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Purpose: To report the outcomes of using topical mitomycin-C (MMC) after reconstructive surgery for contracted socket and to compare the results with those of the conventional postoperative treatment. Patients and Methods: The medical records of patients who underwent reconstructive surgery for contracted anophthalmic socket were retrospectively reviewed. Based on the postoperative treatment protocol, two groups of patients were identified; group I (15 patients) who received topical MMC drops (0.02%) 4 times daily for 6 weeks and group II (15 patients) who received the conventional treatment (topical antibiotic-steroid combination). Preoperative data were extracted for age, gender, cause and timing of anophthalmia, history of previous surgeries, preoperative forniceal depth and socket volume (SV). The main postoperative outcome measures were superior fornix depth (SFD), inferior fornix depth (IFD) and SV at the end of 6th postoperative month. Prosthesis fitting and complications were also considered for analysis. Results: The mean preoperative IFD was 1.67± 0.04 mm in group I and 1.58± 0.37 mm in group II, by the end of the 6th postoperative month it increased to 6.1 ± 0.27 mm and 5.12 ± 0.25mm, respectively. The mean preoperative SFD in group I was 8.3± 0.9 mm and 8.9± 1.1 mm in group II, by the end of the 6th postoperative month SFD became 13.4± 1.2 mm and 10.2± 1.4 mm in groups I and II, respectively. The mean SV measured six months postoperatively was 1.9± 0.2 mL and 1.3± 0.09 mL in groups I and II, respectively. These differences in the postoperative SFD, IFD and SV between both groups were statistically significant. More cases reported successful fitting in group I than in group II but this difference was not statistically significant. Conclusion: Postoperative use of topical MMC is associated with higher forniceal depth and greater SV when compared to the conventional treatment in socket reconstructive surgeries with amniotic membrane graft (AMG). [ABSTRACT FROM AUTHOR]

Anophthalmic socket syndrome determines functional deficits and facial deformities, and may lead to poor psychological outcomes. This review aims to comprehensively evaluate the features of the syndrome, based on literature review and authors' clinical and surgical experience. An electronic database (PubMed,MEDLINE and Google Scholar) search of all articles written in English and non-English language with abstract translated to English on anophthalmic socket syndrome was performed. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. Different types of orbital implants were evaluated; the management of implant exposure was examined; different orbital volume enhancement procedures such as secondary implantation, subperiosteal implants and the use of fillers in anophthalmic patients were described; the problems related to socket contraction were outlined; the treatment options for chronic anophthalmic socket pain and phantom eye syndrome were assessed; the most recent advances in the management of congenital anophthalmia were described. Current clinical evidence does not support a specific orbital implant; late exposure of porous implants may be due to pegging, which currently is seldom used; filler absorption in the orbit appears to be faster than in the dermis, and repeated treatments could be a potential source of inflammation; socket contraction results in significant functional and psychological disability, and management is challenging. Patients affected by anophthalmic socket pain and phantom eye syndrome need specific counseling. It is auspicable to use a standardized protocol to treat children affected by clinical congenital anophthalmia; dermis fat graft is a suitable option in these patients as it helps continued socket expansion. Dermis fat graft can also address the volume deficit in case of explantation of exposed implants and in contracted sockets in both children and adults. Appropriate clinical care is essential, as adequate prosthesis wearing improves the quality of life of anophthalmic patients. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the effects of mitomycin C on human tenon fibroblast proliferation in contracted socket tissue. Material and Methods: Human tenon fibroblasts from a patient who underwent socket reconstruction surgery were cultured in vitro. Cell cultures were exposed to 0.2, 0.4, and 1 mg/ml of mitomycin C solution for 5 min, and serum-free culture medium was used as a control. Proliferation was observed with the MTT cell proliferation assay 24 h after treatment. Results: A 5 min exposure to mitomycin C at 0.2, 0.4, and 1 mg/ml caused inhibition of fibroblast proliferation (p < 0.05). The dose of mitomycin C was not significantly related to the rate of fibroblast proliferation inhibition. Mitomycin C 0.4 mg/ml caused the greatest inhibition of fibroblast proliferation compared with doses of 0.2 and 1 mg/ml. Conclusion: Mitomycin C can inhibit tenon fibroblast proliferation of contracted socket tissue. Dose escalation of mitomycin C is not related to the rate of fibroblast proliferation inhibition. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the use of intraoperative topical application of mitomycin C (MMC) for managing cases of recurrent socket contraction.Methods: A prospective comparative randomized study was carried out on 40 patients suffering from contracted sockets. They were randomly enrolled into 2 groups. Group A included 20 patients who had a surgery to treat contracted socket without augmentation with MMC. Group B patients had an MMC-augmented repair for the contracted socket. Patients were followed up over a period of 12 months for changes in inferior fornix (IF) depth and ability to retain the ocular prosthesis.Results: At the end of the follow-up period, postoperative IF depth was significantly deeper in group B (with MMC) than in group A (without MMC). As well, 75% of the patients in group B could maintain the prosthetic eye shell, whereas only 35% of group A could maintain the prosthesis.Conclusion: This study shows that using intraoperative MMC (0.2 mg/mL) in contracted socket reconstruction plays a significant role in maintaining prosthetic eye. To the best of our knowledge, this study is the first to use MMC on a relatively large scale of patients with contracted socket. However, the follow-up period was relatively short and further work is required to verify the effect of MMC on a longer follow-up period. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of our study is to present a surgical technique of primary porous orbital ball implantation with overlying mucus membrane graft (MMG) for reconstruction of severely contracted socket and to evaluate prosthesis retention and motility in comparison to dermis fat graft (DFG). Study Design: Prospective comparative study. Materials and Methods: A total of 24 patients of severe socket contracture (Grade 2-4 Krishna's classification) were subdivided into two groups, 12 patients in each group. In Group I, DFG have been used for reconstruction. In Group II, porous polyethylene implant with MMG has been used as a primary procedure for socket reconstruction. In Group I DFG was carried out in usual procedure. In case of Group II, vascularized scar tissues were separated 360° and were fashioned into four strips. A scleral capped porous polyethylene implant was placed in the intraconal space and four strips of scar tissue were secured to the scleral cap and extended part overlapped the implant to make a twofold barrier between the implant and MMG. Patients were followed-up as per prefixed proforma. Prosthesis motility and retention between the two groups were measured. Results: In Group I, four patients had recurrence of contracture with fall out of prosthesis. In Group II stable reconstruction was achieved in all the patients. In terms of prosthesis motility, maximum in Group I was 39.2% and Group II, was 59.3%. The difference in prosthesis retention (P = 0.001) and motility (P = 0.004) between the two groups was significant. Conclusion: Primary socket reconstruction with porous orbital implant and MMG for severe socket contracture is an effective method in terms of prosthesis motility and prosthesis retention. [ABSTRACT FROM AUTHOR]

