Advances in ophthalmic plastic and reconstructive surgery最新文献

In attempting to achieve acceptable cosmesis while maintaining comfort for the anophthalmic patient, communication between the ocularist and oculoplastic surgeon is of paramount importance. The ocularist must realize his limitations in correcting deformities prosthetically and must communicate these limitations to the ophthalmologist when surgical alternatives are being considered.

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.

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)

Careful surgical technique is important in enucleation surgery. Gentle and careful handling of tissues leads to superior cosmetic results and fewer complications. Extrusion of orbital implants may occur early or late. Small extrusions may be treated with a scleral patch, and larger extrusions with an acrylic sphere wrapped in fascia lata or donor sclera. Dermis fat grafts are also satisfactory secondary implants.

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.

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.

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.

This article traces the history of facial and ocular prosthetics. Creative individuals who have made significant contributions are highlighted and the evolution of techniques and materials is presented. In view of the significance placed upon facial beauty in today's society, it becomes incumbent upon us to recognize the ingenuity and skill of those in the past to gain appreciation for the present state of the art and to provide incentive for improving facial and ocular prosthetic restorations in the future.

A variety of autogenous materials may be used for orbital implantation in the anophthalmic socket. An understanding of the pathology of the socket is necessary to treat the problem correctly. Autogenous grafts have been used successfully to treat the superior sulcus deformity, extruding implant, and the contracting socket. The major advantages of autogenous material are its minimal inflammatory reaction and its total compatibility with the host.