Assessing the results of anophthalmic prostheses

Abstract

Purpose: Anophthalmic sockets cause disfigurement that may result in emotional and social distress. The choice of procedure and implant is based upon the surgeon’s experience. There remains no standardization of cosmetic result. We sought to identify quantifiable anatomical features and functional properties related to a successful cosmetic result in patients with ocular prosthesis and to determine correlations between self-reported and third-party assessment of cosmetic success. Methods: This was a prospective observational study, which included 107 adult patients (50.1% female; age 53.08 ± 18.64 years, range 18–89) with acquired anophthalmia following prosthesis fitting. Patients completed a self-assessment questionnaire on self-perception of body image and ocular properties. Three independent examiners assessed cosmetic score. Assessed variables included prosthesis movement, eyelid symmetry, prosthesis stability, and socket fullness. Results: The general cosmetic result was 8.1 ± 2.19 (on a predetermined scale of 1–10) as perceived by the patients and 7.2 ± 0.19 by the examiners. Interexaminer correlation was high for all variables ( P < 0.05). A good cosmetic result was correlated with prosthesis movement ( P = 0.02), eyelid symmetry ( P = 0.001), and prosthesis stability ( P = 0.01). Factors that correlated with a good cosmetic result on multivariate analysis were prosthesis movement (odds ratio [OR] 4.95, P = 0.004), eyelid symmetry (OR 4.51, P = 0.006), and socket fullness (OR 3.56, P = 0.005). No correlation was observed between patients’ perceptions of the overall cosmetic result and those of the examiners. Conclusion: The cosmetic result of prosthesis use among anophthalmic patients is generally good, as perceived by both patients and examiners. Good eyelid position and symmetry, orbital fullness, and prosthesis motility were associated with a better cosmetic result.

Acquired Anophthalmic Socket: Clinical Course and Treatment Options

“…A primary orbital implant is recommended to achieve an optimal result 25 . Vardizer et al 12 reported that the cosmetic result of anophthalmic patients wearing a prosthesis, as evaluated by professional examiners, is good in most patients (Figure 2) and that a good result was related to the ability of the prosthetic eye to move in comparison to the contralateral eye, to eyelid symmetry, and socket fullness.…”

“…Ocular or prosthesis motility is an important factor contributing to normal facial appearance. 12 Unfortunately, the motility of the artificial eye is usually reduced compared with the motility of the contralateral eye, especially in the extreme directions of gaze. A primary orbital implant is recommended to achieve an optimal result.…”

“…The primary management goals are to optimize patients’ self-esteem and emotional distress associated with anophthalmos. Most importantly, prosthesis motility and facial symmetry have the highest impact on patient satisfaction 11,12 . Hence, establishing and maintaining adequate volume replacement to optimize prosthesis function, motility, and cosmesis would be the most important consideration when treating anophthalmic patients.…”