2. Introduction
Congenital Anophthalmia – a rare
congenital eye anomaly due to
deficiency in development of primary
optic vesicle.
There is no detectable ocular tissue.
Associated with microblepharon,short
conjunctival sac, absence of
extraocular muscles.
Replaced completely by a cyst.
3.
4. Purpose of review
The introduction of hydrogel socket &
orbital expanders has modified
approach towards rehabilitation of
congenital anophthalmia.
5. Recent advances
Hydrogel socket expander as an
outpatient procedure.
Increased orbital volume confirmed by
CT ,MRI.
Inflatable orbital tissue expander new
design
8. 1.Positioning of progressively enlarging
static acrylic conformers asap after
birth
- Orbital cyst –dynamic expander like
conformer
Drainage or Excision – Rapid growth
- Uncomfortable
to wear
MRI to exclude connection to brain
10. Inert spherical implants
Advantages
Provide comfort and low rates of
extrusion.
Cost-effective choice in patients.
Disadvantages
decreased motility and implant migration.
Buried motility implants
anterior surface projections push the
overlying
prosthesis with direct force and can
improve prosthetic motility.
may pinch the conjunctiva between the
implant and the prosthesis - painful
11. Hydroxyapatite and porous
polyethylene implants allow for drilling
and placement of a peg to integrate
the prosthesis directly with the moving
implant.
Pegging is usually carried out 6-12
months after enucleation. Pegged
porous implants offer excellent
motility,
12.
Locations for implants -within the Tenon capsule
/behind the posteri or Tenon capsule in the
muscle cone.
Spheres may be covered with other materials
such as
sclera (homologous or cadaveric) or autogenous
fascia,
Secure closure of Tenon fasci a over the anterior
surface of an anophthalmic implant is an
important barrier to later extrusion.
14. Hard silicone spheres
-
Need of series of surgeries
Multiple general anaesthesias
Repeated trauma to soft tissues
15. Inflatable soft tissue
expanders
-
Better orbital bone stimulation &
socket enlargement.
Difficult to control direction ,maintain
expansion pressure.
Chance of displacing
conformer,extrusion
16. Hydrogel expander implant
To stimulate growth of conjunctival sac
& eyelids followed by serial
implantation for Orbital volume with
temporary tarsorraphy.
Methylmethacrylate & Nvinylpyrrolidone
materials.
Small Soft tissue incision – quick
surgery , recovery
17. Injectable pellet expanders through
trocar tru skin at inferior orbital rim to
deep orbit.
Safe & minimally invasive technique
Easy to insert , biocompatible.
Migration & extrusion.
18. Positioning with cyanoacrylate glue
- No suture related complications
- Avoids multiple general anaesthesias
- Outpatient procedure with topical
anaesthesia.
19. Dermis –fat grafts
Outcomes:
-Good orbital volume ,adequate
fornices
-No excessive growth / need of
surgery
-Allows lid & socket expansion
Problems:
-second surgical site,unpleasant scar
-delay in healing,chronic discharge
20.
A study on evaluation of an integrated
orbital tissue expander in congenital
anophthalmos . Am J Ophthalmol
2011
-
An inflatable silicone globe sliding on
titanium T- plate secured to lateral
orbital rim with screws.
Inflating with transconjunctival inj of
normal saline ,30 G needle.
-
21. Outcomes:
- ease of insertion
- Absence of displacement
- Uniform pressure
- Reduced trauma
22. Guidelines for enucleation
A functionally and aesthetically acceptable
anophthalmic socket must have following –
an orbital implant of sufficient volume centered
within the orbit
a socket lined with conjunctiva or mucous
membrane with fornices deep enough to hold a
prosthesis.
eyelids with normal appearance and adequate
tone to support a prosthesis
good transmission of motility from the implant to
the overlying prosthesis
a comfortable ocular prosthesis that looks similar
to the normal eye
33. Advantages of Evisceration in
orbital implant
Less disruption of orbital anatomy.
Good motility of prosthesis
Lower rate of
migration,extrusion,reoperation.
34.
35.
36. Anophthalmic Socket
Complications and Treatment
Deep superior sulcus
Contracture of fornices
Exposure & extrusion of implant
Contracted socket
Anophthalmic ectropion
Anophthalmic ptosis
Lash margin entropion
Cosmetic Optics