Major criticisms of quasi-integrated implants, such as the Iowa Implant, have been the time-consuming surgical technique needed to implant the prosthesis, and the high rate of extrusion. The Universal Implant (Oculo-Plas...Major criticisms of quasi-integrated implants, such as the Iowa Implant, have been the time-consuming surgical technique needed to implant the prosthesis, and the high rate of extrusion. The Universal Implant (Oculo-Plastik, Montreal) is designed with these concerns in mind. In addition, those qualities that produce the motility advantages of a quasi-integrated implant and the ease of placement of a sphere have been incorporated into the design of the Universal Implant. The Universal Implant also (1) uses a faster implantation technique at surgery, (2) avoids cleaning the muscles, (3) has smaller mounds that are lower and more rounded, and should decrease the late extrusion rate, (4) can be used as an evisceration implant, enucleation implant, or secondary implant, and (5) has a larger girth and radius on the posterior surface that, in turn, helps support orbital fat and tissues and results in a more natural superior sulcus. It is recommended that the Universal Implant be used by surgeons who were pleased with the Iowa Implant, as the Universal implant represents an excellent alternative with major advantages over most other enucleation implants.
The GORE-TEX soft tissue patch is composed of large open spaces surrounded by polytetrafluoroethylene (PTFE) fibers connected to nodules of solid PTFE. It was used in 12 oculoplastic surgery patients. Primary and seconda...The GORE-TEX soft tissue patch is composed of large open spaces surrounded by polytetrafluoroethylene (PTFE) fibers connected to nodules of solid PTFE. It was used in 12 oculoplastic surgery patients. Primary and secondary spherical silicone implants were wrapped with a GORE-TEX patch and implanted into Tenon's capsule. This study reports our first results using this versatile material.
Standard enucleation techniques provide excellent results. Modifications can render the operative field bloodless and permit the performance of all manipulations under direct visualization. Standard enucleation has been...Standard enucleation techniques provide excellent results. Modifications can render the operative field bloodless and permit the performance of all manipulations under direct visualization. Standard enucleation has been postulated to disseminate choroidal malignant melanoma cells as a result of fluctuations in intraocular pressure incident to surgical manipulations. It is possible that the stabilization of intraocular pressure preceding induction of tumor freezing may decrease such dissemination and thereby increase survival.
In the post enucleation and evisceration patient, we must continually seek to resolve the functional and cosmetic defects that occur following surgery. Fitting a prosthesis that appears to be symmetrical with the fellow...In the post enucleation and evisceration patient, we must continually seek to resolve the functional and cosmetic defects that occur following surgery. Fitting a prosthesis that appears to be symmetrical with the fellow eye is the measuring stick of our success. The success or failure in achieving this cosmetic symmetry will determine to a great degree the rehabilitation of the patient. It is important for the ocularist to have at least a basic understanding of the anatomic changes that have resulted in the anophthalmic socket to correctly assess and treat these changes. The authors suggest a method detailing the steps involved in making an accurate clinical assessment of the patient. The authors will also outline the defects normally associated with post enucleation syndrome, their usual causative effects, and provide a suggested reading list supplying information on both surgical and prosthetic correction for each of these areas.
Close interaction between the patient, surgeon, and ocularist is necessary to obtain the most ideal prosthesis. Communication between these parties will facilitate the patient's adjustment to the anophthalmic state and t...Close interaction between the patient, surgeon, and ocularist is necessary to obtain the most ideal prosthesis. Communication between these parties will facilitate the patient's adjustment to the anophthalmic state and the maintenance of a healthy anophthalmic socket.
The ocularist plays a significant role in the rehabilitation of patients suffering the loss of an eye. As with any role, the function of the ocularist is a multidisciplinary one, involving a wide range of services in the...The ocularist plays a significant role in the rehabilitation of patients suffering the loss of an eye. As with any role, the function of the ocularist is a multidisciplinary one, involving a wide range of services in the overall management of the patient.
