Management of Acquired Anophthalmic Socket

Kim, Myung Hee

Abstract

Following enucleation or evisceration surgery, the anatomy and physiology of the orbit are changed. During the course of fitting prosthesis, several complications including an ophthalmic enophthalmos, anophthalmic ptosis, extrusion or migration of implant and socket contracture could develop. These changes affect not only the cosmetic appearance of anophthalmic patient but also the physiological problems. The author used the hydroxyapatite as a orbital implant in 27 eyes(27 patients) and dermis-fat graft was performed in 3 eyes(3 patients) with moderate contracted sockets in which four rectus muscles couldn't be found during operation. They underwent primary implantation; enucleation(9 cases), evisceration(3 cases), secondary implantation(15 cases) and dermis-fat graft(3 cases) between June 1993 and January 1996. Average follow-up period was 18 months ranged from 6 to 27 months. There were no complications after the first hydroxyapatite insertion surgery. But preoperative condition of patients for the secondary hydroxyapatite insertion and dermis-fat graft have been anophthalmic enophthalmos(13 eyes), loss of lower cul-de-sac(4 eyes) and ptosis(3 eyes). They wanted to fit prosthesis after surgery of lower cul-de-sac and secondary hydroxyapatite insertion. As complications, 3 cases of wound disruption, 2 cases of loss of lower cul-de-sac were encountered after the secondary hydroxyapatite insertion surgery. There were developed anophthalmic enophthalmos and recurrent socket contracture(1 case) after dermis-fat graft surgery.