Congenital anophthalmia: A review of dealing with volume

Abstract

Background:Anophthalmia in childhood whether congenital or acquired is not just a question of cosmesis. Loss of an eye can effect the maturation of the soft tissues and bony structure surrounding the affected orbit. Therefore, a comprehensive approach including medical and surgical interventions is required to rehabilitate a child early in life.Materials and Methods:A literature survey of the past 40 years on the topic of congenital anophthalmia with focus on medical and surgical volume augmentation of the orbit was conducted.Results:Newer technologies including hydrogel implants and saline-filled tissue expanders have allowed for more rapid expansion of the pediatric orbit often with minimally invasive surgical procedures. However, traditional approaches including conformer therapy are still the primary intervention in these complicated cases.Conclusion:Anophthalmia in childhood requires a close interaction between ophthalmologist and ocularist as well as a motivated patient and family. With early intervention a good cosmetic outcome with periocular symmetry is obtainable.

Proliferation and arrest

“…Initially, use of a hydrogel hemisphere with a suture tarsorrhaphy to expand the eyelids works well [96]. This is followed by the ocularist's use of expanding conformers to induce orbital growth.…”

Anoftalmia congénita. Reporte de una serie familiar

“…When choosing a modality to treat an anophthalmic socket, the professional must consider the status of the affected eye, the contralateral eye, the severity of volume deficit, the patient's age, the patient's support system and the cause of the loss (4) . Each etiology leaves its own physical and psychological traits.…”

“…The family's active cooperation and participation is essential, as well as the work of an efficient multidisciplinary team. Comprehensive treatment includes technical and psychological approaches, which will improve the patients' ability to cope with their pathology and its consequences (4,9,10) .…”

Long-term outcomes after cosmetic customized prostheses and dermis fat graft in congenital anophthalmia: a retrospective multicentre study

“…Hard implants are available but require multiple surgical procedures under general anesthesia to modify the implant size according to the socket volume difference [21,22]. On the other hand, self-expanding socket hydrogel tissue expanders feature early expansion in the socket over the first 48 h, occurring along the postero-anterior direction, with no influence on fornices depth [23][24][25][26][27][28].…”

“…Nonetheless, the treatment does not include any measure to stimulate conjunctival socket expansion [31]. Standard conformers by themselves as prosthetic approach or followed by dermis fat graft (DFG) have turned out to be a useful option employed over the years [23]. In particular, cosmetic customized prostheses (CCP) are all the more indicated for CCA due to the advantage of fitting the patient's socket with customized prostheses.…”