Ocularistica Italiana, Rome, Italy.
Ophthalmology Unit, San Raffaele Scientific Institute, Milan, Italy.
Eye (Lond). 2018 Dec;32(12):1803-1810. doi: 10.1038/s41433-018-0179-z. Epub 2018 Jul 24.
To evaluate long-term outcomes of progressively enlarging cosmetic customized prostheses (CCP) early after birth followed by dermis fat graft (DFG), as a strategy of socket rehabilitation in children with clinical congenital anophthalmia (CCA).
Twenty patients with unilateral and two patients with bilateral CCA were enrolled. All patients were treated by inserting a CCP at the time of their first assessment which was then enlarged. Subsequently they underwent DFG. Differences in vertical palpebral aperture (VPA) and horizontal palpebral length (HPL), between affected and unaffected sides, were recorded at the first CCP fitting as well as before and after DFG. Satisfaction with cosmetic results, prosthetic retention, and complications rate were assessed. Magnetic resonance imaging of the orbit was performed in all patients before and after surgery.
A significant decrease in the difference between the normal and the anophthalmic side of both PA and HPL was found over follow-up. Both VPA and HPL differences decreased by 47.6% (10.5 mm, range 1-28 mm) and by 7.1% (5.8 mm, range 0-18 mm), respectively. Satisfaction in terms of cosmetic outcomes proved to be very positive, being "very satisfied" for families and "satisfied" for physicians. Excellent retention of prostheses was observed in all cases.
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.
评估在出生后早期使用逐渐增大的美容定制假体（CCP）并随后进行真皮脂肪移植（DFG）作为临床先天性无眼症（CCA）患儿眼眶康复策略的长期效果。
共纳入 20 例单侧和 2 例双侧 CCA 患者。所有患者在首次评估时插入 CCP，然后进行扩大。随后，他们接受了 DFG。在首次 CCP 适配时以及 DFG 前后，记录了受影响侧和未受影响侧之间垂直睑裂（VPA）和水平睑裂长度（HPL）的差异。评估了美容效果满意度、义眼保留率和并发症发生率。所有患者均在术前和术后进行了眼眶磁共振成像检查。
在随访过程中，发现 PA 和 HPL 的正常侧和无眼侧之间的差异显著减小。VPA 和 HPL 差异分别减少了 47.6%（10.5mm，范围 1-28mm）和 7.1%（5.8mm，范围 0-18mm）。美容效果的满意度非常高，患者家属表示“非常满意”，医生表示“满意”。所有病例均观察到义眼的保留非常良好。
早期 CCP 联合进一步的 DFG 康复策略被证明是 CCA 患儿的一种有价值的方法，在眼眶扩张、义眼保留、心理影响和美容效果方面都具有显著的优势。
