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Schittkowski MP, Weiss N. [Ocular prosthetics in children-Possibilities and challenges]. DIE OPHTHALMOLOGIE 2023; 120:139-149. [PMID: 36662298 DOI: 10.1007/s00347-022-01794-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/21/2023]
Abstract
One of the greatest challenges for ocularists is prosthetic fitting in children, especially in children with congenital anomalies such as clinical anophthalmia or functionless (blind) microphthalmia. The most frequent reason for prosthetic fitting in children is a condition following enucleation for retinoblastoma, followed by trauma and congenital pathologies. The standard treatment after enucleation or evisceration begins intraoperatively with the selection of an suitable implant and the use of a conformer at the end of the operation to shape the prosthetic cavity. An initial prosthesis can be fitted 4 weeks postoperatively, with a final fitting taking place 3 months later. If iatrogenic scarring or scarring due to an infection of the prosthetic cavity occurs, the approach of the ocularist must be appropriately adapted with the use of modified prosthesis shapes and shorter treatment intervals. Surgical options include scar excision and oral mucosa or amniotic membrane transplantation. Congenital anomalies require the shortest treatment intervals and even more so for anophthalmia than for microphthalmia. The strategy is characterized by simultaneous stimulation of the soft tissue of the ocular adnexa as well as the bony orbit. As self-inflating hydrogel expanders are no longer available, conservative prosthetic treatment is the only option. Close cooperation between child/parent, ocularist and ophthalmic plastic surgeon is the best prerequisite for a good long-term treatment outcome.
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Affiliation(s)
- Michael P Schittkowski
- Abteilung Augenheilkunde, Bereich Strabologie, Neuroophthalmologie und okuloplastische Chirurgie, Universitätsmedizin Göttingen, R.-Koch-Str. 40, 37085, Göttingen, Deutschland.
| | - Nikolai Weiss
- Institut für künstliche Augen, Friedrich-Ebert-Str. 116, 34119, Kassel, Deutschland
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Katowitz WR, Prat DL, Munroe CE, Revere K, Khatib L, Hua P, Ying GS, Binenbaum G. Primary Monocanalicular Stent Intubation for Children With Congenital Nasolacrimal Duct Obstruction: Surgical Outcome and Risk Factors. Ophthalmic Plast Reconstr Surg 2022; 38:490-495. [PMID: 35502807 DOI: 10.1097/iop.0000000000002182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the risk factors impacting the surgical success of primary monocanalicular stent intubation for congenital nasolacrimal duct obstruction (CNLDO). METHODS This is a retrospective interventional case series of patients 18 years and younger treated more than a 12-year period with monocanalicular stent intubation with inferior turbinate fracture for CNLDO by a single surgeon. Patients with dacryocystoceles, dacryocystitis, Down syndrome and previous tear duct surgery were excluded. An intraoperative grading scale of tear duct stenosis, date of stent removal, stent length, and postoperative symptoms were recorded. Surgical success was defined as the complete resolution of symptoms. RESULTS One thousand four hundred sixty-nine stents were placed in 1,001 pediatric participants (533 unilateral, 468 bilateral). The mean age at surgery was 1.86 years (0.1-18.07). The mean follow up was 34.99 months (0.43-134.3) with mean in-office stent removal at 3.41 months (0.63-36.9). Early stent loss occurred in 14.8% intubations (217/1,469). The overall success rate was 92.4% (1,357/1,469 eyes). Subjects less than the age of 4 years had a success rate of 92.8% (1,296/1,397) compared with 84.7% (61/72) in children more than 4. In multivariable analysis, bilateral surgery, severe tear duct stenosis, and early stent loss were significantly associated with higher risk of surgical failure. CONCLUSIONS Severe tear duct stenosis, early stent loss, and bilateral surgery were significant risk factors for surgical failure. While the success rate stratified by age at surgery suggested a lower success after the age of 4. Primary monocanalicular stent intubation is an effective and safe treatment for CNLDO sparing a child the need for multiple staged surgeries.
