Fitting of the dermis-fat grafted socket.

Anophthalmic orbits that reject conventional implants may accept the dermis-fat graft. The subsequent fitting of such a socket differs in many important ways from the fitting of sockets containing conventional implants. Before surgery, the ocularist should construct a custom-made scleral ring to be inserted after the operation. This replaces the standard conformer that can erode the underlying dermis. The socket must be observed carefully for any evidence of damage to the conjunctiva-dermis suture line by the ring, and the latter modified or replaced as necessary. Granulation tissue forming around the sutures uniting conjunctiva and dermis may have to be resected and cauterized. Impression molding of an artificial eye is performed five weeks after surgery. The artificial eye always requires modifications over the first six months as the graft recedes due to partial atrophy of the fat of the graft, thus deepening the socket.