Rehabilitación protésica individualizada en un defecto ocular de origen traumático. Reporte de caso / Individualized prosthetic rehabilitation in an ocular defect of traumatic origin. Case report

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)

Integrated versus non-integrated orbital implants for treating anophthalmic sockets.

BACKGROUND: Anophthalmia is the absence of one or both eyes, and it can be congenital (i.e. a birth defect) or acquired later in life. There are two main types of orbital implant: integrated, whereby the implant receives a blood supply from the body that allows for the integration of the prosthesis within the tissue; and non-integrated, where the implant remains separate. Despite the remarkable progress in anophthalmic socket reconstruction and in the development of various types of implants, there are still uncertainties about the real roles of integrated (hydroxyapatite (HA), porous polyethylene (PP), composites) and non-integrated (polymethylmethacrylate (PMMA)/acrylic and silicone) orbital implants in anophthalmic socket treatment. OBJECTIVES: To assess the effects of integrated versus non-integrated orbital implants for treating anophthalmic sockets. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to August 2016), Embase (January 1980 to August 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to August 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 8 August 2016. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs of integrated and non-integrated orbital implants for treating anophthalmic sockets. DATA COLLECTION AND ANALYSIS: Two authors independently selected relevant trials, assessed methodological quality and extracted data. MAIN RESULTS: We included three studies with a total of 284 participants (250 included in analysis). The studies were conducted in India, Iran and the Netherlands. The three studies were clinically heterogenous, comparing different materials and using different surgical techniques. None of the included studies used a peg (i.e. a fixing pin used to connect the implant to the prosthesis). In general the trials were poorly reported, and we judged them to be at unclear risk of bias.One trial compared HA using traditional enucleation versus alloplastic implantation using evisceration (N = 100). This trial was probably not masked. The second trial compared PP with scleral cap enucleation versus PMMA with either myoconjunctival or traditional enucleation (N = 150). Although participants were not masked, outcome assessors were. The last trial compared HA and acrylic using the enucleation technique (N = 34) but did not report comparative effectiveness data.In the trial comparing HA versus alloplastic implantation, there was no evidence of any difference between the two groups with respect to the proportion of successful procedures at one year (risk ratio (RR) 1.02, 95% confidence interval (CI) 0.95 to 1.09, N = 100, low-certainty evidence). People receiving HA had slightly worse horizontal implant mobility compared to the alloplastic group (mean difference (MD) -3.35 mm, 95% CI -4.08 to -2.62, very low-certainty evidence) and slightly worse vertical implant motility (MD -2.76 mm, 95% CI -3.45 to -2.07, very low-certainty evidence). As different techniques were used - enucleation versus evisceration - it is not clear whether these differences in implant motility can be attributed solely to the type of material. Investigators did not report adverse events.In the trial comparing PP versus PMMA, there was no evidence of any difference between the two groups with respect to the proportion of successful procedures at one year (RR 0.92, 95% CI 0.84 to 1.01, N = 150, low-certainty evidence). There was very low-certainty evidence of a difference in horizontal implant motility depending on whether PP was compared to PMMA with traditional enucleation (MD 1.96 mm, 95% CI 1.01 to 2.91) or PMMA with myoconjunctival enucleation (-0.57 mm, 95% CI -1.63 to 0.49). Similarly, for vertical implant motility, there was very low-certainty evidence of a difference in the comparison of PP to PMMA traditional (MD 3.12 mm 95% CI 2.36 to 3.88) but no evidence of a difference when comparing PP to PMMA myoconjunctival (MD -0.20 mm 95% CI -1.28 to 0.88). Four people in the PP group (total N = 50) experienced adverse events (i.e. exposures) compared to 6/100 in the PMMA groups (RR 17.82, 95% CI 0.98 to 324.67, N = 150, very low-certainty evidence).None of the studies reported socket sphere size, cosmetic effect or quality of life measures. AUTHORS' CONCLUSIONS: Current very low-certainty evidence from three small published randomised controlled trials did not provide sufficient evidence to assess the effect of integrated and non-integrated material orbital implants for treating anophthalmic sockets. This review underlines the need to conduct further well-designed trials in this field.

