Rehabilitation of an ocular defect with intraorbital implant and custom-made prosthesis using digital photography and gridded spectacle

Abstract

Accidental trauma involving the eye may necessitate surgical removal of the eye ball. Immediate management should consider future prosthetic rehabilitation. Insertion of eye ball implant after enucleation or evisceration preserves socket anatomy, maintains sulcus and fornix which ensures proper retention of ocular prosthesis in future. Placement of intraorbital ball implant also reduces the weight as well as enhances motility of the prosthesis, thus imparting life-like appearance. Custom-made acrylic prosthesis has been shown to deliver superior functional and esthetic result. Exact positioning of the iris disc on a custom-made scleral blank is critical from esthetic point of view. This clinical report describes prosthetic rehabilitation of an anophthalmic socket where intraorbital ball implant was inserted during evisceration. Custom-made acrylic ocular prosthesis with a prefabricated iris button was used. Here, digital photography and a specially fabricated spectacle gridded with mm scale were used for positioning iris button on the ocular prosthesis. These two methods of centration of iris button may be used to reduce chairside time and increase patient cooperation with a positive clinical outcome.

A narrative review on techniques of iris replication in an ocular prosthesis

“…The methods and techniques involved for iris positioning in an ocular prosthesis that were included in this review were pupillometers by Roberts,[ 5 ] facial measurements using anatomic landmarks by Brown,[ 6 ] window light by Joneja et al .,[ 7 ] visual assessment by James et al .,[ 8 ] ocular locator by McArthur,[ 9 ] inverted anatomic tracings by Nusinov et al .,[ 10 ] graph grid method by Guttal et al .,[ 11 ] Boleys gauge by Manvi et al .,[ 12 ] grid cutouts placed on spectacle frame by Pai et al .,[ 13 ] customized scale computer-aided designing/computer-aided manufacturing (CAD/CAM) by Gupta et al .,[ 14 ] modified Hanau wide-view spring bow by Shetty et al .,[ 15 ] customized frame spring bow assembly by Chamaria et al .,[ 16 ] pupillary distance (PD) ruler by Bhochhibhoya et al .,[ 17 ] digital photograph by Dasgupta et al .,[ 18 ] and optical Vernier interpupillary distance (IPD) ruler by Chicago and Syafrinani,[ 19 ] a laser pointer technique by Belkhode et al . [ 20 ] and digital imaging by Lanzara et al .,[ 21 ] and Naes' ruler by Atwal et al .…”

Positioning of iris in an ocular prosthesis: A systematic review

“…also designed spectacles with transparent gridded acrylic glasses similar to Kestenbaum glasses to orient iris in a prosthetic eye. [ 25 ] This method of using gridded spectacles is simple, requires less armamentarium and less chairside time. Moreover mounting the graph grid on eyewear reduces the need for assistance and is stable unlike the graph grid held in hands in front of the face.…”

“…Clicks were taken in such a manner the flashlight reflected in pupil at the center of the pupil of the normal eye on the photograph and the different measures were then recorded for positioning iris accurately on the photograph itself. [ 25 ] These digital methods did not require complex armamentarium and patient cooperation as facial measurements and positioning were done on the photograph. However, the knowledge and skills for using this software are to be developed by professionals to achieve the aesthetic results in an ocular prosthesis.…”

Novel techniques for precise fixation of gaze in ocular prosthesis - Case series

“…Graph sheet has been used by various authors for estimation of size and position of iris. 12 13 14 Transparent grid paper on frontoparallel acrylic glasses, 15 graph grid printed on a transparent sheet placed directly over patient's face 16 or attached to suitable eyewear 17 has been highlighted in literature. In the present case series modification of graph grid using spectacle, cassette holder Fig.…”