We present a brief review of mobility implants, their contribution, and the experiences derived after almost 40 years since the new concepts of full mobility implants were introduced. In early 1940, experiments with a ne...We present a brief review of mobility implants, their contribution, and the experiences derived after almost 40 years since the new concepts of full mobility implants were introduced. In early 1940, experiments with a new material for the making of plastic artificial eyes was also being considered for the making of orbital implants. Methyl-methacrylate (MMA) had proven inert and satisfactory for dental products. The Surgeon Generals office of the Armed Services encouraged further research and experimental work in the development of plastic eyes. The success of the new material sponsored the beginning of great expansion with new concepts for orbital implants. Through a period of more than a decade, the design and types of implants went through three stages. First, the buried implant was introduced, then the exposed integrated followed, and the buried integrated subsequently followed. The path of progress was not smooth. Theoretically correct designs and surgical procedures met unexpected practical difficulties for the ophthalmic surgeon, the patient, and the eye maker. Surgical and technical efforts were carefully reviewed to eliminate the problems encountered, only to have further unforeseen complications arise. Infections, extrusions, and migration of the implant were not uncommon. The exposed integrated implant was eventually abandoned. However, there were some extraordinary successes of mobility. A new era introduced fully buried mobility implants that were more successful. However, this procedure also produced some problems, causing infection (or allergy), extrusion, and migration. Tantalum mesh and gauze gave great promise with the inception of their use. Orbital tissue grew into the material in an astonishing way, making it possible to secure the extraocular muscles and tenons.(ABSTRACT TRUNCATED AT 250 WORDS)
Surgical psycho-ophthalmology is the integration of ophthalmic surgery and medicine with basics in psychiatry and psychology, lest the psyche be forgotten amid the spectacular leaps in techniques and technology, or our j...Surgical psycho-ophthalmology is the integration of ophthalmic surgery and medicine with basics in psychiatry and psychology, lest the psyche be forgotten amid the spectacular leaps in techniques and technology, or our judgment be veiled by our related psychodynamics [1]. Its scope encompasses a much broader spectrum than the conventional psychosomatic eye diseases. Besides due consideration of the psychological and physical conditions of patients, it increases the awareness of the surgeons' psychodynamics that reflect on our continuing judgment before, during, and after surgery. Further, surgical psycho-ophthalmology impacts on the indications, timing, planning, and performance of each individual operation and/or reoperation. It equally emphasizes both the psychologic priming of patients and attuning of the surgical team. In establishing and maintaining rapport with the patient, surgical psycho-ophthalmology helps to curb the growing problems of malpractice, iatrogenicity, and noncompliance. It also stresses careful weighing of the risk/benefit ratio in adherence to the surgical axiom: "primum non nocere". Despite all advances and ingenuity in contracted socket surgery, the challenge still remains. However, with the proper evaluation and management in the perspective of psycho-ophthalmology we may achieve success, not only in esthetics, but also in sight preservation, and even in life salvage.
This seldom discussed subject is brought into focus with examples of the complex emotional ramifications of eye loss. The professional who is best equipped to counsel these patients is the ocularist. Patients psychologic...This seldom discussed subject is brought into focus with examples of the complex emotional ramifications of eye loss. The professional who is best equipped to counsel these patients is the ocularist. Patients psychological needs are successfully met with accurate information. Our objective is to alter the patient's attitude concerning losing an eye. A step-by-step method of achieving that goal is presented.
The surgeon must be aware of the psychological impact on a patient when performing an enucleation. The surgeon should offer patients psychiatric assistance to deal with the trauma of an enucleation. The formation of a gr...The surgeon must be aware of the psychological impact on a patient when performing an enucleation. The surgeon should offer patients psychiatric assistance to deal with the trauma of an enucleation. The formation of a group therapeutic organization may be a viable approach to gathering patients to talk about their concerns. "Enucleations Anonymous" is proposed.
Eye prosthetics and its practitioners have evolved through self-development studies, to become an integral part of the ophthalmic plastic surgery multidisciplinary team. Eye prosthetics is a distinct art and science in d...Eye prosthetics and its practitioners have evolved through self-development studies, to become an integral part of the ophthalmic plastic surgery multidisciplinary team. Eye prosthetics is a distinct art and science in dealing with the many facets of eye surgery. The ocularist must have in his armamentarium alternate procedures, flexibility, cooperation, and become knowledgeable of all the options available to him. This in turn will offer opportunities for providing the plastic artificial eye patients with the best final results possible.
