Custom wave-shaped CAD/CAM orbital wall implants for the management of post-enucleation socket syndrome

Delayed treatment of traumatic eyeball dislocation into the maxillary sinus and treatment algorithm: a case report and literature review

Orbital floor fractures are commonly encountered, but the dislocation of the eyeball into the maxillary sinus is relatively rare. When it does occur, globe dislocation can have serious consequences, including vision loss, enucleation, and orbito-ocular deformity. Immediate surgical intervention is typically attempted when possible. However, severe comorbidities and poor general health can delay necessary surgery. In this report, we present the surgical outcomes of a 70-year-old woman who received delayed treatment for traumatic eyeball dislocation into the maxillary sinus due to a subarachnoid hemorrhage and hemopneumothorax. Additionally, we propose a treatment algorithm based on our clinical experience and a review of the literature.

Automatic segmentation of orbital wall from CT images via a thin wall region supervision-based multi-scale feature search network

PURPOSE

Orbital wall segmentation is critical for orbital measurement and reconstruction. However, the orbital floor and medial wall are made up of thin walls (TW) with low gradient values, making it difficult to segment the blurred areas of the CT images. Clinically, doctors have to manually repair the missing parts of TW, which is time-consuming and laborious.

METHODS

To address these issues, this paper proposes an automatic orbital wall segmentation method based on TW region supervision using a multi-scale feature search network. First of all, in the encoding branch, the densely connected atrous spatial pyramid pooling based on the residual connection is adopted to achieve a multi-scale feature search. Then, for feature enhancement, multi-scale up-sampling and residual connection are applied to perform skip connection of features in multi-scale convolution. Finally, we explore a strategy for improving the loss function based on the TW region supervision, which effectively increases the TW region segmentation accuracy.

RESULTS

The test results show that the proposed network performs well in terms of automatic segmentation. For the whole orbital wall region, the Dice coefficient (Dice) of segmentation accuracy reaches 96.086 ± 1.049%, the Intersection over Union (IOU) reaches 92.486 ± 1.924%, and the 95% Hausdorff distance (HD) reaches 0.509 ± 0.166 mm. For the TW region, the Dice reaches 91.470 ± 1.739%, the IOU reaches 84.327 ± 2.938%, and the 95% HD reaches 0.481 ± 0.082 mm. Compared with other segmentation networks, the proposed network improves the segmentation accuracy while filling the missing parts in the TW region.

CONCLUSION

In the proposed network, the average segmentation time of each orbital wall is only 4.05 s, obviously improving the segmentation efficiency of doctors. In the future, it may have a practical significance in clinical applications such as preoperative planning for orbital reconstruction, orbital modeling, orbital implant design, and so on.

Management of post enucleation socket syndrome patients - A retrospective study

The aim of this retrospective monocentric study was to report the outcomes following the correction of post enucleation socket syndrome (PESS) as well as the factors predicting for a multistep management. Patients were included, if they had received surgery to manage PESS. Demographics and patient history were collected. The symptoms of PESS were clinically rated by the same surgeon and ocularist, preoperatively and after each procedure. The surgery was considered as successful when no PESS clinical symptoms were observed. A prognostic study was performed to investigate the surgical outcomes. RESULTS: Thirty-six patients were included and eight of them had their PESS corrected after the first surgery. In the multivariate analysis (MVA), the deep upper lid sulcus symptom remained the main significant factor associated with an incomplete correction after the first surgery (OR 45.5, IC 95% (3.481-594.6), p = 0.004). For further corrections, the ptosis was the only significant prognostic factor requiring several surgeries (p = 0.005). At the end of the management, 94.4% of the patients had satisfying outcomes. CONCLUSIONS: The management of a PESS involves the correction of both the orbital cavity and the soft tissues. Although its correction is complex and time consuming in the majority of cases, the patients should be informed that the final cosmetic outcomes remain good at the expense of several surgeries.

