Groot Alw, Remmers Jelmer S, Kloos Roel Jhm, Saeed Peerooz, Hartong Dyonne T
Amsterdam UMC, Department of Ophthalmology, Amsterdam Orbital Center, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
Eur J Ophthalmol. 2022 Jan;32(1):717-724. doi: 10.1177/11206721211000013. Epub 2021 Mar 11.
Recurrent contracted sockets are complex situations where previous surgeries have failed, disabling the wear of an ocular prosthesis. A combined method of surgery and long-term fixation using custom-made, three-dimensional (3D) printed conformers is evaluated.
Retrospective case series of nine patients with recurrent excessive socket contraction and inability to wear a prosthesis, caused by chemical burns ( = 3), fireworks ( = 3), trauma ( = 2) and enucleation and radiotherapy at childhood due to optic nerve glioma ( = 1) with three average previous socket surgeries (range 2-6). Treatment consisted of a buccal mucosal graft and personalized 3D-printed conformer designed to be fixated to the periosteum and tarsal plates for minimal 2 months. Primary outcome was the retention of an ocular prosthesis. Secondary outcome was the need for additional surgeries.
Outcomes were measured at final follow-up between 7 and 36 months postoperatively (mean 20 months). Eight cases were able to wear an ocular prosthesis after 2 months. Three cases initially treated for only the upper or only the lower fornix needed subsequent surgery for the opposite fornix for functional reasons. Two cases had later surgery for cosmetic improvement of upper eyelid position. Despite pre-existing lid abnormalities (scar, entropion, lash deficiency), cosmetic outcome was judged highly acceptable in six cases because of symmetric contour and volume, and reasonably acceptable in the remaining two.
Buccal mucosal transplant fixated with a personalized 3D-designed conformer enables retention of a well-fitted ocular prosthesis in previously failed socket surgeries. Initial treatment of both upper and lower fornices is recommended to avoid subsequent surgeries for functional reasons.
复发性睑裂缩窄性眼窝是一种复杂情况，此前的手术已失败，导致无法佩戴义眼。评估一种联合手术方法及使用定制的三维（3D）打印贴合器进行长期固定的效果。
对9例复发性眼窝过度收缩且无法佩戴义眼的患者进行回顾性病例系列研究，病因包括化学烧伤（3例）、烟花伤（3例）、外伤（2例）以及儿童期因视神经胶质瘤行眼球摘除及放疗（1例），平均此前进行过3次眼窝手术（范围2 - 6次）。治疗包括颊黏膜移植和个性化3D打印贴合器，该贴合器设计用于固定在骨膜和睑板上至少2个月。主要结局是义眼的保留情况。次要结局是是否需要额外手术。
在术后7至36个月（平均20个月）的最终随访时评估结局。8例患者在2个月后能够佩戴义眼。3例最初仅治疗上穹窿或下穹窿的患者，因功能原因随后需要对另一侧穹窿进行手术。2例患者后来进行了手术以改善上睑位置的外观。尽管存在眼睑异常（瘢痕、睑内翻、睫毛缺失），但6例患者的美容效果因轮廓和体积对称而被判定为高度可接受，其余2例为尚可接受。
用个性化3D设计的贴合器固定颊黏膜移植可使义眼在先前失败的眼窝手术中得以保留。建议对上、下穹窿进行初始治疗，以避免因功能原因进行后续手术。
