[Morphological evaluation of orbital implants in postenucleation reconstruction (an experimental study)]

About 12 thousand surgeries for eyeball removal are performed every year in the Russian Federation. Formation of the supporting stump and implantation of the proper orbital implant is essential for successful cosmetic prosthesis.

PURPOSE

Comparison of materials biocompatibility, design of different orbital implants and morphological condition of formed postenucleation stumps in an in vivo experiment.

MATERIAL AND METHODS

In the course of the study 24 rabbits were operated, divided into three comparable groups. Enucleation with primary implantation of an orbital implant was performed in all subjects. The following implants were used: polymeric orbital implant - in the main (experimental) group, polytetrafluorethylene insertion implant - in the control group 1, and silicone endoprosthesis - in the control group 2. We assessed features of the implantation process, implant design, general condition of the operated animals, condition of the postenucleation stumps, passive motility of the stumps, and reaction of the surrounding tissues to the implants.

RESULTS

Performed surgeries did not negatively affect the general condition of the rabbits, and there was no significant local tissue reaction to the implants. The structural and design features of the implants used in the main group were found to be more convenient for implantation, ensured stable fixation and position in the orbit. Postenucleation stump motility was comparable in all groups during the early postoperative period. This parameter decreased at later follow-up times mostly in the control group 2. When extracting the implants, it was revealed that in the main group it had secure fixation to the orbital tissues and stable position, did not cause abundant proliferation of connective tissue. Pathomorphological examination revealed that tissue reaction to the implants was less prominent and was reversed soon with fine connective tissue capsule formation in the main group and control group 2. In the control group 1 tissue reaction increased progressively, and capsule formation was delayed.

CONCLUSION

Polymeric implant is the most suitable orbital implant for postenucleation orbital reconstruction.

[Clinical forms of ocular dirofilariasis]

The prevalence of dirofilariasis in Russian Federation has been increasing in recent years. Diagnosis of ocular dirofilariasis is difficult due to polymorphism of its clinical manifestations. Systematized data on this disease in literature is virtually absent. The study included 142 cases of ocular dirofilariasis registered in Russian Federation and the former Soviet Union, which were described in the literature of 1915-2016 years. An analysis of the registered cases of dirofilariasis allowed the following classification points to be defined: localization-based - subcutaneous soft tissue, subconjunctival, orbital, scleral, intraocular; in terms of clinical forms - capsular (with perifocal inflammation, asymptomatic disease course, with fixed or unfixed capsule) and acapsular/migrating (with or without infiltration of surrounding tissues). The most difficult to diagnose are the capsular forms. In such cases, ultrasonography is used to reach final diagnosis. The developed working classification of ocular dirofilariasis enables to refine the approaches to diagnosing this pathology, which will undoubtedly improve the quality of medical care.

[Orbital case of ocular dirofilariasis]

AIM

to report a clinical case of orbital dirofilariasis with attention to peculiarities of disease presentation, diagnostic measures, and treatment results.

MATERIAL AND METHODS

A patient with a history of spontaneously subsiding recurrent oedema of the lower eyelid suspicious of parasitic cyst formation. The diagnosis was confirmed preoperatively by orbital ultrasound. Surgical intervention included orbitotomy with microsurgical excision of the parasitic cyst via a percutaneous approach through the lower eyelid skin crease.

RESULTS

Ultrasonography of the orbits appeared to be the most informative diagnostic method in this case. Thorough surgical planning allowed us to avoid complications in the postoperative period and to achieve good cosmetic results.

CONCLUSION

A painless solid mass lesion with recurrent perifocal oedema and hyperaemia without inflammatory infiltration of surrounding tissues is characteristic of parasitic cysts of the orbit. Amond other infectious diseases, a parasitic cyst stands out for symptomatic relapses and spontaneous regression, irrespective of the treatment received. The use of ultrasound allowed preoperative identification of the sac and the living helminth.

[Staged complex treatment of paralytic lagophthalmos (case report)]

Paralytic lagophthalmos, resulting from facial nerve palsy, is a difficult medical and social issue that requires cooperation of different specialists. Complications that arise in paralytic lagophthalmos may cause significant vision loss and even eye loss. Various techniques of paralytic lagophthalmos correction are used to protect the cornea and restore eyelid anatomy and functions. These comprise palliative (conservative), surgical, and alternative treatments (such as botulinum toxin type A therapy). Surgical treatment of paralytic lagophthalmos patients often has to be staged and complex. This article presents a clinical case of a female patient with paralytic lagophthalmos complicated by corneal perforation. Her staged complex treatment included lower eyelid surgery, chemodenervation of the upper eyelid levator and optical reconstructive surgery. The following positive results were achieved: the protective function of the eyelids was restored, residual visual functions - preserved, the risk of eye loss - eliminated, and the asymmetry between the two halves of the face - corrected.