Critical appraisal of patient-specific implants for secondary post-traumatic orbital reconstruction

In orbital reconstruction, a patient-specific implant (PSI) may provide accurate reconstruction in complex cases, since the design can be tailored to the anatomy. Several design options may be embedded, for ease of positioning and precision of reconstruction. This study describes a cohort of 22 patients treated for secondary orbital reconstruction with a PSI; one patient received two PSI. The preoperative clinical characteristics and implant design options used are presented. When compared to preoperative characteristics, the postoperative clinical outcomes showed significant improvements in terms of enophthalmos (P < 0.001), diplopia (P < 0.001), and hypoglobus (P = 0.002). The implant position in all previous reconstructions was considered inadequate. Quantitative analysis after PSI reconstruction showed accurate positioning of the implant, with small median and 90th percentile deviations (roll: median 1.3°, 90th percentile 4.6°; pitch: median 1.4°, 90th percentile 3.9°; yaw: median 1.0°, 90th percentile 4.4°; translation: median 1.4 mm, 90th percentile 2.7 mm). Rim support proved to be a significant predictor of roll and rim extension for yaw. No significant relationship between design options or PSI position and clinical outcomes could be established. The results of this study show the benefits of PSI for the clinical outcomes in a large cohort of secondary post-traumatic orbital reconstructions.

Hyaluronic acid injections in post-enucleation or evisceration socket syndrome: a case series

Background

One of the primary goals of enucleation and evisceration surgery is the restoration of an adequate orbital volume through the use of appropriately sized alloplastic or autogenous tissues. In patients inadequately treated, post-enucleation or evisceration socket syndrome occurs. Fillers are an ideal alternative for eyelid and eyebrow arcade volume enhancement since their injection is easily performed in an outpatient setting avoiding several complications. The aim of this study is to report the use of hyaluronic acid (HA) fillers to treat volume deficits of the upper and lower eyelids, projecting the brow arcade and reducing the asymmetry.

Methods

Thirteen patients (2 male, 11 female, mean age 32.7 years) were treated from June 2012 to May 2020. Non-surgical treatment by HA filler injection for aesthetic rehabilitation of deep superior sulcus, inferior tear trough deformity, and scleral show was performed.

Results

No complications as orbital-ache and/or vasovagal response were reported during the injections. Minor complications such as light swelling at the site of injection, self-resolved within 2 days, were recorded. Stable results were observed at follow-ups. In two cases, two successive treatments were required at 3 and 6 years from the first injection.

Conclusions

Hyaluronic acid fillers offer a versatile and safe method for replacing soft tissue lost from the upper eyelid/brow complex in cases of post-enucleation or evisceration socket syndrome.

Level of evidence: Level IV, therapeutic study.

Reliability of orbital volume measurements based on computed tomography segmentation: Validation of different algorithms in orbital trauma patients

PURPOSE

To compare the most common methods of segmentation for evaluation of the bony orbit in orbital trauma patients.

MATERIALS AND METHODS

Computed tomography scans (before and after treatment) from 15 patients with unilateral blowout fractures and who underwent orbital reconstructions were randomly selected for this study. Orbital volume measurements, volume difference measurements, prolapsed soft tissue volumes, and bony defect areas were made using manual, semi-automated, and automated segmentation methods.

RESULTS

Volume difference values between intact and damaged orbits after surgery using the manual mode were 0.5 ± 0.3 cm³, 0.5 ± 0.4 cm³ applying semi-automated method, and 0.76 ± 0.5 cm³, determined by automated segmentation (р = 0.216); the mean volumes (MVs) for prolapsed tissues were 3.0 ± 1.9 cm³, 3.0 ± 2.3 cm³, and 2.8 ± 3.9 cm³ (p = 0.152); and orbital wall defect areas were 4.7 ± 2.8 cm², 4.75 ± 3.1 cm², and 4.9 ± 3.3 cm² (p = 0.674), respectively.

CONCLUSIONS

The analyzed segmentation methods had the same accuracy in evaluation of volume differences between two orbits of the same patient, defect areas, and prolapsed soft tissue volumes but not in absolute values of the orbital volume due to the existing diversity in determination of anterior closing. The automated method is recommended for common clinical cases, as it is less time-consuming with high precision and reproducibility.