The current alternative for ocular surface and anophthalmic socket reconstruction, cryopreserved umbilical amniotic membrane (cUAM).

PURPOSE: This report presents the results of using cryopreserved umbilical amniotic membrane (cUAM) as an alternative mucosal graft for ocular surface reconstruction in cases of anophthalmic socket contracture (ASC), cicatricial entropion (CE), and conjunctival-scleral defects. METHODS: The study included patients who underwent non-commercial implantation of cUAM grafts (prepared by corneal banking methods) for ASC, CE, conjunctival defect, and scleral melting. The main success criteria for this study were the comfortable fitting of the ocular prosthesis in ASC patients, the natural eyelid position in CE patients, and the degree of conjunctivalisation in melting patients. RESULTS: cUAM transplantation was performed in 2 patients who could not use a prosthetic eye due to conjunctival contracture, 2 patients with CE, and 1 patient with conjunctival defect and 1 patient with conjunctival-scleral melting. The primary outcome was achieved in 83.3% (5/6) of patients. In one patient with CE, partial healing was achieved due to the persistence of CE in the medial upper eyelid. CONCLUSIONS: cUAM is a viable alternative to mucosal grafting for reconstructing the bulbar and palpebral conjunctival surface, fornix, and orbit, with reduced donor morbidity and shorter surgical time. Its regenerative ability allows for tissue defect healing and improves cosmetic appearance through epithelialization within weeks.

Acquired enophthalmos in idiopathic orbital inflammatory disease.

Purpose: To describe a rare case of acquired enophthalmos in a patient with idiopathic orbital inflammatory disease after treatment with systemic corticosteroids. Observations: Orbital socket contracture produces a non-traumatic enophthalmos and is most frequently reported as a consequence of orbital trauma or metastatic fibrosis. A previously healthy 64-year-old male presented with 3-month history of binocular diplopia and left proptosis, hypoglobus, supraduction deficit, and compressive neuropathy. Imaging techniques showed a left orbital mass; laboratory tests and biopsy of the mass lead to the diagnosis of idiopathic orbital inflammatory disease. Systemic corticosteroids were administered and, surprisingly, the patient developed left enophthalmos with eyelid retraction. Conclusions and Importance: Although extremely unusual, orbital socket contracture can cause enophthalmos and visual morbidity in patients with idiopathic orbital inflammatory disease treated with corticosteroids.

Clinical use of cryopreserved ultra-thick human amniotic membrane for anophthalmic socket contracture.

PURPOSE: To study the use of ultra-thick human amniotic membrane for management anophthalmic socket contracture. METHODS: A prospective study done at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Thirty-six patients (45 eyelids) were involved. Contracted socket caused by trauma, previous surgery or radiotherapy, delay in use of prosthesis, Congenital Anophthalmia/Microphthalmia, and Anophthalmia secondary to Enucleation/Evisceration were included in the study. RESULTS: Thirty-three patients (42 eyelids) underwent fornix reconstruction with cryopreserved ultra-thick human amniotic membrane. Mean ± SD age at surgery was (40.90 ± 17.32) years. Mean follow up was 10.5 months. Grade II fornix contracture was the most common type in 23 (54.8%) eyelids. The most common involved primary diagnosis was Anophthalmia secondary to Enucleation/Evisceration (n = 13). The incidence of pyogenic granuloma (PG) after surgery was seen in 8 eyelids (19.0%). CONCLUSION: Anophthalmic contracted socket secondary to significant history of multiple PG excision (> 5 times) and secondary to enucleation/evisceration were associated with good surgical outcome. Cryopreserved ultra-thick human amniotic membrane is an ideal material for the management of anophthalmic socket contracture.

Prosthetic Rehabilitation Following Socket Reconstruction with Blair-Brown Graft and Conformer Therapy for Management of Severe Post-Enucleation Socket Syndrome--A Clinical Report.

One of the most common tumors of the eye diagnosed in childhood is retinoblastoma, which mandates enucleation with adjunctive chemotherapy and radiotherapy to save the patient's life. The most common late enucleation complication is post-enucleation socket syndrome (PESS), which poses a management dilemma for the prosthodontist and surgeon, along with being a major esthetic concern for the patient. The reconstruction of such sockets is complex. The purpose of this clinical report is to describe the rehabilitation of such a pediatric patient with severe PESS. The patient was successfully rehabilitated by presurgical conformer therapy, socket reconstruction surgery with non-meshed intermediate split thickness skin graft (STSG)/Blair-Brown graft, and postsurgical conformer stent. This was followed by fabrication of a custom ocular prosthesis, to achieve favorable functional, physical, and psychological effects.

Amniotic membrane transplantation in the treatment of conjunctival rupture, dehiscence and socket contracture after hydroxyapatite orbital implantation / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To investigate the clinical effect of preserved amniotic membrane transplantation in the treatment to conjunctival rupture, dehiscence and socket contracture after hydroxyapatite ( HA) orbital implantation. METHODS: ln 16 cases of conjunctival rupture and socket contracture after HA orbital implantation, conjunctival tension was release by operation and preserved amniotic membrane was transplanted on conjunctival scleral exposure area. RESULTS:ln all cases, conjunctiva healing, completely cover the sclera and conjunctiva socket recover ideal depth after operation in 15 cases, 1 case was fail. CONCLUSlON: Preserved amniotic membrane transplantation is an effective method to treat conjunctival dehiscence and keeping the ideal conjunctival socket depth after orbital implantation.

Reconstruction of Contracted Anophthalmic Socket with Acellular Dermal Allograft

PURPOSE: To study the use of acellular dermal allografts for the reconstruction of contracted anophthalmic sockets. METHODS: A retrospective analysis was performed on 12 patients with contracted sockets who underwent reconstructive surgery using acellular dermal allografts from 2002 to 2006. RESULTS: The mean age of the patients was 44.4 years. The mean duration of conjunctival sac contracture after removal of the eyeball was 21.4 years. In 4 patients, acellular dermal allografts were used as spacer grafts to elevate the eyelids, and in 8 patients the allografts were used as a conjunctival grafting material. All patients were able to wear ocular prostheses comfortably 2.2 months after surgery with acceptable cosmesis. There were no serious complications, such as infections or graft rejections during follow-up period. CONCLUSIONS: When used as conjunctival grafting materials and tarsal substitutes to elevate patients' eyelids, acellular dermal allografts gave cosmetically and functionally acceptable results in the surgical rehabilitation of contracted sockets.

Anophthalmic Conjunctival Sac Reconstruction using Acellular Dermal Allograft

PURPOSE: To investigate the clinical results and safety of the acellular dermal allograft (SureDerm(R), Hans Biomed co., Korea) as a new spacer graft in anophthalmic socket contracture. METHODS: We grafted SureDerm(R) as the replacing spacer in 8 patients for the treatment of anophthalmic socket contracture. Under local anesthesia, SureDerm(R) was sutured at the levator aponeurosis and upper margin of the tarsus using 6-0 Vicryl in the upper lid. In the lower lid, SureDerm(R) was sutured at the tarsal conjunctiva and lower margin of the incised conjunctiva. The patients were followed-up individually for 6 to 15 months. RESULTS Surgical results in all 8 eyelids (6 lower lids, 2 upper lids) were satisfactory. The grafted SureDerm(R) survived in all patients with little contracture. There were no other complications such as infection, rejection, or exposure. CONCLUSIONS: We consider SureDerm(R) a good replacing spacer material for the treatment of anophthalmic socket contracture.