Aesthetic and functional ocular rehabilitation

A technique for fabricating custom translucency tabs for the esthetic imitation of sclera in an ocular prosthesis

The accurate replacement of a missing eye with an ocular prosthesis that matches the healthy eye in terms of color and dimension of the sclera and iris is crucial for individuals who have lost an eye from trauma or cancer. A method is shown for precisely imitating the patient's sclera in terms of translucency from the patient's healthy eye for the prosthetic eye by creating custom translucency tabs. It is a straightforward, effective, and time-saving method of improving results during prosthesis fabrication.

Children and young adults with anophthalmia and microphthalmia: Diagnosis and Management

PURPOSE

Congenital anophthalmia (A) and microphthalmia (M) are rare developmental defects, which could be isolated or syndromic. Our objective was to describe a cohort of children and young adults with A/M treated with ocular prosthesis, emphasizing clinical features, diagnosis, treatment, and follow-up.

METHODS

Eighteen individuals (10 female) with unilateral A (n = 3) and M (n = 15) with a mean age of 9.5 years (range 0.8-31.8) and treated with ocular prosthesis were included. Data on medical history, clinical examinations and management of ocular prosthesis were collected. Genetic screening with microarray and whole-exome sequencing targeting 121 A/M-related genes was performed.

RESULTS

A/M appeared isolated (seven cases) or as part of a syndromic condition (11 cases). In 4/16 patients, mutations were detected in TFAP2A, CHD7, FOXE3 and BCOR-genes. In one patient, a possibly causal microdeletion 10q11 was shown. Associated ocular anomalies such as cataract and cysts were found in 16 (89%) of the A/M eyes, and in nine (50%) ophthalmological findings were found in the fellow eyes. The median ages at which the conformer and ocular prosthesis first were initiated were 7.8 months and 1.5 years. 16/17 patients fulfilled satisfactory orbital growth and cosmetic results when treated with ocular prosthesis from an early age.

CONCLUSION

Based upon our findings, a multidisciplinary approach, including genetic assessment, is necessary to cover all aspects of A/M. Imaging, ultrasound and visual evoked potentials should be included. Early management is crucial for the outcome, in terms of non-ocular findings, vision in the fellow eye, and for facial cosmetic development.

Microbiological analysis of conjunctival secretion in anophthalmic cavity, contralateral eye and ocular prosthesis of patients with maxillofacial abnormalities

The purpose of this study was to identify and analyse the micro-organisms present in the conjunctival secretion in anophthalmic cavities of wearers of ocular prostheses, as well as on the prostheses used by them, correlating them with the microbiota of the contralateral eye. Nine patients with maxillofacial abnormalities, wearers of an acrylic resin ocular prosthesis participated in the study. Collections of conjunctival secretions and biofilm were performed on the prosthesis, anophthalmic cavity and contralateral eye for the mycological and bacterial analyses. The data were submitted to statistical analysis, performing a Kendall correlation test to identify the correlation between the collection site and the identified micro-organism (P < 0·05). It was verified that the most prevalent micro-organisms were the Staphylococcus aureus and Staphylococcus epidermidis, independent of the collection site, and that negative cultures for fungi were encountered in 85·2% of collections, independent of the region. It was not possible to establish a correlation among the types of micro-organisms and the collection sites.

SIGNIFICANCE AND IMPACT OF THE STUDY

Some evidence suggests that the surface roughness of ocular prostheses can influence interactions with micro-organisms, with greater prejudicial consequences, such as the establishment of biofilms, which could lead to infections. Thus, it becomes extremely important to identify the micro-organisms present on the acrylic surfaces of ocular prostheses, as well as the microbiota of the anophthalmic cavity and contralateral eye of wearers of the same, so that subsequent control measures promote the homeostatic maintenance of the ocular region.

An iris positioning device and centering approach: A technique

For patients who have lost an eye as result of trauma or a carcinoma, accurate replacement with an ocular prosthesis that is symmetrical to the natural eye is essential. This report describes a technique for recording the measurement and position of the iris of the natural eye and accurately transferring it to the prosthetic eye of the patient. The technique is both straightforward and accurate.

[Ocular prosthetics. Fitting, daily use and complications]

BACKGROUND

Ocular prosthetics make a decisive contribution to the functional, esthetic and psychosomatic rehabilitation of patients after ocular extirpation.

OBJECTIVES

This article provides an overview of the fitting, daily care and complications of ocular prosthetics.

METHODS

The study comprised a PubMed literature review and own clinical results.

