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Different Intraorbital Implant Situations and Ocular Prosthetic Rehabilitation

Aggarwal H, Kumar P, Eachempati P, Alvi HA

J Prosthodont, 2016 Dec;25(8):687-693.
PMID: 26447725 DOI: 10.1111/jopr.12369

Enucleation is the removal of the entire globe of the eye and a portion of the optic nerve, while evisceration involves the removal of the contents of the globe leaving the sclera, extraocular muscles, and optic nerve. Following enucleation or evisceration, intraorbital implants are routinely placed to enhance the prosthetic outcome in addition to restoring the lost orbital volume. Current practice employs intraorbital implants made of nonporous silicone, hydroxyapatite, or porous polyethylene. Intraorbital implant selection and placement, being a highly demanding procedure in terms of knowledge, skill, and expertise, may be associated with a multiplicity of technical and surgical errors. Complications are usually minimal with these implants, but they do occur. The literature reveals many articles related to intraorbital implants, their benefits, and complications; however, the literature regarding the effect of various intraorbital implant situations on the subsequent prosthetic rehabilitation is markedly scarce. Moreover, the need for interdisciplinary surgical and prosthetic interventions required for successful rehabilitation in cases of compromised implant situations has been underemphasized. Hence, this review aimed to evaluate the effect of different intraorbital implant situations on ocular rehabilitation and the required interdisciplinary surgical and prosthetic treatment approach for rehabilitation of enucleated/eviscerated sockets with compromised implant situations, to provide a critical appraisal, and to present a simplified management strategy.

Matched MeSH terms: Eye Enucleation*
Fulltext Lower eyelid fornix deepening: A new indication for the facial artery myomucosal flap

Saad AZM, Nordin NR, Sulaiman WAW, Jamayet N, Johar SFNM, Hussein A

Arch Plast Surg, 2021 Jan;48(1):80-83.
PMID: 33503749 DOI: 10.5999/aps.2020.00206

Eye socket contracture is a well-known late complication of enucleation surgery, and the additional insult of radiotherapy at an early age causes even further fibrosis and scarring of the socket. Management of the contracted socket is challenging, and several methods have been proposed. We report a case of eye socket contracture after enucleation and radiotherapy in which multiple reconstructive procedures failed. The recurrent contracture caused difficulty in housing and retaining the eye prosthesis. We reconstructed the lower eyelid with a facial artery myomucosal flap and nasolabial flap, and the upper eyelid with a Fricke flap following reconstruction of the orbital rims (supraorbital and infraorbital rims with a calvarial bone graft, and further augmentation of the infraorbital rim with a rib bone graft). Cosmesis post-reconstruction was acceptable and the prosthesis was retained very well.

Matched MeSH terms: Eye Enucleation
Fulltext Retinoblastoma in an older child: a case report

Ong, Wu Zhuan, Jamalia Rahmat, Ramasamy, Sunder, Amir Samsudin

Malaysian Journal of Medicine and Health Sciences, 2018;14(2):93-96.
MyJurnal

Retinoblastoma is a rare intraocular malignant tumour more commonly seen in children below five years of age. We presented a rare case of retinoblastoma in an older child. A nine-year-old girl noticed that she had loss of vision OS following a fall at home. Her vision was 6/6 OD and only light perception OS. Examination of the left eye revealed an extensive exudative retinal detachment. Her right eye examination was unremarkable. CT scan showed a left eye intraocular mass with calcification. EUA revealed a mixed endophytic and exophytic mass with extensive exudative retinal detachment. Family members consented to left eye enucleation and histopathological report confirmed the diagnosis of retinoblastoma. Post enucleation, patient is doing well with a prosthetic eye. In conclusion, any unexplained visual loss in children regardless of age warrants a full ophthalmological examination as the possibility of retinoblastoma cannot be ruled out.

Matched MeSH terms: Eye Enucleation
Fulltext Choroidal melanoma – a silent killer

Pei, Fang Neoh, Tai, Evelyn L.M., Liza-Sharmini A.T.

Journal of Biomedical and Clinical Sciences, 2017;2(2):29-31.
MyJurnal

A 65-year-old lady complained of occasional flashes of light over her left eye for 2 months. She was referred for ocular assessment after she underwent refractive assessment at the optometrist. On examination, best corrected visual acuity in both eyes was 6/9. Both eyes anterior segments were normal, with normal intraocular pressure. The pupils were equal with no relative afferent pupillary defect. Left eye fundus examination was normal. On the contrary, the "normal" right eye fundus examination revealed a huge, well-circumscribed hypo-pigmented elevated choroidal mass. B scan ultrasonography of the right eye showed a mushroom-shaped intraocular mass. Magnetic resonance imaging showed an intraocular lesion. Comprehensive systemic examination and investigations to rule out distant primary malignancy were unremarkable. A provisional diagnosis of right eye primary choroidal melanoma was made. Despite good vision in the affected eye, she underwent right eye enucleation in view of the large intraocular mass. The diagnosis was confirmed by histopathological examination.