Biosocial profile of New Zealand prosthetic eye wearers.

AIM: To describe the biosocial profile of New Zealand (NZ) artificial eye wearers and establish a basis for future research and international comparison. METHODS: This retrospective study surveyed 431 NZ artificial eye wearers to investigate their ethnicity, gender, age, causes of eye loss, age of current prosthesis, ocular prosthetic maintenance regimes and the extent and severity of discharge associated with prosthesis wear. RESULTS: Approximately 3000 people wear artificial eyes in NZ. Accidents were the main cause of eye loss prior to 1990 and medical conditions have been the main cause since. In the 1960s, the ratio of men to women losing an eye from accidents was 5:1, but during the past decade the ratio was 1.4:1. Socket discharge occurred at least twice daily for one-third of the study group. CONCLUSIONS: Approximately 1 in 1440 people wear artificial eyes in NZ. Decline of eye loss due to accidents is consistent with decreasing workplace and traffic accidents and may be due to improved medical management, workplace safety standards and safer roads. Mucoid discharge is prevalent in the anophthalmic population of NZ and an evidence based treatment protocol for discharge associated with prosthesis wear is needed. Research into this distressing condition is planned.

[Profile of patients with anophthalmic cavity: study at Faculdade de Medicina de Botucatu - UNESP]. / Perfil dos portadores de cavidade anoftálmica: estudo na Faculdade de Medicina de Botucatu - UNESP.

PURPOSE: To evaluate the profile of anophthalmic cavity carriers and patients' evolution with the employed treatments. METHODS: Retrospective study carried out at Faculdade de Medicina de Botucatu, to evaluate the profile and the evolution of patients with anophthalmic cavity treated in our service. Data were evaluated according to the frequency of occurrence and analysis of association. RESULTS: Anophthalmic cavity was more frequently observed in young males, workers in activities carried on with their hands. Trauma and phthisis bulbi were the most frequent causes, with differences according to age and gender. The complications were high (57.1% of cases), the majority occurred belatedly. CONCLUSIONS: Trauma is still an important cause of loss of the eye. The complications during the follow-up of the patient are frequent, occurring in general, very late, which reinforces the need for periodic and prolonged monitoring of patients with anophthalmic cavity.

Perfil dos portadores de cavidade anoftálmica: estudo na Faculdade de Medicina de Botucatu - UNESP / Profile of patients with anophthalmic cavity: study at Faculdade de Medicina de Botucatu - UNESP

OBJETIVO: Avaliar o perfil dos portadores de cavidade anoftálmica e a evolução dos pacientes com os tratamentos empregados. MÉTODOS: Estudo retrospectivo, realizado na Faculdade de Medicina de Botucatu, avaliando-se o perfil e a evolução dos portadores de cavidade anoftálmica, tratados no serviço. Os dados foram estudados segundo frequência de ocorrência e análise de associação. RESULTADOS: Os portadores de cavidade anoftálmica eram mais frequentemente em homens, trabalhadores em atividades exercidas com as mãos, jovens. O trauma e a phthisis bulbi foram as causas mais encontradas, havendo diferenças de acordo com a faixa etária e sexo. O índice complicações foi alto (57,1 por cento dos casos), a maioria ocorrendo tardiamente. CONCLUSÕES: O trauma continua sendo causa importante de perda do olho. As complicações que ocorrem durante o acompanhamento do portador de cavidade anoftálmica são frequentes e ocorrem, em geral, tardiamente, o que reforça a necessidade de acompanhamento periódico e prolongado destes pacientes.

PURPOSE: To evaluate the profile of anophthalmic cavity carriers and patients' evolution with the employed treatments. METHODS: Retrospective study carried out at Faculdade de Medicina de Botucatu, to evaluate the profile and the evolution of patients with anophthalmic cavity treated in our service. Data were evaluated according to the frequency of occurrence and analysis of association. RESULTS: Anophthalmic cavity was more frequently observed in young males, workers in activities carried on with their hands. Trauma and phthisis bulbi were the most frequent causes, with differences according to age and gender. The complications were high (57.1 percent of cases), the majority occurred belatedly. CONCLUSIONS: Trauma is still an important cause of loss of the eye. The complications during the follow-up of the patient are frequent, occurring in general, very late, which reinforces the need for periodic and prolonged monitoring of patients with anophthalmic cavity.

