Abstract:In this series, enhanced MRI showed satisfactory fibrovascular ingrowth of orbital implants since the 13th week after HA spheres insertion, with a trend towards progressive enhancement during the following weeks. The data also confirm the advice to wait at least 5-6 months after enucleation to perform drilling and peg placement.
“…Magnetic resonance imaging of HA implants demonstrates a “cold” zone of failed fibrovascular ingrowth anteriorly for up to 2 months. 25,26 Several other studies observed similar timing of 3.8 to 4 months. 2,15 The resorption of polymer necessary for the biointegration of an implant exposes the abrasive anterior face of HA to the overlying tissues.…”
Purpose
To determine the impact of chemotherapy or external beam radiotherapy (EBRT) on pediatric anophthalmic sockets.
Design
A retrospective, nonrandomized, interventional cohort study.
Participants
A total of 135 sockets of 133 children undergoing enucleation from late 1999 to early 2009 at the St. Jude Children’s Research Hospital were included.
Methods
A retrospective chart review of outcomes after enucleation in patients treated with systemic chemotherapy or orbital EBRT either before or after removal of the eye compared with patients who received no other treatment.
Main Outcome Measures
Incidence of implant exposure, migration, extrusion, socket contracture, and pyogenic granuloma formation.
Results
Retinoblastoma was the primary diagnosis in 128 eyes (95%). Median follow-up was 3.6 years (range, 0.1–9.3 years). Event-free course was observed in 94 sockets (69.6%). Complications included implant exposure (n = 28, 20.7%), socket contracture (n = 16, 11.9%), pyogenic granuloma (n = 9, 6.7%), implant extrusion (n = 3, 2.2%), and migration (n = 2, 1.5%). Exposure resolved in 21 sockets (77.8%) and improved in 2 sockets (11.1%); 1 patient with exposure died. Use of prior, adjuvant, or subsequent chemotherapy increased the long-term risk of exposure (odds ratio [OR] = 3.7; 95% confidence interval [CI], 1.4–9.4), and contracture (OR could not be calculated, P<0.0001). External beam radiotherapy greatly increased the risk of contracture (OR 24.0; 95% CI, 6.9–82.8) and exposure (OR 2.89; 95% CI, 1.1–7.9).
Conclusions
In this unique pediatric population with cancer, chemotherapy and EBRT had an additive effect, significantly increasing the incidence of exposure and socket contracture.
“…Magnetic resonance imaging of HA implants demonstrates a “cold” zone of failed fibrovascular ingrowth anteriorly for up to 2 months. 25,26 Several other studies observed similar timing of 3.8 to 4 months. 2,15 The resorption of polymer necessary for the biointegration of an implant exposes the abrasive anterior face of HA to the overlying tissues.…”
Purpose
To determine the impact of chemotherapy or external beam radiotherapy (EBRT) on pediatric anophthalmic sockets.
Design
A retrospective, nonrandomized, interventional cohort study.
Participants
A total of 135 sockets of 133 children undergoing enucleation from late 1999 to early 2009 at the St. Jude Children’s Research Hospital were included.
Methods
A retrospective chart review of outcomes after enucleation in patients treated with systemic chemotherapy or orbital EBRT either before or after removal of the eye compared with patients who received no other treatment.
Main Outcome Measures
Incidence of implant exposure, migration, extrusion, socket contracture, and pyogenic granuloma formation.
Results
Retinoblastoma was the primary diagnosis in 128 eyes (95%). Median follow-up was 3.6 years (range, 0.1–9.3 years). Event-free course was observed in 94 sockets (69.6%). Complications included implant exposure (n = 28, 20.7%), socket contracture (n = 16, 11.9%), pyogenic granuloma (n = 9, 6.7%), implant extrusion (n = 3, 2.2%), and migration (n = 2, 1.5%). Exposure resolved in 21 sockets (77.8%) and improved in 2 sockets (11.1%); 1 patient with exposure died. Use of prior, adjuvant, or subsequent chemotherapy increased the long-term risk of exposure (odds ratio [OR] = 3.7; 95% confidence interval [CI], 1.4–9.4), and contracture (OR could not be calculated, P<0.0001). External beam radiotherapy greatly increased the risk of contracture (OR 24.0; 95% CI, 6.9–82.8) and exposure (OR 2.89; 95% CI, 1.1–7.9).
Conclusions
In this unique pediatric population with cancer, chemotherapy and EBRT had an additive effect, significantly increasing the incidence of exposure and socket contracture.
“…At the same time, by contrast-enhanced MRI good vascularization was observed in patients with HA implantation (Fig 2 .g).It was probably associated to LLLT, which contributed to the acceleration of local blood ow. Moreover, it have been proved [31] that HA orbital implants permit host brovascular ingrowth can reduce the risks of exposure.…”
Objective: To analyze the efficacy of the therapeutic use of Low-Level Laser Therapy (LLLT) on the tissue repair process of allogeneic sclera graft in patients with contracted sockets through the analysis of the speed of graft vascularization and the fornices depth of contraction percentage.
Methods: A retrospective chart review was performed on all patients whose socket contraction from April 2015 to April 2021, 39 patients were included. All the patients were repaired with allogeneic scleral graft.They were randomly enrolled into 2 groups, Laser Group included 18 patients treated with LLLT after operation.Control Group 21 patients who without LLLT after operation and healed naturally. The LLLT equipment used in the research has a wavelength of 650 nm,10mW power, 3.8J/cm2 dosimetry, performed once daily for 5 min over a course of 5 days began with 1 week postoperative. All patients were followed up over a period of 6 months for changes in the size of the area of the non-vascularized graft, upper fornix (UF),inferior fornix (IF) depth.
Results: The Laser Group presented a significant increase speed of conjunctival vascularization compared with the Control Group, with a significant statistical difference (P =0.003). The fornices depth of contraction percentage occurred apparent in Control Group compared with Laser Group (P =0.000).
Conclusion: LLLT accelerate the speed of conjunctival vascularization,stimulated conjunctival incision healing in a short period,shorten the tissue repair process and reduce the local inflammatory response and no significant conjunctival sac shrinkage occurred.
“…This was probably associated with LLLT, which contributed to the acceleration of local blood flow. Moreover, it has been demonstrated that HA orbital implants permit host fibrovascular ingrowth and reduce the risk of HA exposure [ 31 ]. Fig.…”
Objective
To analyse the efficacy of the therapeutic use of low-level laser therapy (LLLT) on the tissue repair process of allogeneic scleral grafts in patients with contracted sockets by analysing the speed of graft vascularisation and fornice depth of contraction percentage.
Methods
A retrospective chart review was performed from April 2015 to April 2021 including 39patients with socket contraction. Allogeneic scleral grafts were used to repair the sockets in all patients. They were randomly enrolled into two groups. The laser group included 18 patients treated with LLLT after the surgery, whereas the control group included 21 patients without LLLT after the surgery who healed naturally. The LLLT equipment used in the research had a wavelength of 650 nm, 10 mW power, and 3.8 J/cm2 dosimetry, and the procedure was performed once daily for 5 min over 7 days, beginning 1 week postoperatively. All patients were followed up over 6 months to examine the changes in the size of the area of the non-vascularised graft and upper and inferior fornice depth.
Results
The laser group presented a significantly increased speed of conjunctival vascularisation compared with the control group (P = 0.003). The fornice depth of contraction percentage was more apparent in the control group than that in the laser group (P = 0.000).
Conclusion
LLLT accelerates conjunctival vascularisation, stimulates conjunctival incision healing within a short period, shortens the tissue repair process, reduces the local inflammatory response, and causes no significant shrinkage of the conjunctival sac.
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