Matched MeSH terms: Eye Enucleation
Fulltext Reducing the failure rate of ocular prosthesis at Hospital Sultanah Aminah

Muhamad Imran Abdulah, Ikmal Abdul Hakim, Rosni Amin, Rosliza Parumo, Ma, Bee Chai, Noraziyah Abdul Aziz, et al.

Q Bulletin, 2020;1(29):16-27.
MyJurnal

The Department of Oral & Maxillofacial Surgery at Hospital Sultanah Aminah, Johor Bahru started managing patients who lost their eyeballs with ocular prosthesis in 2013. Unfortunately, there was an increasing trend of failed ocular prosthesis from 2013-2015. The failure rate went from 28.6% in 2013 to 40% in 2014 and increased to 44.4% in 2015. Failed ocular prosthesis not only leads to dissatisfied patients but also an increase in cost due to redoing of prosthesis. The objective of this project was to reduce the incidence rate of failed ocular prosthesis. A failed case is when the prosthesis does not pass the issue stage and has to be redone from the beginning. The standard failure rate is 0%, as the average number of cases per year is only about 10 cases. We determined the contributing factors of failed ocular prosthesis by analysing retrospective data from patients’ dental and lab records. This was followed by a self-administered questionnaire on reasons for failed cases which was distributed among the dentists and lab technicians in our department. The contributing factors that were identified included insufficient knowledge or skill of dentist and lab technicians in the construction of the ocular prosthesis, as well as improper screening of new cases which was the main factor of all the failed cases. The strategies for change included improving the process of care by creating a checklist for proper screening of new patients, mentoring of new staff, and continuous training on construction of ocular prosthesis, Fabricated Iris Mould innovation technique and early referral for insertion of eye conformer. The interventions that were implemented reduced the failure rate to 20% in 2016 followed by 0% in 2017, 2018 and 2019. Ongoing efforts are being done to replicate this project in other Oral & Maxillofacial Surgery clinics in Johor.

Matched MeSH terms: Eye Enucleation
Fulltext Retinoblastoma in Asia: Clinical Presentation and Treatment Outcomes in 2112 Patients from 33 Countries

Kaliki S, Vempuluru VS, Mohamed A, Al-Jadiry MF, Bowman R, Chawla B, et al.

Ophthalmology, 2024 Apr;131(4):468-477.
PMID: 37839559 DOI: 10.1016/j.ophtha.2023.10.015

PURPOSE: To describe the clinical presentation and treatment outcomes of children who received a diagnosis of retinoblastoma in 2017 throughout Asia.
DESIGN: Multinational, prospective study including treatment-naïve patients in Asia who received a diagnosis of retinoblastoma in 2017 and were followed up thereafter.
PARTICIPANTS: A total of 2112 patients (2797 eyes) from 96 retinoblastoma treatment centers in 33 Asian countries.
INTERVENTIONS: Chemotherapy, radiotherapy, enucleation, and orbital exenteration.
MAIN OUTCOME MEASURES: Enucleation and death.
RESULTS: Within the cohort, 1021 patients (48%) were from South Asia (SA), 503 patients (24%) were from East Asia (EA), 310 patients (15%) were from Southeast Asia (SEA), 218 patients (10%) were from West Asia (WA), and 60 patients (3%) were from Central Asia (CA). Mean age at presentation was 27 months (median, 23 months; range, < 1-261 months). The cohort included 1195 male patients (57%) and 917 female patients (43%). The most common presenting symptoms were leukocoria (72%) and strabismus (13%). Using the American Joint Committee on Cancer Staging Manual, Eighth Edition, classification, tumors were staged as cT1 (n = 441 [16%]), cT2 (n = 951 [34%]), cT3 (n = 1136 [41%]), cT4 (n = 267 [10%]), N1 (n = 48 [2%]), and M1 (n = 129 [6%]) at presentation. Retinoblastoma was treated with intravenous chemotherapy in 1450 eyes (52%) and 857 eyes (31%) underwent primary enucleation. Three-year Kaplan-Meier estimates for enucleation and death were 33% and 13% for CA, 18% and 4% for EA, 27% and 15% for SA, 32% and 22% for SEA, and 20% and 11% for WA (P < 0.0001 and P < 0.0001), respectively.
CONCLUSIONS: At the conclusion of this study, significant heterogeneity was found in treatment outcomes of retinoblastoma among the regions of Asia. East Asia displayed better outcomes with higher rates of globe and life salvage, whereas Southeast Asia showed poorer outcomes compared with the rest of Asia.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Matched MeSH terms: Eye Enucleation
Late presentation of retinoblastoma in Malaysia

Menon BS, Alagaratnam J, Juraida E, Mohamed M, Ibrahim H, Naing NN

Pediatr Blood Cancer, 2009 Feb;52(2):215-7.
PMID: 18855905 DOI: 10.1002/pbc.21791

The aims of this study were to review the presenting features, treatment and outcome for Malaysian children with retinoblastoma currently.

Matched MeSH terms: Eye Enucleation