Results of surgical treatment and rehabilitation of patients with post-traumatic subatrophy and anophthalmic syndrome in combination with bone deformities of the orbit

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Abstract

BACKGROUND: Ocular prosthetics remains an important and actual task in the rehabilitation of patients with anophthalmos of various origins.

AIM: To increase the effectiveness of cosmetic prosthetics in patients at the formation of a primary and/or delayed supporting stump with simultaneous reconstructive procedures on the orbital bone structures.

MATERIALS AND METHODS: A retrospective analysis of patients with subatrophy and anophthalmos with deformities of the orbital walls was carried out. Results were analyzed according to the criteria for the severity of clinical signs — enophthalmos, deepening of the superior orbitopalpebral sulcus, prosthesis mobility.

RESULTS: 22 patients with orbital bone deformities were operated and examined; they underwent surgery on the orbital walls in combination with evisceration with posterior scleral pole resection, neurectomy and implantation of a spherical endoprosthesis (in modifications) in 12 patients and delayed stump plasty in 10 patients with anophthalmos. It was possible to eliminate enophthalmos in 18 patients, to correct the retraction of the upper eyelid on the prosthesis side in 19 patients, and to significantly increase the mobility of the prosthesis in 9 patients.

CONCLUSIONS: Carrying out a combined surgical procedure aimed at restoring a voluminous mobile primary or delayed supporting stump and eliminating the deformation of the orbital walls with restoring the lost volume creates conditions for optimal individual ocular prosthetics, significantly reduces prosthesis enophthalmos, increases its mobility and improves cosmetic results of rehabilitation.

About the authors

Dmitry V. Davydov

National Medical Research Radiological Centre; Saint Petersburg Diagnostic Center No. 7 (Ophthalmological) for Adults and Children

Author for correspondence.
Email: d-davydov3@yandex.ru
ORCID iD: 0000-0001-5506-6021
http://www.doctordavydov.com

Professor, Head of the Department of Oncoplastic Surgery

Russian Federation, 3, Borkinskii lane, Moscow, 125284; Saint Petersburg

Nadezhda A. Baranova

Saint Petersburg Diagnostic Center No. 7 (Ophthalmological) for Adults and Children

Email: baranova-n@bk.ru

Ophthalmologist, Head, Laboratory of Ocular Prosthesis

Russian Federation, Saint Petersburg

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Supplementary files

Supplementary Files
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2. Fig. 1. General view of a 50 y.o. patient before surgery — 6 months after injury. Subatrophy of the left eyeball, chronic uveitis, deformation of the conjunctival cavity, ptosis of the upper eyelid, deep orbitopalpebral sulcus

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3. Fig. 2. Patient, 50 у.о. Multispiral computed tomography before surgery. Front view. Posttraumatic deformity of the inferior and the temporal walls of the left orbit. Increased socket volume

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4. Fig. 3. Multispiral computed tomography before surgery: a — axial sections; b — sagittal sections. Socket deformity . Increased socket volume. Posstraumatic eyeball subatrophy

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5. Fig. 4. General view of a 50 y.o. patient on the 2nd day after surgery. Edema of orbital tissues. Absence of the orbitopalpebral sulcus deepening

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6. Fig. 5. General view of the patient 2 years after surgery. A prosthesis is installed in the left cavity (Laboratory of complex eye prosthetics, Saint Petersburg)

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7. Fig. 6. Multispiral computed tomography. Frontal view. Two years after surgery. Titanium mesh over the zone of the defect. Spherical implant and external cosmetic prosthesis in the orbital cavity

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8. Fig. 7. Multispiral computed tomography: а — axial view; b — sagittal view. Titanium mesh over the defect zones. Prosthesis is congruent to the stump shape

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