Pediatric Enucleation, Evisceration, and Exenteration Techniques

Piest, Kenneth L.; Welsh, Michael G.

doi:10.1007/978-0-387-21630-0_32

Cited by 6 publications

(4 citation statements)

References 27 publications

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“…[24][25][26] Acrylic implants are useful when treating children, as ease of removal should be considered for the possible need of implant exchange with a larger one with time. 27 Moreover, in a study conducted on patients after enucleation for uveal melanoma no major differences between hydroxyapatite and acrylic implants in surgical outcomes and patient satisfaction were noted. 28 Wrapping of the implant is important in case of enucleation or secondary implantation, as wrapped orbital implants facilitate muscle suturing, leading to a better motility.…”

Section: Orbital Implants and Management Of Implant Exposurementioning

confidence: 97%

Anophthalmic Socket Syndrome: Prevalence, Impact and Management Strategies

Quaranta‐Leoni¹,

Fiorino²,

Quaranta‐Leoni³

et al. 2021

OPTH

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Anophthalmic socket syndrome determines functional deficits and facial deformities, and may lead to poor psychological outcomes. This review aims to comprehensively evaluate the features of the syndrome, based on literature review and authors’ clinical and surgical experience. An electronic database (PubMed,MEDLINE and Google Scholar) search of all articles written in English and non-English language with abstract translated to English on anophthalmic socket syndrome was performed. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. Different types of orbital implants were evaluated; the management of implant exposure was examined; different orbital volume enhancement procedures such as secondary implantation, subperiosteal implants and the use of fillers in anophthalmic patients were described; the problems related to socket contraction were outlined; the treatment options for chronic anophthalmic socket pain and phantom eye syndrome were assessed; the most recent advances in the management of congenital anophthalmia were described. Current clinical evidence does not support a specific orbital implant; late exposure of porous implants may be due to pegging, which currently is seldom used; filler absorption in the orbit appears to be faster than in the dermis, and repeated treatments could be a potential source of inflammation; socket contraction results in significant functional and psychological disability, and management is challenging. Patients affected by anophthalmic socket pain and phantom eye syndrome need specific counseling. It is auspicable to use a standardized protocol to treat children affected by clinical congenital anophthalmia; dermis fat graft is a suitable option in these patients as it helps continued socket expansion. Dermis fat graft can also address the volume deficit in case of explantation of exposed implants and in contracted sockets in both children and adults. Appropriate clinical care is essential, as adequate prosthesis wearing improves the quality of life of anophthalmic patients.

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Section: Orbital Implants and Management Of Implant Exposurementioning

confidence: 97%

Anophthalmic Socket Syndrome: Prevalence, Impact and Management Strategies

Quaranta‐Leoni¹,

Fiorino²,

Quaranta‐Leoni³

et al. 2021

OPTH

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“…The problematic rate of silicone orbital grafts is typically minimal ( Nunery et al, 1993a ; Nunery et al, 1993b ), although one documented disadvantage is the development of a thick, avascular fibrous capsule around the graft ( Sami et al, 2007 ). Due to the ease of removal for subsequent implant exchange, surgeons appear to favor using a nonporous silicone implant when repairing an anophthalmic socket in a juvenile patient ( Piest and Welsh, 2002 ). Because of its high biocompatibility, PMMA is another widely utilized polymer in ophthalmic applications; it is now the most often used polymeric biomaterial to produce intraocular lenses and hard contact lenses ( Bozukova et al, 2010 ) as well as OIs.…”

Section: An Overview Of the Various Biomaterials For Ocular Implantsmentioning

confidence: 99%

The Evolution of Orbital Implants and Current Breakthroughs in Material Design, Selection, Characterization, and Clinical Use

Chen

Yang

Fan

2022

Front. Bioeng. Biotechnol.

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It is occasionally essential to surgically remove the damaged eye of the patient in the case of serious oculoorbital injuries, intraocular cancers, and other life-threatening diseases. An orbital implant is placed into the anophthalmic socket after the eye is removed to provide adequate volume reinstatement and revamp the cosmetic look of a normal eye. In the previous few decades, implant design and material selection criteria have progressed from basic nonporous polymeric spheres to devices with more complicated shapes and functions to ensure improved long-term clinical results. Because of their highly interconnected porous design, ceramic and polymeric porous implants have found popularity as a passive framework for fibrovascular ingrowth, with lower obstacle rates and the option of setting to improve prosthetic eye mobility. These materials, however, are not without flaws. The danger of migration and extrusion, infections after surgery, and poor motility transferred to the cosmetic ocular prosthesis are important elements of orbital implants of today. As a result, the development of novel biomaterials with improved functionalities (i.e., antibacterial effect, angiogenesis, and in situ moldability) that allow better eye replacement is more desirable than ever, highlighting one of the most challenging aspects of research topics in the field of ocular implants. This study highlights the history of orbital implants. It gives an outline of current advancements in the area, over and above some essential observations for materials design, selection, characterization, and transformation to clinical applications.

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“…1–3 Because of concerns for wound breakdown and implant exposure, smaller implants were often inserted. 4,5 However, small implants can contribute to the development of anophthalmic socket syndrome with a deep superior sulcus. Several authors have advocated individualizing implant size, hoping to maximally replace the volume lost during the enucleation procedure.…”

mentioning

confidence: 99%

Volumetric Versus Empirical Determination of Enucleation Implant Size

Custer

Maamari

Huecker

et al. 2020

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To compare the use of sizing implants versus intraoperative volume measurements for individualization of enucleation implant size, and to identify preoperative factors affecting the choice of implant. Methods: In this retrospective observational cohort study, 2 implant sizing methods were compared using clinical records and photographs in 139 patients who underwent enucleation between 2007 and 2016. Results: There was no difference in mean implant (p = 0.6562) or prosthetic (p = 0.1990) enophthalmos between the 2 methods, or when comparing patients with and without conjunctival-Tenons fibrosis. The incidence and severity of superior sulcus deformity was similar between the methods (p = 0.6394). Preoperative phthisis (p < 0.0001) and intraoperative conjunctival-Tenons fibrosis (p = 0.0010) were more common in the sizing implant group. Among all study patients, mean implant size was larger in males (21.3 mm, n = 80) than females (20.7 mm, n = 59) (p = 0.0027). Implants >20 mm were more frequently inserted in patients with a wider Hertel exophthalmometry base (80% of males >95 mm; 77% of females >97 mm). Approximately 21.0% of patients demonstrated ≥8 mm of implant enophthalmos, suggesting an undersized implant. The authors estimate that 11% of patients could have received a sphere larger than 22 mm. Conclusions: Individualization of enucleation implant size can reduce the incidence of anophthalmic socket syndrome. The empirical use of sizing implants provided similar results as intraoperative volumetric measurements, when evaluated by postoperative superior sulcus depth and prosthetic or implant enophthalmos. Preoperative exophthalmometry may facilitate selection of implant size. Preexisting conjunctival-Tenon fascial fibrosis often did not limit implant size and was not associated with a higher prevalence of wound breakdown or implant exposure.

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Pediatric Enucleation, Evisceration, and Exenteration Techniques

Cited by 6 publications

References 27 publications

Anophthalmic Socket Syndrome: Prevalence, Impact and Management Strategies

Anophthalmic Socket Syndrome: Prevalence, Impact and Management Strategies

The Evolution of Orbital Implants and Current Breakthroughs in Material Design, Selection, Characterization, and Clinical Use

Volumetric Versus Empirical Determination of Enucleation Implant Size

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