Changing the geometry of polymer spherical orbital implants

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Abstract

BACKGROUND: Over the past decades, various polymer implants have been actively used in the rehabilitation of patients with anophthalmos to form a volumetric support stump and improve the results of cosmetic prosthetics.

AIM: To assess clinical symptoms and features of the X-ray picture in patients with anophthalmos after implantation of polymeric spherical endoprostheses with a modified geometry.

MATERIALS AND METHODS: The study is based on the analysis of 30 patients with anophthalmos after enucleations (23) and eviscerations (7) performed using various methods of procedure and insertion into tissues of an implant made of domestic polytetrafluoroethylene. All patients underwent a multispiral computed tomography (MSCT) of the eye sockets according to the same algorithm.

RESULTS: On the basis of the performed studies, the fact of making a change in the geometry of the implanted spherical implants was revealed, while the parameters of the modified part of the spheres were different and ranged from 14 to 18 mm of final diameters with the initial diameters of the spheres ranging from 18 to 20 mm. A decrease in the volume of spheres with modified geometry from 0.114 to 0.651 cm3 was revealed with initial diameters ranging from 18 to 20 mm.

CONCLUSIONS: Changes in the geometry of the orbital spheres do not improve the results of cosmetic prosthetics in patients, increase the percentage of implant exposure at different times after surgery, and increase the manifestations of anophthalmic syndrome.

About the authors

Dmitry V. Davydov

P.A. Hertsen Moscow Oncology Research Institute; 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, Moscow; Saint Petersburg

Nadezda A. Baranova

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

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2. Fig. 1. Patient, 61 y. o., 4 years after surgery: a — left-side anophthalmos, retraction of the cosmetic prosthesis, deepening of the upper orbito-palpebral sulcus, ptosis; b — without the prosthesis, discharge in the cavity, flattened anterior surface of the stump, deep upper fornix. State after surgery with the introduction of an implant with modified geometry

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3. Fig. 2. Patient, 34 y. o. 3 years after surgery: a — exophthalmos of the left prosthesis, deformation and stretching of the eyelids, of the conjunctival cavity; b — MRI-exam. The arrow shows the front surface of the implant with modified geometry

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4. Fig. 3. Patient, 45 y. o. Knots of non-absorbable material on the front surface of the stump

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5. Fig. 4. Suture material on the stump, implant exposure (photo slit lamp)

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6. Fig. 5. Patient, 28 y. o. 2 years after surgery. Defect of the epithelium above the surface of the implant with modified geometry, chronic conjunctivitis

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7. Fig. 6. Patient K., 42 y. o. 3 years after surgery. Granulation in the conjunctivas cavity of the anophthalmic orbit

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8. Fig. 7. Patient, 32 y. o. 3 years after surgery with implantation of an endoprosthesis with modified geometry. MSCT of the socket

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9. Fig. 8. Patient, 21 y. o. 2,5 years after surgery with implantation of an endoprosthesis with modified geometry. MSCT of the socket

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10. Fig. 9. Patient, 57 y. o. 3 years after surgery with implantation of an endoprosthesis with modified geometry. Defect of the anterior surface of the stump, exposure of the orbital implant

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11. Fig. 10. Patient, 42 y. o. The state after surgery using an implant with modified geometry (a), and multiple fragments of the same material in the tissues of the orbit (b, shown by arrows)

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12. Fig. 11. Patient, 33 y. o.: a — general view of the conjunctival cavity without prosthesis. Edema of the conjunctiva covering the stump and anophthalmic cavity; b — MSCT study. Soft tissue hypertrophy anterior to the implant with modified geometry. Thin-walled prosthesis; c — general view with prosthesis. Deformation of eyelids, protrusion of a thin-walled prosthesis due to hypertrophy and edema of soft tissues

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