Peculiarities of ocular prosthetics in congenital anophthalmia and microphthalmia

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Abstract

Aim — to determine optimal terms of the primary ocular prosthetics, to develop the most auspicious regimen of adaptation to the ocular prosthesis in children with congenital anophthalmia and microphthalmia.

Material and methods. A total of 46 children aged from 1 month to 16 years with congenital defect were under observation. Among patients with congenital microphthalmia, only unpromising eyes were subject to ocular prosthetics. Examination methods in the laboratory included external examination of the orbit, palpebral fissure, and eyelids. The state of the cul-de-sac of eyelids, the configuration of the conjunctival cavity, the anterior segment of the abnormally small eyeball were assessed. Photography was performed to achieve a dynamic control of external prosthetics signs of, and to evaluate the face symmetry.

Results. Best results were observed at early stepwise ocular prosthetics with consideration of features of the ocular prosthesis material, without prior surgery. Long-term cosmetic performance of children with congenital anophthalmia and microphthalmia directly depended on age at which the non-surgical treatment began, on the timely replacement of the ocular prosthesis, compliance to the regimen developed for the adaptation to the prosthesis.

Conclusion. This study showed that the terms of primary ocular prosthetics are of crucial importance for the symmetrical development of soft tissues and facial skeleton. Prosthetics for patients with congenital anophthalmia should be started at the first month of life. The optimal term for primary prosthetics in congenital microphthalmia depends on the length of the antero-posterior axis at birth. If the axial length is less than 7.5 mm, prosthetics should be started at the first month of life, if the axis is longer than 10 mm — no later than from the fourth month of life.

About the authors

Nadezhda A. Baranova

Diagnostic Center No 7 (ophthalmological) for Adults and Children

Author for correspondence.
Email: baranova-n@bk.ru

Ophthalmologist, Head of the Laboratory of Ocular Prosthesis

Russian Federation, Saint Petersburg

Vadim P. Nikolaenko

Saint Petersburg State University

Email: dr.nikolaenko@mail.ru

MD, PhD, Professor of Otorhinolaryngology and Ophthalmology Chair of Medical Faculty

Russian Federation, Saint Petersburg

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Supplementary files

Supplementary Files
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2. Fig. 1. Congenital microphthalmia with the rudiment of the eyeball (the clinical picture is identical to the congenital anophthalmia)

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3. Fig. 2. The structure of the ophthalmological morbidity of children who are consulted and live in St. Petersburg (the percentage of microphthalmia in the nosological structure is 25%)

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4. Fig. 3. Right-side congenital microphthalmia: a — before prosthetics; b — after prosthetics

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5. Fig. 4. Bilateral congenital microphthalmia in a 3 y.o. child: a — before prosthetics; b — after prosthetics

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6. Fig. 5. Dynamics of size changes of ocular prostheses during 2.5 years

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7. Fig. 6. Congenital anophthalmia in a 2 y.o. child: a — the result of non-rational surgical intervention and late prosthesis fitting; b — prosthetics with individual conformers, insufficient dynamics of tissue stretching of the socket

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8. Fig. 7. Left-side congenital microphthalmia in a 12 y.o. child. State after external cantotomy. Cicatricial deformation of the eyelids. Instability of the ocular prosthesis: a — before prosthetics; b — after prosthetics

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9. Fig. 8. Left-side congenital microphthalmia in a 7 y.o. child (a); result of inadequate prosthetics with an excessively large prosthesis (b); satisfactory result of prosthetics in the laboratory of the Center (c); proportional individual eye prosthesis on the right (d)

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Copyright (c) 2018 Baranova N.A., Nikolaenko V.P.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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