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

Modugno, Alessandra; Resti, Antonio Giordano; Mazzone, Giacomilde; Moretti, Caterina; Terreni, Maria Rosa; Albanese, Giorgio; Savino, Gustavo; Grimaldi, Gabriela; Collin, Richard

doi:10.1038/s41433-018-0179-z

Cited by 9 publications

(5 citation statements)

References 36 publications

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“…Over the longer term, the objective here is to improve facial symmetry, also by stimulating orbital growth. No complications were observed in our patient group with this therapeutic approach, nor have other authors reported such complications to date [15,18].…”

Section: Conservative Prosthetic Therapymentioning

confidence: 45%

“…As is frequently the case in rare diseases, there are no uniform therapeutic guidelines for the MAC complex spectrum since the low case numbers mean no controlled prospective studies with high evidence levels are carried out, nor can they be. The available therapeutic recommendations are in most cases based on expert opinions interpreting case series including fewer than 100 patients 13 , 15 , 16 , 17 , 18 , 19 , 20 .…”

Section: Discussionmentioning

confidence: 99%

“…Längerfristiges Ziel ist dabei die Verbesserung der Gesichtssymmetrie, auch durch Stimulation des Orbitawachstums. Komplikationen waren bei dieser Behandlungsform in unserer Patientengruppe nicht zu beobachten und diese wurden bisher auch nicht von anderen Autoren berichtet 15 , 18 .…”

Section: Diskussionunclassified

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Therapiestrategien bei 103 Kindern mit kongenitalem Mikrophthalmus

Schittkowski

Martius

Elabbasy

et al. 2022

Klin Monbl Augenheilkd

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Zusammenfassung Einleitung Ein kongenitaler Mikrophthalmus kann entweder isoliert auftreten (einfacher Mikrophthalmus) oder mit weiteren okulären Fehlbildungen, wie einer Sklerokornea oder einer Katarakt, assoziiert sein (komplexer Mikrophthalmus). Aufgrund des seltenen Auftretens fehlen einheitliche Behandlungsempfehlungen. Material und Methoden Retrospektive Fallserie von 103 Patienten bzw. insgesamt 114 Augen mit kongenitalem Mikrophthalmus mit Erfassung von Alter, Geschlecht, Visus, Pupillenreaktion, axialer Bulbuslänge, horizontaler Weite der Lidspalte, Art der durchgeführten Therapie, Komplikationen. Ergebnisse Alle Patienten waren ausnahmslos primär prothesenfähig. Die Größe der Lidspalte hing vom zugrunde liegenden Befund ab: „beidseits Mikrophthalmus“ < „Mikrophthalmus und gesundes Partnerauge“ < „Mikrophthalmus und Anophthalmus der anderen Seite“. Um bei einem Säugling in den ersten Lebenswochen oder -monaten die visuelle (Rest-)Funktion als wichtigsten Faktor für die Entscheidung über die Therapie zu beurteilen, ist die Pupillenreaktion, speziell bei einseitiger Erkrankung die indirekte Lichtreaktion des gesunden Auges, von größter Bedeutung. In etwa der Hälfte der Fälle war eine konservative Prothesenbehandlung ausreichend. Nach der erfolgreichen Erstanpassung einer Vorlegeprothese fand eine regelmäßige Prothesenvergrößerung nach Maßgabe des Okularisten statt. Wenn die Bulbuslängendifferenz so groß war, dass auch mit einer doppelwandigen Prothese keine Symmetrie zu erzielen war, wurde eine Volumenauffüllung durch retrobulbär implantierte selbstquellende Pelletexpander (osmed GmbH, Ilmenau) angeboten. Bei knapp einem Drittel der Patienten erfolgte keine operative Therapie oder prothetische Versorgung. Die Ursache dafür war meist das Vorliegen einer minimalen Sehfunktion des Mikrophthalmus (Wahrnehmung von Lichtschein bis Angabe von Handbewegungen). Schlussfolgerung Bei vorhandener Sehfähigkeit des Mikrophthalmus sollten operative Maßnahmen nicht oder nur mit äußerster Zurückhaltung indiziert werden, da der Erhalt des vorhandenen Visus als vorrangig vor dem kosmetischen Befund angesehen werden muss. Bei Asymmetrie oder unterentwickelter Lidspalte kann der Therapiebeginn frühzeitig im 1. Lebensjahr erfolgen, ohne dass daraus resultierende Komplikationen zu befürchten sind.