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Affiliation(s)
| | - Daphna Landau Prat
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Division of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Center, Sheba Talpiot Medical Leadership Program, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Karen Revere
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Lama Khatib
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, U.S.A
| | - Peiying Hua
- Center for Preventative Ophthalmology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Gui-Shuang Ying
- Center for Preventative Ophthalmology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Gil Binenbaum
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
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Schittkowski MP, Leha A, Horn M, Naxer S. The Nasolacrimal Drainage System in 143 Children with the Microphthalmos-Anophthalmos Complex. Klin Monbl Augenheilkd 2022; 239:57-63. [PMID: 35120378 DOI: 10.1055/a-1721-2375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Report of clinical findings relating to the lacrimal system in congenital clinical anophthalmos and severe blind microphthalmos (MAC-complex patients). METHODS A retrospective study of the notes of 207 consecutive patients treated surgically at least once with highly hydrophilic self-inflating expanders for MAC between 1998 and 2021. The lacrimal drainage system was always probed and irrigated under general anaesthesia before any other procedure was started. RESULTS 64 patients were excluded due to possible misdiagnosis because of previous lid or orbit surgery elsewhere or due to missing data. The analysis therefore included 67 girls and 76 boys aged between 1 and 126 months (median age: 5 months). 72 patients presented with unilateral and 42 with bilateral anophthalmos, and 24 had unilateral and 5 bilateral microphthalmos; consequently, 286 orbits (of which, 190 with probable pathology) were available for assessment. In unilateral cases the lacrimal system on the normal side was never affected. On the anophthalmic or microphthalmic side the lacrimal system was normal in 68 orbits only (35.8%). The most frequent finding was canalicular stenosis (91 orbits; 48%). Common canaliculus stenosis was observed in 12 orbits (6.3%) and nasolacrimal duct obstruction in 9 orbits (4.7%). There were four cases of punctal aplasia, but no other anomalies. In unilateral MAC pathologic findings during lacrimal probing were found to be associated with anatomical malformation of the contralateral fellow eye. Only in unilateral anophthalmos there was a significant association with cleft lip and palate, which was not found in the three other groups. CONCLUSIONS In congenital clinical anophthalmos the lacrimal system is affected in up to 66.5% of cases, mostly due to canalicular stenosis. Even if there is no clear evidence of an embryological connection, this association is certainly not a random finding.
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Affiliation(s)
- Michael P Schittkowski
- Abteilung Augenheilkunde, Bereich Strabologie, Neuroophthalmologie und okuloplastische Chirurgie, Universitätsmedizin Göttingen, Deutschland
| | - Andreas Leha
- Institut für Medizinische Statistik, Georg-August-Universität Göttingen, Universitätsmedizin Göttingen, Deutschland
| | - Maren Horn
- Abteilung Augenheilkunde, Bereich Strabologie, Neuroophthalmologie und okuloplastische Chirurgie, Universitätsmedizin Göttingen, Deutschland
| | - Sabine Naxer
- Abteilung Augenheilkunde, Bereich Strabologie, Neuroophthalmologie und okuloplastische Chirurgie, Universitätsmedizin Göttingen, Deutschland
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Singh DD, Schorn L, Strong EB, Grant M, Schramm A, Hufendiek K, Gellrich NC, Rana M. Computer-Assisted Secondary Orbital Reconstruction. Craniomaxillofac Trauma Reconstr 2020; 14:29-35. [PMID: 33613833 DOI: 10.1177/1943387520935004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Study Design This study presents a case-control study of 33 patients who underwent secondary orbital reconstruction, evaluating techniques and outcome. Objective Adequate functional and aesthetical appearance are main goals for secondary orbital reconstruction. Insufficient premorbid orbital reconstruction can result in hypoglobus, enophthalmos, and diplopia. Computer-assisted surgery and the use of patient-specific implants (PSIs) is widely described in the literature. The authors evaluate the use of selective laser-melted PSIs and hypothesize that PSIs are an excellent option for secondary orbital reconstruction. Methods The sample was composed of 33 patients, previously treated with primary orbital reconstruction, presenting themselves with indications for secondary reconstruction (i.e. enophthalmos, diplopia, or limited eye motility). Computed tomography and/or cone beam data sets were assessed before and after secondary reconstruction comparing intraorbital volumes, infraorbital angles, and clinical symptoms. Clinical outcomes were assessed using a standardized protocol. Results Results show a significant change in intraorbital volumes and a reduction of clinical symptoms after secondary reconstruction. Conclusions Outcomes of this study suggest that secondary orbital reconstruction can be performed routinely using selective laser-melted PSIs and titanium spacers.
