Advances in ophthalmic plastic and reconstructive surgery最新文献

Throughout history, the human eye has been mentioned by authors as the most precious of gifts. It unveils the entire outer world to our consciousness, gives life expression and dignity to the face. The loss of an eye must therefore have always been regarded as the greatest misfortune. The ancient cultures of Babylon, Jericho, and Egypt used "art-eyes" in mummies, sarcophagus lids, and statues; they were made from precious stones, silver, gold, and copper as a symbol of light and life in their religious beliefs. Most of the recorded sources concerning the ancient practice of medicine were among the scrolls contained in the library of Alexandria. In the period between the Roman Colonial wars, the rise of Christianity and the fall of Alexandria to Arabs in 642 A.D., almost all of these sources, including those concerning the practice of Ophthalmology were lost. The largest collection of antiquity "art-eyes" and artificial eyes, mentioned in this paper, are found in the collection of the firm of Mueller and Sohne, Wiesbaden, Germany. They include the progress made in human artificial eyes to modern times. Historically, man has tried to alleviate the psychological suffering incurred by the loss of an eye, by hiding or covering the defacement with a patch. Of greater significance are the efforts made by the ophthalmologist and the ocularist (past and present) to restore functionally and cosmetically the natural facial appearance by means of an ocular prosthesis that corresponds to the remaining natural eye. Associated problems frequently concern both the reconstructive surgeon, who must be informed of the ocular prosthetic possibilities that are within the capacity of the ocularist, and the ocularist, who must create the prosthesis.

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.

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.