The influence of the locomotor stump’s form on the ocular prosthetics result with different methods of eye removal

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Abstract

Aim. To determine the optimal shape of the locomotor stump and the configuration of the corresponding ocular prosthesis, ensuring their maximum motility in patients with anophthalmia with different methods of eye removal.

Materials and methods. The study group consisted of 132 patients aged 18–80 years after enucleation or evisceration. Examination methods included medical history; examination of eyelids, measurement of length and width of the palpebral fissure, as well as of the depth of conjunctival fornices on both sides; assessment of the volume, shape, surface topography, position and excursions of the locomotor stump, of the protrusion of the ocular prosthesis compared to the contralateral eye; photo registration of the studied parameters.

Results. During the study, there were 3 types of locomotor stump identified: moderate with retraction in the upper third; voluminous flattened; voluminous hemispherical. The locomotor stump after enucleation was voluminous flattened or moderate with retraction in the upper third. The best motility of the locomotor stump was noted nasally and downward. The motility of the ocular prosthesis was 47.4% compared to the contralateral eye. The locomotor stump after evisceration with keratectomy was voluminous hemispherical or voluminous flattened. Its motility in all four directions was about the same. The motility of the ocular prosthesis in comparison to the contralateral eye was 55.9%. The locomotor stump after evisceration without keratectomy was voluminous hemispherical, uniform, smooth. The motility of the locomotor stump was maximal in comparison to other groups and relatively equal in all four directions. The motility of the ocular prosthesis in comparison to the contralateral eye was 68.2%.

Conclusion. The optimal shape of the locomotor stump, providing the greatest motility of the ocular prosthesis is voluminous hemispherical. The same protrusion of the eyeball and that of the cosmetic prosthesis relatively to the frontal plane after enucleation is achieved by increasing the thickness of the prosthesis itself, which reduces its motility. Evisceration with implantation of the orbital prosthesis involves the use of a thin-walled ocular prosthesis, the back surface of which ideally repeats the locomotor stump surface and does not prevent its maximum motility. When removing a squinting eyeball with preserved corneal diameter, a smaller implant should be used to prevent excessive opening of the palpebral fissure, or to prefer evisceration with keratectomy.

About the authors

Nadezhda A. Baranova

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

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

Ophthalmologist, Head, Laboratory of Ocular Prosthesis

Russian Federation, Saint Petersburg

Irina A. Senina

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

Email: i.senina@mail.ru

Ophthalmologist

Russian Federation, Saint Petersburg

Vadim P. Nikolaenko

Saint Petersburg State Hospital No. 2; Saint Petersburg State University

Email: dr.nikolaenko@mail.ru

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

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Measurement of the mobility of the locomotor stump using a protractor scale and the arrow-pointer formed of the hemostatic sponge

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3. Fig. 2. Measurement of the mobility of an ocular prosthesis using a protractor scale and a needle pointer

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4. Fig. 3. Locomotor stump with uneven surface after evisceration with keratectomy

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5. Fig. 4. Post-evisceration state without keratectomy: upper figure – centrally located locomotor stump with a commensurate implant; lower figure – the result of prosthetics

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6. Fig. 5. Locomotor stump during enucleation: a – having moderate volume with retraction in her upper third; b – voluminous flattened

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7. Fig. 6. Voluminous hemispherical locomotor stump after evisceration: a – with keratectomy; b – without keratectomy

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8. Fig. 7. Prosthetics with locomotor stump with retraction in her upper third: a – insufficient stump volume; b – ocular prosthesis of a complex form; c – the result of prosthetics

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9. Fig. 8. State after evisceration without keratectomy: a – the consequences of the installation of a disproportionate implant, excessively convex locomotor stump is displaced to the temple, the left palpebral fissure even without the prosthesis is wider than the right one; b – cosmetic result of prosthetics with thin-walled prosthesis

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10. Fig. 9. State after evisceration without keratectomy: a – horizontal displacement of the cornea to the nose; b – the opening of the palpebral fissure on the side of the prosthesis is wider in the medial third; c – convex and flatter ocular prostheses; d – the gap between the ciliary edge of the upper eyelid, the lacrimal caruncle and the edge of the prosthesis during the manufacture of a flatter prosthesis

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11. Fig. 10. The cut of the complex is cornea – pupil – iris of a thin-walled plastic eye prosthesis

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Copyright (c) 2020 Baranova N.A., Senina I.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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