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Affiliation(s)
- Daman D Singh
- Department of Oral-, Maxillo- and Plastic Facial Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Lara Schorn
- Department of Oral-, Maxillo- and Plastic Facial Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - E Bradley Strong
- Department of Otolaryngology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Michael Grant
- Plastic and Reconstructive Surgery at the R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA
| | - Alexander Schramm
- Department of Oral-, Maxillo- and Plastic Facial Surgery, University of Ulm, Ulm, Germany
| | - Karsten Hufendiek
- Department of Oral-, Maxillo- and Plastic Facial Surgery, University of Hannover, Hannover, Germany
| | - Nils-Claudius Gellrich
- Department of Oral-, Maxillo- and Plastic Facial Surgery, University of Hannover, Hannover, Germany
| | - Majeed Rana
- Department of Oral-, Maxillo- and Plastic Facial Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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Management of Congenital Clinical Anophthalmos with Orbital Cyst: A Kinshasa Case Report. Case Rep Ophthalmol Med 2018; 2018:5010915. [PMID: 30402316 PMCID: PMC6198575 DOI: 10.1155/2018/5010915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/17/2018] [Indexed: 11/30/2022] Open
Abstract
An early developmental lack of the optic vesicle can result in congenital anophthalmia, defined as a complete absence of the eye, which can be distinguished from congenital microphthalmos, where ocular rudiments are present. Here, a rare pediatric case of congenital clinical anophthalmos with orbital cyst in the left orbit is reported. The patient was a 14-month-old girl with no other congenital defects who underwent surgical and prothetic management in St. Joseph's Hospital Kinshasa, Democratic Republic of the Congo (DRC). Surgery was carried out under general anesthesia. The cyst was punctured and its wall fully excised. Near the orbital apex pigmented elements representing iris, ciliary body, and choroidal or retinal remnants were found. The specimens were fixed in formalin for histological examination. Surgical cyst removal including socket deepening for an artificial eye was performed. Postoperative wound healing was uneventful and a satisfactory cosmetic outcome was achieved in all follow-up examinations. Histological examination revealed rudimentary ocular structures similar to degenerated lens tissue with a typical, PAS-positive capsule. Additionally, pigmented epithelial structures, which seem to be of ciliary body, iris, and choroidal or retinal-type epithelium origin, could be detected, prompting the final diagnosis, microphthalmia with dominant cyst formation.
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El Essawy RA, Abdelbaky SH. Successful conjunctival socket expansion in anophthalmic patients until the age of 2 years: an outpatient procedure. Clin Ophthalmol 2016; 10:1743-8. [PMID: 27672305 PMCID: PMC5026185 DOI: 10.2147/opth.s109486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the results of a simple outpatient method for soft tissue socket expansion in young children with congenital anophthalmos. Methods Seventeen congenital anophthalmic sockets of 15 infants of a mean age of 4.2±4.4 months were fitted with specially designed serial solid acrylic shapes or hydrogel expanders using cyanoacrylate for eyelids closure when using the latter. Results At the age of 2 years, the mean horizontal eyelid length increased from a mean of 11.6±4.5 to 19.4±4.6 mm and the volume of the last expander from a mean of 0.6±0.2 to 2.0±0.3 cm2. The specially designed acrylic shapes could be a substitute to the custom-made molds, which require general anesthesia. Conclusion Successful increase in the horizontal eyelid length as well as the conjunctival socket volume could be achieved by a simple outpatient procedure without the need for repeated hospitalization and general anesthesia in these infants.
