeks postoperatively, with a final fitting taking place 3 months later. If iatrogenic scarring or scarring due to an infection of the prosthetic cavity occurs, the approach of the ocularist must be appropriately adapted with the use of modified prosthesis shapes and shorter treatment intervals. Surgical options include scar excision and oral mucosa or amniotic membrane transplantation. Congenital anomalies require the shortest treatment intervals and even more so for anophthalmia than for microphthalmia. The strategy is characterized by simultaneous stimulation of the soft tissue of the ocular adnexa as well as the bony orbit. As self-inflating hydrogel expanders are no longer available, conservative prosthetic treatment is the only option. Close cooperation between child/parent, ocularist and ophthalmic plastic surgeon is the best prerequisite for a good long-term treatment outcome.

Effect of microwave polymerization on the thermomechanical and surface properties of ocular prosthetic acrylic resins.

BACKGROUND: Polymerization conditions affect the physical-mechanical properties of acrylic resins used for craniofacial prostheses. OBJECTIVE: The aim of this study was to evaluate the effect of microwave polymerization on the thermomechanical properties and surface morphology of ocular prostheses fabricated with polymethyl methacrylate (PMMA). METHODS: PMMA discs were polymerized with microwave energy and with conventional heat polymerization (CHP) method. Ocular prostheses were fabricated to determine whether there were changes according to the polymerization method. The surface morphology and roughness were observed under SEM and AFM. The Vickers Hardness number (VHN) and flexural strength were measured. Thermal properties were evaluated with TGA/DSC, and chemical composition with FTIR. RESULTS: The PMMA acrylic resin polymerized with microwave energy showed a smooth surface with some relief areas. In the internal surface of the ocular prosthesis with microwave energy the PMMA is more compact. The mean roughness values were higher and statistically significant with CHP (P < 0.05), while the surface hardness and flexural strength were higher with microwave energy (P < 0.05). CONCLUSION: There were no changes in the calorimetry with either method, TGA showed an exothermic peak around 120 °C with CHP method. PMMA polymerized with microwave energy improved the mechanical and surface properties of the ocular prostheses.

Motility of the Ocular Prosthesis in Anophthalmic Patients: Objective and Patient-perceived Findings.

AIM: To study the impact of the prosthesis motility on the Quality of Life (QoL) in anophthalmic patients. METHODS: Cross-sectional, observational study of 100 anophthalmic patients, of whom 64% had an acryl implant, 6% an Allen implant, 1% a hydroxyapatite implant, 4% a dermis fat graft, 16% no implant, and 9% an unknown implant. We quantitatively assessed the motility of the prosthesis with Kestenbaum glasses and the QoL with a validated questionnaire covering five domains: General functional abilities and care, wearing comfort, physical appearance, psychological and social functioning. Associations between measured prosthetic eye motility, patient-perceived motility, and satisfaction were made. RESULTS: Motility of the prosthesis was impaired with an average loss of 76%, and correlated with Cosmetic satisfaction (adduction P = .02, abduction P = .008, elevation P = .04) and Social satisfaction (adduction P = .03, abduction P = .003). The patient-perceived motility of the prosthesis correlated with General functioning abilities (horizontal P = .0004, vertical P = .0004), Comfort (horizontal P = .001, vertical P = .003), Cosmetic satisfaction (horizontal P = .0002, vertical P = .0002), Psychological satisfaction (horizontal P = .001, vertical P = .001), and Social satisfaction (horizontal P = .002, vertical P = .003). CONCLUSIONS: Ocular prosthetic motility has a significant impact on patient-perceived satisfaction and physical appearance, and predicts coping with the prosthetic condition on the psychosocial level. This highlights the need of introducing patient-reported outcome measures in the prosthetic rehabilitation of the anophthalmic patient.