Consideraciones generales sobre las técnicas de evisceración y enucleación del globo ocular / General considerations of the evisceration and enucleation techniques of the eyeball

Se revisó la bibliografía médica concerniente a la enucleación y evisceración como técnicas quirúrgicas mutilantes del globo ocular, principales indicaciones, contraindicaciones, ventajas, desventajas y controversias, así como la descripción de cada proceder, tomando también en cuenta los resultados de los cuales se dispone en el Departamento de Oculoplastia y de la Clínica de Rehabilitación Bucomaxilofacial del Hospital Clinicoquirúrgico Docente Saturnino Lora de Santiago de Cuba desde 1989 hasta la fecha(AU)

This is a review about the medical literature concerning the enucleation and evisceration as mutilating surgical techniques of the eyeball, main suggestions, counterindications, advantages, disadvantages and controversies, as well as the description of each procedure, also taking into account the results in the Oculoplasty Department of the Bucomaxillofacial Rehabilitation Clinic of Saturnino Lora Teaching Clinical Surgical Hospital in Santiago de Cuba from 1989 up to now(AU)

Consideraciones generales sobre las técnicas de evisceración y enucleación del globo ocular / General considerations of the evisceration and enucleation techniques of the eyeball

Se revisó la bibliografía médica concerniente a la enucleación y evisceración como técnicas quirúrgicas mutilantes del globo ocular, principales indicaciones, contraindicaciones, ventajas, desventajas y controversias, así como la descripción de cada proceder, tomando también en cuenta los resultados de los cuales se dispone en el Departamento de Oculoplastia y de la Clínica de Rehabilitación Bucomaxilofacial del Hospital Clinicoquirúrgico Docente Saturnino Lora de Santiago de Cuba desde 1989 hasta la fecha.

This is a review about the medical literature concerning the enucleation and evisceration as mutilating surgical techniques of the eyeball, main suggestions, counterindications, advantages, disadvantages and controversies, as well as the description of each procedure, also taking into account the results in the Oculoplasty Department of the Bucomaxillofacial Rehabilitation Clinic of Saturnino Lora Teaching Clinical Surgical Hospital in Santiago de Cuba from 1989 up to now.

[Reconstruction of anophthalmic socket by adipocyte grafting using the Coleman technique, after extrusion of an orbital implant: a case study]. / Comblement d'une cavité orbitaire éviscérée par greffe d'adipocytes selon la technique de Coleman, après expulsion d'implant.

INTRODUCTION: Since the end of the 19th century, autologous fat grafting has often been used in plastic surgery. The first use was described in 1893 by Neurer and consisted in transferring a piece of fat tissue for facial reconstruction. Since then, this technique has evolved somewhat thanks to Coleman, who developed lipostructure. This technique is used in plastic surgery in the filling of orbital cul-de-sacs and unsightly scars. We report a clinical case where this technique was used to fill an anophthalmic socket after extrusion of an orbital implant. OBSERVATION: A 52-year-old man had evisceration of the right eye for ocular phthisis bulbi after injury to the eye. Two weeks later, he presented an expulsion of the hydroxyapatite eyeball with significant secretions. The bacteriological samples showed Staphylococcus aureus and Streptococcus anginous infection. Despite local and general antibiotic treatment and anti-inflammatory drugs, the secretions persisted. The implant material was initially ablated. Twenty days later, adipocyte was grafted in the residual scleral stump using the Coleman technique. Follow-up showed no complications; the adipocyte grafting made it possible to restore orbital volume so that the prosthesis could be adapted. After 6 months, secondary atrophy is moderate and a good esthetic result was obtained. DISCUSSION: The Coleman technique consists in taking adipocytes in abdominal or buttocks fat with nontraumatic liposuction. This is purified after centrifugation, then reinjected into the scars or the orbital cul-de-sacs to be filled. In general, these indications relate to small volumes. In our case, the procedure involved an anophthalmic socket with residual septated scleral tissue. This can explain the good esthetic result obtained. Indeed, the fat atrophy after surgery is more significant when there is no supporting tissue. CONCLUSION: This technique seems simpler and avoids an unsightly scar on the harvest site (contrary to the traditional dermis-fat graft). On the other hand, it is more expensive and requires a minimum of training.