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Kim EL, Bernardino CR, Levin F. Orbital volume augmentation using expandable hydrogel implants in acquired anophthalmia and phthisis bulbi. Orbit 2016; 35:91-6. [PMID: 26928353 DOI: 10.3109/01676830.2016.1139593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study is to describe our experience using expandable spherical hydrogel implants and injectable hydrogel pellets for orbital volume augmentation in cases of post-enucleation socket syndrome after acquired anophthalmia or phthisis bulbi. We retrospectively reviewed the clinical records of all adult patients who received an expandable hydrogel implant for orbital volume loss following enucleation or phthisis bulbi at the Emory Eye Center between 2004 and January 2007 and the Yale Eye Center between 2009 and 2011. The study included 9 women and 5 men with a mean age of 51.2 years old (range 35-76 years old). Follow-up spanned 6 to 71 months (median of 18.5 months). Four patients received spherical hydrogel implants and 10 patients received hydrogel pellet injections. On average, nine pellets (range 5-16) were placed in each patient over an average of 1.7 injections (range 1-3). Most commonly, five pellets were injected per session, as was the case for 13 of the 17 treatment sessions. Post-operative complications included 2 cases of pellet migration, one subcutaneously and one anteriorly due to insufficiently posterior implant placement, and 1 hospital admission for pain after injection of 10 pellets in one visit. All patients experienced an overall subjective improvement in cosmesis. Self-expandable hydrogel implants appear to offer several advantages over other existing options for orbital volume augmentation, as they are easy to place, generally well-tolerated, volume-titratable, and to the extent that our follow-up shows, may be a safe and durable means of treating orbital volume loss in patients with acquired anophthalmia and phthisis bulbi.
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Affiliation(s)
- Esther Lee Kim
- a Department of Ophthalmology , University of Southern California Eye Institute , Los Angeles , California , USA.,b Department of Ophthalmology & Visual Science , Yale Eye Center , New Haven , Connecticut , USA
| | - Carlo Rob Bernardino
- c Oculoplastics and Aesthetic Surgery , Vantage Eye Center , Monterey , California , USA
| | - Flora Levin
- b Department of Ophthalmology & Visual Science , Yale Eye Center , New Haven , Connecticut , USA
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Llorente-González S, Peralta-Calvo J, Abelairas-Gómez JM. Congenital anophthalmia and microphthalmia: epidemiology and orbitofacial rehabilitation. Clin Ophthalmol 2011; 5:1759-65. [PMID: 22267908 PMCID: PMC3258083 DOI: 10.2147/opth.s27189] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To describe the prevalence of congenital anophthalmia and microphthalmia in Hospital Universitario La Paz, and to identify associated risk factors and evaluate cosmetic results in treated and nontreated patients. Methods A retrospective, descriptive, cross-sectional study of patients treated with orbital expanding techniques (cases) and nontreated patients (controls) was carried out as a comparative case series study. A total of 36 patients with unilateral or bilateral anophthalmia or microphthalmia as main diagnosis were included; 52 epidemiological and management variables for each patient were analyzed. The study evaluated orbital growth and facial symmetry. Results The overall cosmetic result in the study’s group of patients was satisfactory: 66.7% showed good or very good orbital growth, and 75% showed good or very good facial symmetry. Controls had better cosmetic outcome but showed more cataracts (P = 0.05), inferior colobomas (P = 0.026), and family history (P = 0.056) than the cases. Controls also showed significantly better orbital growth (P = 0.042) and facial symmetry (P = 0.014) than the cases. Conclusion This study suggests that the mere presence of a globe (controls) still provides better orbitofacial development than the artificial stimulation (cases) currently available for patients with congenital anophthalmia and microphthalmia, who receive internal and external orbital rehabilitation.
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Küstner M, Riebeling P, Podmelle F, Kaduk W, Tost F. Volumenüberschuss durch Hydrogelexpander nach Enophthalmuskorrektur. Ophthalmologe 2009; 106:1126-9. [DOI: 10.1007/s00347-009-1995-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bartz-Schmidt U, Szurman P, Wong D, Kirchhof B. [New developments in retinal detachment surgery]. Ophthalmologe 2008; 105:27-36. [PMID: 18210123 DOI: 10.1007/s00347-007-1662-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The initial surgery is one of the most important factors influencing the anatomic and functional outcome of retinal detachment surgery. With the continual modifications in vitrectomy techniques, the strategy in primary vitrectomy surgery is also changing. Recent developments are the use of 25- and 23-gauge trocar systems and new surgical techniques without the use of perfluorcarbons or gas or silicone oil tamponade. In addition, heavy silicone oils are now entering routine clinical use, especially for proliferative vitreoretinopathy (PVR) redetachments of the lower fundus periphery. Regarding adjunct pharmacologic therapy, daunorubicin and 5-fluorouracil/low molecular weight heparin have been found to improve the results of patients with PVR or at risk for PVR.