The socket surfaces, conjunctival fornices and palpebral aperture are intimately related. Any socket or fornix abnormality will affect the contour and size of the palpebral aperture. Conversely, a cicatricial lid deformi...The socket surfaces, conjunctival fornices and palpebral aperture are intimately related. Any socket or fornix abnormality will affect the contour and size of the palpebral aperture. Conversely, a cicatricial lid deformity will alter the depth and contour of the conjunctival fornix. Any surgical correction of a lid malposition must calculate the resultant effect on the socket.
There are many different procedures to camouflage the superior sulcus deformity that occurs after an evisceration or enucleation. We have studied 5000 anophthalmic patients. In every case the previous adaptation of the p...There are many different procedures to camouflage the superior sulcus deformity that occurs after an evisceration or enucleation. We have studied 5000 anophthalmic patients. In every case the previous adaptation of the prosthesis was satisfactory. We noted the frequency of the superior sulcus deformity, and we would like to discuss silicone oil infiltration and a modified polymethyl-methacrylate (PMMA) banana superior sulcus implant. The silicone oil infiltration is easily performed and the results are permanent.
Patients who have worn an ocular prosthesis for many years often develop laxity of the lower eyelid and deepening of the superior sulcus caused by downward displacement of the orbital contents. Herein we describe our tec...Patients who have worn an ocular prosthesis for many years often develop laxity of the lower eyelid and deepening of the superior sulcus caused by downward displacement of the orbital contents. Herein we describe our technique and results with the lateral canthal sling and subperiosteal room temperature vulcanizing (RTV) silastic volume augmentation procedure performed through a single incision in the lateral canthus.
Anophthalmic patients can develop a deep recess or sulcus in the upper lid, usually associated with enophthalmos. If due to an absence or loss of a socket implant, a secondary one can be implanted. In those cases with a...Anophthalmic patients can develop a deep recess or sulcus in the upper lid, usually associated with enophthalmos. If due to an absence or loss of a socket implant, a secondary one can be implanted. In those cases with a socket implant, one method of treatment is directed at adding a silicone block to the inferior orbit to cause a forward movement of fat to fill out the upper eyelid as well as reducing the enophthalmos. Another approach, particularly if enophthalmos is minimal, is to directly implant a dermis-fat graft into the upper eyelid. The graft is taken from above the iliac crest and the amount implanted should create a slight overcorrection, allowing for some fat absorption.
There are a number of etiologies underlying the development of socket deformity with associated lower eyelid malposition, lateral canthal tendon laxity, and/or contraction of the inferior fornix. In addition to cosmetic...There are a number of etiologies underlying the development of socket deformity with associated lower eyelid malposition, lateral canthal tendon laxity, and/or contraction of the inferior fornix. In addition to cosmetic considerations, each of these anatomic problems can interfere with comfortable wear and retention of a prosthesis. This chapter gives an overview of these problems and details our preferred surgical approaches to repair of these anatomic deformities. Specifically discussed are techniques for: mucous membrane and ear cartilage grafting to repair lower lid inner lamellar tissue shortage, reconstruction of the inferior fornix/cul-de-sac, direct lower eyelid lateral canthal resuspension, and resuspension using a periosteal flap or autogenous fascia lata from the iliotibial tract.
It is important that an ocularist be knowledgeable of the five types of anophthalmic ptosis, their causes and most effective treatment method. In earlier days ocularists had only one method of correcting this problem. Wi...It is important that an ocularist be knowledgeable of the five types of anophthalmic ptosis, their causes and most effective treatment method. In earlier days ocularists had only one method of correcting this problem. With the advent of plastic material several more were invented, but none were totally effective or comfortable for the patient. This chapter describes the five types of ptoses, some simpler methods for correction with prostheses, but emphasizes a complex method initiated in the early 1950s by Lee Allen. It has been used by many other ocularists since. A description of the method and its effectiveness is discussed.