Study of dimensional alterations of the orbit following loss of the eye.

PURPOSE: This study aimed to assess the dimensional alterations in the anterior region of the orbit after enucleation or evisceration. MATERIALS AND METHODS: Analysis of orbital areas and perimeters of 17 patients with unilateral removal of the ocular bulb was performed, and posteroanterior radiographic examination was carried out by a single specialist, who had been previously calibrated. RESULTS: Data obtained from measurements confirmed the clinically observed facial asymmetry. CONCLUSION: The observation of asymmetry in the anterior orbital area, confirmed by our results, indicates early treatment to prevent orbital disturbances and will aid in the planning of prosthetic rehabilitation.

Bovine hydroxyapatite orbital implant: a preliminary report.

PURPOSE: To determine the safety and efficacy of bovine hydroxyapatite as an orbital implant material. METHODS: Prospective, consecutive case series of patients undergoing enucleation, evisceration, or secondary orbital implantation. A motility peg was placed in all consenting candidates. Patients were followed 1 week, 1 month, and several months after surgery for signs of inflammation, infection, extrusion, or other complication. RESULTS: Twenty-seven patients received a bovine hydroxyapatite orbital implant. Magnetic resonance imaging was obtained in 3 patients (3 orbits) approximately 4 weeks after surgery and showed signs of peripheral fibrovascular ingrowth in all three cases. Magnetic resonance imaging was obtained in 9 patients (9 orbits) 4 to 12 months after surgery and showed signs of incomplete fibrovascular ingrowth in 1 of 9 (11%) cases, subtotal fibrovascular ingrowth in 2 of 9 (22%) cases, and complete fibrovascular ingrowth in 6 of 9 (67%) of cases. Complications included postoperative chemosis in 3 cases (11%) and exposure requiring reoperation in 2 cases (7%). Motility peg placement was performed successfully in 5 patients (5 orbits). CONCLUSIONS: Bovine hydroxyapatite appears to be a safe and effective orbital implant material. The material appears to be biocompatible and nonallergenic. Bovine hydroxyapatite allows for fibrovascular integration and motility peg placement.

The hydroxyapatite orbital implant: a prospective study.

The hydroxyapatite orbital implant was first released for use as an orbital implant in humans in August 1989. It has been shown to be well tolerated, providing good motility of the artificial eye with a low complication rate when used as a primary implant. This prospective study evaluated the hydroxyapatite orbital implant used as both a primary and a secondary implant. Sixty patients were implanted between October 1992 and November 1994, 28 being implanted as a primary procedure at the time of enucleation or evisceration, and 32 as a secondary procedure. Seven patients underwent second-stage drilling and pegging of the implant. The mean follow-up time was 13 months (range 2-26 months). A standardised operative and post-operative protocol was followed. The patients were evaluated post-operatively for the amount of enophthalmos, degree of upper lid sulcus deformity, motility of the prosthesis, location of the implant in the socket, socket status and the presence or absence of discharge, position of the drill hole and coverage of the implant. Complications and their management were documented. Both patient and surgeon made a subjective assessment of cosmesis and the patient's satisfaction with the overall result was noted. The results of this study show the hydroxyapatite orbital implant to provide excellent motility of the artificial eye and good cosmesis with a low rate of complications when used both as a primary and as a secondary implant.

[The adipose tissue of the orbit. Anatomic classification, therapeutic deductions]. / Le tissu graisseux de l'orbite. Rappel anatomique, déductions thérapeutiques.

There are two types of adipose tissue in the orbit. The yellow fat and the more abundant white, or orbital fat. Orbital fat cannot be dissociated from the contents of the orbit and plays an important role in ocular physiology and oculomotricity. Orbital fat is essential for aesthetic orbits. Graves' disease and anophthalmia. Adipose tissue in the orbit is particularly important in protecting the ocular globe from lateral wall trauma.