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Schittkowski MP, Guthoff RF. Results of lacrimal assessment in patients with congenital clinical anophthalmos or blind microphthalmos. Br J Ophthalmol 2007; 91:1624-6. [PMID: 17567663 PMCID: PMC2095504 DOI: 10.1136/bjo.2007.120121] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To report clinical findings relating to the lacrimal system in congenital clinical anophthalmos and severe blind microphthalmos. METHODS A retrospective (up to 2003) and prospective (2004 onwards) study of the notes of 60 consecutive patients treated surgically with highly hydrophilic self-inflating expanders for congenital anophthalmos or severe blind microphthalmos between 1997 and 2006. The lacrimal drainage system was always probed and irrigated under general anaesthesia before any other procedure was started. RESULTS Nine patients were excluded due to possible misdiagnosis because of previous lid or orbit surgery elsewhere or due to missing data. The analysis therefore included 23 girls and 28 boys aged between 1 and 90 months (median age: 4 months). Twenty-three patients presented with unilateral and 18 with bilateral anophthalmos, and 10 had unilateral microphthalmos; consequently, 102 orbits (of which, 69 were with probable pathology) were available for assessment. In unilateral cases, the lacrimal system on the normal side was never affected. On the anophthalmic or microphthalmic side, the lacrimal system was normal in 17 orbits only (24.6%). The most frequent finding was canalicular stenosis (40 orbits; 58%). Common canaliculus stenosis was observed in 5 orbits (7.3%) and nasolacrimal duct obstruction in 7 orbits (10.1%). There were no cases of punctal anomaly. CONCLUSIONS In congenital clinical anophthalmos the lacrimal system is affected in up to 78% of cases, mostly due to canalicular stenosis. Even if there is no clear evidence of an embryological connection, this association is certainly not a random finding.
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Affiliation(s)
- M P Schittkowski
- University Eye Department, Rostock University, Doberaner Strasse 140, D-18055 Rostock, Germany.
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Mischkowski RA, Kübler AC. Correction of congenital nasal hypoplasia associated with Kallmann syndrome using self-inflating injectable tissue expander pellets. Plast Reconstr Surg 2006; 118:1447-1452. [PMID: 17051117 DOI: 10.1097/01.prs.0000239601.13560.88] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Robert A Mischkowski
- Cologne, Germany. From the Department of Craniomaxillofacial and Plastic Surgery, University of Cologne
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Schittkowski MP, Guthoff RF. Injectable self inflating hydrogel pellet expanders for the treatment of orbital volume deficiency in congenital microphthalmos: preliminary results with a new therapeutic approach. Br J Ophthalmol 2006; 90:1173-7. [PMID: 16707526 PMCID: PMC1857413 DOI: 10.1136/bjo.2006.092478] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIM Children with congenital microphthalmos are usually able to wear an eye prosthesis but the cosmetic aspect is determined by the size of the orbital volume deficiency. Instead of using a ball shaped standard hydrogel expander or a regular orbital implant, which would necessitate enucleation of the microphthalmic eye, this study investigates the feasibility of volume augmentation with injectable pellet expanders, as formerly suggested for acquired anophthalmos in adults only. METHOD The pellet expander is made from a self inflating hydrogel that takes up water by osmosis (dry state: length 8 mm, diameter 2 mm, volume 0.025 ml; in vitro hydrated state after around 1 day: length 15 mm, diameter 4 mm, volume 0.24 ml; swelling capacity: 9.6-fold). This report concerns six patients (two girls and four boys) aged between 4 months and 42 months with unilateral microphthalmos who were treated by injection of 4-14 pellet expanders into the retrobulbar orbital tissue. Volume augmentation was 1-3.5 ml. The pellets were injected using a customised trocar and placed behind the microphthalmos directed into the intraconal space. RESULTS The increasing orbital volume was noticeable within 2 days and was confirmed by ultrasonography and magnetic resonance imaging. The final result can be anticipated by the volume augmentation effect produced by the amount of saline solution injected in the orbital apex region. All patients were fitted with an artificial eye, which was subsequently enlarged every 3-5 months. Anophthalmic enophthalmos was fully compensated with this technique. No complications have been encountered to date. CONCLUSIONS Orbital volume augmentation with injectable self inflating hydrogel expander pellets is apparently a safe, quick, and minimally invasive technique for various indications in orbital reconstructive surgery-for example, to treat an enophthalmic appearance in microphthalmos and congenital or acquired anophthalmos.