RESULTS

Ocular prosthetics made from cryolite glass or perspex can be manufactured and fitted 5-8 weeks after removal of the eye. During this period a conformer is placed within the conjunctival sac in order to prevent scar formation and shrinking of the socket. Artificial eyes can be worn continuously, only interrupted by a short but regular cleaning procedure. Artificial tears and lid hygiene improve the comfort of wearing. Glass prostheses have to be renewed every 1-2 years, while perspex prostheses need to be polished once a year. Complications, such as giant papillary conjunctivitis or blepharoconjunctivitis sicca are facilitated by poor fit, increased age and inappropriate care of the prosthetic device. In the case of socket shrinkage or anophthalmic socket syndrome, surgical interventions are needed to re-enable the use of an artificial eye.

CONCLUSION

Adequate fitting, daily care of ocular prosthetics and therapeutic management of associated complications are mandatory for a durable functional, esthetic and psychosomatic rehabilitation after ocular extirpation.

Fabrication techniques for ocular prostheses--an overview

The goals of treatment with ocular prostheses are to restore facial aesthetics and self-esteem to anophthalmic patients. Fabricated in acrylic resin, artificial eyes should be aesthetically pleasing, scratch-resistant, and adequately polished. Use of a prosthesis without such characteristics can lead to psychological damage, as well as infection and inflammation due to the accumulation of microorganisms and other substances on an irregularly shaped prosthesis. The present literature review describes the different techniques for fabricating ocular prostheses. Reproduction of the iris color and color stability are important factors that promote adequate aesthetics. The fabrication of an individual ocular prosthesis in acrylic resin provides satisfactory aesthetic results because the impression process establishes the defect contour. Additionally, the iris and sclera can be individually characterized. As the techniques, materials, and manufacturing methods for ocular prostheses continue to evolve, the aesthetics and functionality of prostheses will also improve.

Prosthodontic and surgical management of anophthalmia: a case report

True Anophthalmos is an extremely rare condition and can cause psychological problems due to not only the absence of an eye but also from the disfigurement of the orbital socket and the eyelids. The present case shows the multidisciplinary approach in the treatment of a patient with anophthalmos. He needed an ocular plastic surgery for correct prosthesis insertion. The disfigurement caused by the loss of ocular content when restored with prosthesis maintains the facial symmetry there by improves the esthetics as well as anatomic and physiological function.

Changing ocular prostheses in growing children: a 5-year follow-up clinical report

Eye loss in children can be caused by trauma, glaucoma, or cancer, and may result in anxiety and depression. Recovery after eye loss involves a replacement with a custom-made eye prosthesis, but, as the patient ages, changes in the size and shape of the eye socket can result in a sunken appearance of the child's prosthetic eye. This article describes the fabrication of a custom-made eye and the necessity of changing ocular prostheses for a growing child, with a 5-year follow-up.

Influence of natural weathering on colour stability of materials used for facial prosthesis

Colour stability of resin and silicone is an important factor for longevity of facial prostheses. The aim of this study was to evaluate the colour stability of resins and silicone for facial prostheses. Three brands of acrylic resin and one of facial silicone were evaluated considering pigment incorporation for the colourless materials. Ten samples of each material were fabricated and submitted to measurements of chromatic alteration initially and after 90 and 180 days of weathering natural through visual analysis and spectrophotometry. Data were evaluated by ANOVA and Tukey test (p < 0.05). Statistically significant colour alteration was observed among some materials regardless of the period. The materials did not present a statistical difference between 90 and 180 days except for the pigmented heat-polymerized resin. The colour difference between pigmented Silastic MDX4-4210 and colourless Silastic was statistically significant (p < 0.01) in both periods as well as between pigmented and colourless heat-polymerized resin, and between the resins Rapidaflex and Lentaflex. The visual method demonstrated colour alteration in all materials evaluated during the first 90 days of ageing. All materials exhibited colour alteration due to exposure to environment.

Chromatic stability of acrylic resins of artificial eyes submitted to accelerated aging and polishing

Esthetics and durability of materials used to fabricate artificial eyes has been an important eissue since artificial eyes are essential to restore esthetics and function, protect the remaining tissues and help with patients' psychological therapy. However, these materials are submitted to degrading effects of environmental agents on the physical properties of the acrylic resin.

Evaluation of the color stability of two techniques for reproducing artificial irides after microwave polymerization

The use of ocular prostheses for ophthalmic patients aims to rebuild facial aesthetics and provide an artificial substitute to the visual organ. Natural intemperate conditions promote discoloration of artificial irides and many studies have attempted to produce irides with greater chromatic paint durability using different paint materials.