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Section: Conservative Prosthetic Therapymentioning

confidence: 45%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Therapiestrategien bei 103 Kindern mit kongenitalem Mikrophthalmus

Schittkowski

Martius

Elabbasy

et al. 2022

Klin Monbl Augenheilkd

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“…According to previous research, DFG has multiple indications, such as congenital anophthalmia [ 14 , 15 ], contracted anophthalmic socket (if there is enough vascularized tissue) [ 16 , 17 ], enucleation per primam or per secundam [ 13 ], chronic anophthalmic socket pain [ 7 , 18 ], as primary and secondary orbital implants for both adults [ 19 ] and children [ 20 ], anophthalmic socket in children enucleated for RB [ 21 ], early implant exposure [ 22 ], superior sulcus reconstruction [ 23 , 24 ], fornix reconstruction [ 25 ], and eyelid malposition [ 15 ]. Smith et al proposed that the advantage of the DFG lies in its ability to replace the orbital volume, while, at the same time, maintaining the fornix and conjunctiva [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

A Sandwich-Like Oral Mucosa Graft–Conjunctiva In Situ–Dermis-Fat Graft for Reconstruction of the Anophthalmic Socket with Ocular Infection History

et al. 2022

Ophthalmol Ther

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Introduction A novel technique of using a sandwich-like structure, namely, an oral mucosa graft (OMG)–conjunctiva in situ–dermis-fat graft (DFG) (OMG-C-DFG), to reconstruct a contracted and low-capacity anophthalmic socket for a patient with ocular infection history was evaluated. Methods This was retrospective case study of four patients (cases) who underwent anophthalmic socket reconstruction surgery in which the OMG-C-DFG technique was applied. The procedures were performed in the Department of Ophthalmology at the Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine (Shanghai, China). Postoperative cosmetic appearance, graft outcome, the ability to wear an ocular prosthesis, and postoperative complications were evaluated. Results The median (± standard deviation) age of patients was 41.5 ± 22.1 (range 10–60) years. All patients suffered from contracted and low-capacity anophthalmic sockets. Three patients had a history of orbital implant infection and one patient had a history of enucleation due to exogenous endophthalmitis after globe rupture. The DFG and OMG were harvested from the abdominal region and lower lip, respectively. All four patients achieved a good postoperative appearance, with dermal surfaces appearing pink and smooth, the orbital areas showing good fullness, the ocular prosthesis showing good wearability, and no narrowing of the sockets. There was no lipid secretion, fat lysate outflow, or infection in the graft bed. There were only small amounts of scars and no infection of the donor site. Conclusion The sandwich-like structure can be effectively used to reconstruct the contracted and low-capacity anophthalmic socket with a history of orbital infection in one stage.

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“…7 Several clinical and experimental studies have confirmed that dermis-fat graft is a good option for congenital or acquired orbital soft tissue defects as well as primary or secondary anophthalmic socket reconstruction, with or without contraction. [32][33][34][35][36] .…”

Section: Disscussionmentioning

confidence: 99%

Deep Orbital Hyaluronic Acid Gel Filler for Volume Augmentation in Orbital Dysplasia

Pang

Wang

Shi

et al. 2022

Journal of Craniofacial Surgery

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Purpose: Orbital dysplasia is caused by congenital microphthalmos, anophthalmos, or eye atrophy. Orbital volume growth is known to parallel ocular growth and the absence of an eye results in noticeable hemifacial deformity that affects patients’ lives. The aim of this study was to observe the effects of injections of hyaluronic acid gel into the orbit combined with ocular prosthesis to treat orbital dysplasia. Methods: Three patients with orbital dysplasia who were 3 to 7 years old treated in our department. Each year, the hyaluronic acid gel was injected into each patient intraconal and extraconal posterior orbit and each wore an ocular prosthesis. The length of the palpebral fissure and orbital volume were measured before and after the injections. Results: A total of 9 injections were performed on 3 patients ages 7, 5, and 4 years old, respectively. The follow-up periods were 5, 5, and 2 years. The authors observed significant improvements in patient appearance. The length of the palpebral fissure and the volume of the orbit increased linearly with the increasing age, and there were no complications, such as intraorbital hemorrhage or local hyperplastic stimulation. Conclusions: Orbital hyaluronic acid gel injection and combined with an ocular prosthesis is a safe, convenient, and effective treatment for orbital dysplasia.

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

Abstract: A rehabilitating strategy combining early CCP and further DFG proved to be a valuable approach in children with CCA, offering significant benefits in terms of socket expansion, prosthetic retention, psychological impact, and cosmetic outcomes.

Cited by 9 publications

References 36 publications

Therapiestrategien bei 103 Kindern mit kongenitalem Mikrophthalmus

Therapiestrategien bei 103 Kindern mit kongenitalem Mikrophthalmus

A Sandwich-Like Oral Mucosa Graft–Conjunctiva In Situ–Dermis-Fat Graft for Reconstruction of the Anophthalmic Socket with Ocular Infection History

Deep Orbital Hyaluronic Acid Gel Filler for Volume Augmentation in Orbital Dysplasia

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