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Affiliation(s)
- M P Schittkowski
- Department of Opthalmology, University of Rostock, Doberaner Strasse 140, D-18055 Rostock, Germany.
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Rapp DE, Cohn AB, Gottlieb LJ, Lyon MB, Bales GT. Use of tissue expansion for scrotal sac reconstruction after scrotal skin loss. Urology 2005; 65:1216-8. [PMID: 15913727 DOI: 10.1016/j.urology.2005.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2004] [Revised: 01/21/2005] [Accepted: 02/11/2005] [Indexed: 12/01/2022]
Abstract
We describe a two-stage technique for scrotal sac reconstruction using tissue expansion, best described as a tissue expanded V-Y scrotoplasty. This technique has been used after extensive scrotal skin loss, providing excellent functional and cosmetic outcomes.
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Affiliation(s)
- David E Rapp
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637, USA.
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Scholl HPN, Fleckenstein M, Krohne TU, Holz FG. Klassifikation biomedizinischer Forschungsberichte als Grundlage evidenzbasierter Medizin in der Augenheilkunde. Ophthalmologe 2005; 102:1152-61. [PMID: 16283184 DOI: 10.1007/s00347-005-1293-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Evidence-based medicine requires careful appraisal of published data derived from experimental and clinical studies. Based on classification of biomedical research reports, evidence levels can be determined and recommendations for therapeutic decisions can be made. METHODS A classification system for clinical studies was developed. It was evaluated in classifying the reports published in Der Ophthalmologe during 2003-2004 (study design: descriptive cross-sectional study, case series). RESULTS In the 2-year interval, 70 longitudinal and 95 cross-sectional studies were published. The vast majority of the longitudinal studies were interventional cohort studies. Not considering case reports, 73% of the original articles were longitudinal prospective studies, 1% were retrospective (case-control) studies, and 26% were cross-sectional studies. CONCLUSIONS The study design of all published articles could be classified using the classification system. This classification system proves to be applicable in the context of clinical studies in ophthalmology and may be helpful in the process of critical appraisal of the literature and synthesis of clinical evidence and an evidence-based recommendation.
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Mazzoli RA, Raymond WR, Ainbinder DJ, Hansen EA. Use of self-expanding, hydrophilic osmotic expanders (hydrogel) in the reconstruction of congenital clinical anophthalmos. Curr Opin Ophthalmol 2004; 15:426-31. [PMID: 15625905 DOI: 10.1097/01.icu.0000138618.61059.4c] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Rehabilitation of the congenitally anophthalmic orbit is frustrating to both the parents and physician. Traditional methods involve using progressively enlarging static acrylic conformers to expand the conjunctival socket, followed by placement of conventional static spherical orbital implants, dermis-fat grafts, or inflatable balloon expanders for orbital enlargement. Limitations of these methods typically result in less-than-optimal cosmetic outcomes, with retardation of bony orbital and overlying soft tissue growth adversely affecting midfacial growth and symmetry. Recent advances in tissue expansion technology may offer additional, novel alternatives to conventional therapies. RECENT FINDINGS Hydrogel tissue expanders were recently adapted for use in congenital anophthalmia. The expanders are placed in their dry, contracted states, and expand gradually to their full size via osmosis of surrounding tissue fluid, with up to a 10-fold increase in volume. Offering the benefit of predictable and controllable self-expansion, hydrogel expanders may offer yet another alternative or adjunctive therapy to the early rehabilitation of the contracted socket. Separate appliances are used for conjunctival and orbital reconstruction. Initial results appear promising. Tempering the enthusiasm for their use, however-particularly in terms of implanted orbital expanders-is the recent spate of long-term complications reported from previous uses of hydrogels as scleral buckling material. SUMMARY Self-expanding hydrogel tissue expanders appear to offer an intriguing reconstructive alternative to the frustrating condition of congenital anophthalmia. Long-term safety of the material as an orbital implant has not yet been demonstrated, but early results are promising.
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Affiliation(s)
- Robert A Mazzoli
- Department of Ophthalmology, Madigan Army Medical Center, Tacoma, WA 98431, USA.
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