Evaluation of an integrated orbital tissue expander in congenital anophthalmos: report of preliminary clinical experience.

PURPOSE: To evaluate the effectiveness of an orbital tissue expander designed to stimulate orbital bone growth in an anophthalmic socket. DESIGN: Retrospective, noncomparative, interventional case series. SETTINGS: Institutional. STUDY POPULATION: Nine consecutive patients with unilateral congenital anophthalmos. INTERVENTION: The orbital tissue expander is made of an inflatable silicone globe sliding on a titanium T-plate secured to the lateral orbital rim with screws. The globe is inflated by a transconjunctival injection of normal saline through a 30-gauge needle to a final volume of approximately 5 cm(3). Computed tomography scans were used to determine the orbital volume. The data studied were: demographics, prior orbital expansion procedures, secondary interventions, orbital symmetry, and implant-related complications. MAIN OUTCOME MEASURES: The primary outcome measure was the orbital volume change, and the secondary outcome measures were changes in forehead, brow, and zygomatic eminence contour and adverse events. RESULTS: The average patient age at implantation was 41.89 ± 39.42 months (range, 9 to 108 months). The initial average volume of inflation was 3.00 ± 0.87 cm(3) (range, 2.0 to 4.0 cm(3)), and the average final volume of 4.33 ± 0.50 cm(3) (range, 4.0 to 5.0 cm(3)) was achieved. The duration of expansion was 18.89 ± 8.80 months (range, 4 to 26 months). All patients demonstrated an average increase in the orbital tissue expander implanted orbital volume of 5.112 ± 2.173 cm(3) (range, 2.81 to 10.38 cm(3)). The average difference between the volume of the implanted and the initial contralateral orbit was 5.68 ± 2.34 cm(3), which decreased to 2.53 ± 1.80 cm(3) at the final measurement (P < .001, paired t test). All implants remained inflated except for 2 iatrogenic punctures at the second inflation and 1 that was the result of implant failure. All were replaced. CONCLUSIONS: The integrated orbital tissue expander is safe and effective in stimulating anophthalmic socket bone growth.

A new modification in the porous polyethylene-coated lester jones tube.

PURPOSE: Conjunctivodacryocystorhinostomy (CDCR) is the gold standard for the treatment of many cases of canalicular obstruction since 1965 (Kominek & Cervenka, 2004). With a proper CDCR and a well-placed Jones tube, the success rate in our experience is almost 100%. The most frequent complication is extrusion and dislocation. Rates as high as 49% have been reported in some studies (Rose & Welham, 1991). Various modifications have been introduced in the tube design in order to minimize extrusion, including tubes with suture holes, the frosted Jones tubes, and regular porous polyethylene-coated tubes. The regular porous polyethylene-coated tubes are covered by a long sleeve of porous polyethylene, which irritates the conjunctiva causing discharge and sometimes granuloma formation. We describe here a modification of this tube with a much shorter porous polyethylene sleeve to minimize the ocular irritation and discharge. METHODS: Ten patients, age 29-50 years, with complete canalicular obstruction and excessive tearing after failed DCR with canaliculoplasty were included in this study. All patients underwent CDCR with anastomoses of the sac mucosa with that of the nasal mucosa via posterior and anterior flaps. Subsequent placement of porous polyethylene-coated Lester Jones tubes were done at the site of carunculectomy. The regular porous polyethylene coat was shortened using a surgical blade to correspond to the fistula opening, only without extension to the caruncle. The average length of the coat in the 10 cases was about 5 mm. RESULTS: Postoperatively, all patients had surgically successful outcomes, with no complaints of epiphora or discomfort. All tubes are still in proper position and functioning well. Our follow-up has been limited to an 18-month period. CONCLUSION: CDCR with the modified porous polyethylene-coated Lester Jones tube has the same advantages of the traditional porous polyethylene-coated tube. Moreover, it reduces the discharge and ocular irritation, which are the main complications of the CDCR with the current porous polyethylene-coated Jones tube.

Improved non-coupled prosthetic motility utilizing motility-enhancing fornix sutures.

PURPOSE: To evaluate the surgical technique and the motility of non-coupled ocular implant and prosthesis complex, utilizing fornix sutures, by examining the outcomes following evisceration surgery. MATERIALS AND METHODS: Forty patients with atrophic, phthyiscal, or staphylomatous globes underwent evisceration using the scleral overlapping technique with a transequatorial release incision. All the patients were implanted with high-density porous polyethylene implants. Twenty patients underwent evisceration utilizing fornix sutures. The remaining 20 patients underwent a conventional described evisceration technique. Care was taken that no conjunctival shortening was present. Follow-up was for three months. The patients were all fitted by a non-coupled ocular prosthesis at one month and follow-up continued as usual. RESULTS: All cases showed functional improvement with an average increase of motility measurements when utilizing the motility-enhancing fornix sutures in comparison to the described conventional evisceration technique. Motility was measured by evaluating horizontal and vertical excursions. Results were documented up to three months postoperatively. Apart from a late postoperative exposure developing in one case, no cases of additional infection, extrusion, or granuloma formation were encountered. CONCLUSION: The non-coupled prosthetic motility utilizing motility enhancing sutures was more predictable with superior motility effect over the conventional evisceration technique. However, a longer follow-up and perhaps a larger number of cases may be needed to provide additional support to the findings of this study.