Background: To evaluate the effects and side-effects of serial sub-conjunctival injections of 5-fluorouracil (5-FU) in early postoperative period for recurrent anophthalmic contracted socket. Methods: Retrospective comparative case series at tertiary eye care centre including fifteen adult patients with features of postoperative recurrent socket contraction after buccal mucosal graft. Group A comprised eight patients treated with 10 mg weekly sub-conjunctival injection of 5–FU in the fornices. Group B comprised seven patients taken as control. Main outcome measures were: superior fornix depth (SFD), inferior fornix depth (IFD), and socket volume (SV) at 6 months follow up. Patients were re-evaluated clinically for recurrence at last follow-up. Results: The mean ± SD values in group A versus group B were as follows: 10 ± 1.6 mm vs 5.1 ± 0.9 mm ( p < 0.005) for SFD, 6.7 ± 1.5 mm vs 3.5 ± 0.5 mm ( p = 0.02) for IFD; and 2 ± 0.55 ml versus 0.27 ± 0.06 ml ( p = 0.005) for SV at 6 months. There was significant improvement in depth of fornices and volume of socket in seven patients in group A. One patient in group A did not benefit from 5-FU treatment. The beneficial effects of 5-FU were observed when first injection was given within 4 weeks after socket reconstruction. There was no recurrence (in six cases) and no side-effects seen in group A at final follow-up of 18.2 (12–24) months. Conclusions: Weekly injections of 5-FU are effective for stopping the progression of recurrent contracted socket following primary reconstructive surgery. It provides early rehabilitation, and avoids repetitive surgery. [ABSTRACT FROM AUTHOR]

The authors report the case of a 20-year-old man who underwent enucleation of his right eye with teratoma when he was an infant, without volume replacement by an implant. As a result, an underdeveloped shallow bony orbit finally occurred. Also, a contracted socket was present with shallow lower fornix, making ophthalmic prosthesis fitting almost impossible. The patient underwent surgical reconstruction of the orbit with expansion of the orbit vertically and horizontally. A secondary implant with an adequate volume was inserted to correct the orbital volume deficit. The previous expansion of the orbit allowed the insertion of an 18 mm-diameter hydroxyapatite implant wrapped in fascia lata. The lower fornix was expanded with a mucosal graft in order to overcome the socket contraction and the conjunctival shortage. The authors conclude that the final result of this approach is satisfactory. Almost 20 years after enucleation of an eye with teratoma, an attempt was made to correct most of the difficult problems dealing with a malformed shallow orbit and a contracted socket. The young patient is now able to wear a fine ophthalmic prosthesis and his appearance is greatly improved. [ABSTRACT FROM AUTHOR]