Orbital Implants and the Post Enucleation Socket Syndrome
© Dr.sc.nat. O.-E. Martin, Swiss Institute for Artificial
Eyes
published
at the 2nd International Symposium on Ocular Trauma, Geneva/Switzerland,
April 2-5, 1992
.....................................................................................................................................................
Background
The Post-Enucleation-Socket-Syndrome is characterized by enophthalmos,
deep upperlid sulcus, ptosis,
and laxity of the lower lid. Primary orbital implants are thought
to prevent this syndrome. However, only
few data exist on the long-term course of orbital implants among
patients of different ages. Is this treatment
really necessary in any case?
Question
How is the long-term course of orbital implants among patients of
different ages?
Methods
We have examined during two years 500 consecutive anophthalmic patients
with respect to:
-
age in which enucleation was performed
-
presence of, or secondary removal of orbital implant
-
enophthalmic difference between eye and prosthesis
-
depression of supratarsal sulcus
-
lid closure insufficiency
-
conjunctival irritation
Results
| Distribution
of patients |
 |
Causes of enucleation
| Trauma |
330 |
66% |
| Disease
(without tumor) |
84 |
17% |
| Tumor |
63 |
13% |
| Microphthalmy |
12 |
2% |
| Total
of enucleations |
489 |
98% |
| Microphthalmies
without enucleation |
11 |
2% |
Total |
500 |
100% |
Number
of Orbital Implants
| No
of patients without primary implant |
399 |
80% |
| No
of patients with primary implant |
90 |
18% |
| No
of patients whose primary implant was removed |
11 |
2% |
Total |
500 |
100% |
Originally
there have been 101 patients with primary orbital implant. Eleven
implants had to be removed
later on (due to dehiscence, dislocation, extrusion).
1
out of 10 implants is the cause of an additional surgical intervention.
Differences
of enophthalmus (a) and supratarsal sulcus (b) between patients
with
and without implant
| (a)
Enophthalmic differences between eye and prosthesis |
|
The
mean enophthalmic difference between eye and prosthesis about 2
mm is normal.
(b)
Supratarsal sulcus differences between eye and prosthesis
|
|
Lid
The mean supratarsal sulcus difference between eye and prosthesis
of at least 3 mm is normal.
Lid
closure insufficiency and conjunctival irritation
Lid
closure insufficiency sustains conjunctival irritation.
|
|
Supratarsal
sulcus depression and age in which enucleation was performed
(a)
without implant
|
|
(b)
with implant
|
|
Significant
differences between the figures above are only visible at age of
enucleation more than
45 years. The average supratarsal sulcus depression is distinctly
smaller in this group. Younger patients
have no advantage of an orbital implant with respect to supratarsal
sulcus depression.
Conclusions
- Conjunctival irritation of an anophthalmic socket is closely related
to lid closure insufficiency.
The volume of orbital implant plus eye prosthesis should allow for
complete lid closure.
-
The average enopthalmic difference between eye and prosthesis is
at least 2mm (also in cases
with orbital implants.)
-
Differences of supratarsal sulcus depht are at least 3mm (also in
cases with orbital implants).
-
Significant differences (enophthalmic and sulcus) between patients
with and without primary orbital
implant are only visible in patients who had enucleation at the
age of about 60 years or more.
-
The deformity most recognized after enucleation is supratarsal sulcus
depression. Orbital implants
only improve the cosmetic result in patients who had enucleation
at the age of about 45 years or more.
-
Thus, the long-term cosmetic effects of an orbital implant is highly
dependent on the age in which
enucleation is performed.
Copyright
© 1999 Istituto Svizzero per Protesi Oculari, CH-Lucerna. Riproduzione
solamente con il permesso
dell'autore.
|
