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There are various techniques available for constructing a custom ocular prosthesis. The present technique report describes a digital workflow for constructing an ocular prosthesis using computed tomography integrated with digital technologies. The outer region of the healthy eyeball was segmented to produce the top surface of the prosthesis, while the contour and bottom surface were segmented from the tissue bed of the anophthalmic socket. The iris position was determined by tracing the optical nerve and confirmed by superimposing the patient's facial scan onto the soft tissue model of the computed tomography. Using these parameters, a standard tessellation language file for the ocular prosthesis was generated and 3D printed. The iris was then printed via UV technology using digital photographs of the patient's contralateral eye; characterization of the sclera and the final layer of clear acrylic resin were done conventionally. [ABSTRACT FROM AUTHOR]

Purpose: Enucleation is a common treatment modality performed for pediatric retinoblastoma patients, and the resultant defects are reconstructed using an ocular prosthesis. The prostheses are modified or replaced periodically, as the child develops due to orbital growth and patient‐error. The purpose of this report is to evaluate the replacement frequency of prostheses in the pediatric oncologic population. Methods: A retrospective review was completed by the two senior research investigators, of patients that had ocular prostheses fabricated following enucleation of their retinoblastoma from 2005 to 2019 (n = 90). Data collected from the medical records of the patient included the pathology, date of surgery, date of prosthesis delivery, and the replacement schedule of the ocular prosthesis. Results: During the 15‐year study period, 78 enucleated observations (ocular prosthesis fabricated) were included for analysis. The median age of the patients at the time of delivery of their first ocular prosthesis was calculated to be 2.6 years (range 0.3–18 years). The median time to the first modification of the prosthesis was calculated to be 6 months. The time to modification of the ocular prosthesis was further stratified by age. Conclusion: Pediatric patients require modification of their ocular prostheses throughout their growth and development period. Ocular prostheses are reliable prostheses with predictable outcomes. This data is helpful to set an expectation among the patient, parent, and provider. [ABSTRACT FROM AUTHOR]

Purpose: This prospective study evaluated and correlated the impact of ocular prostheses on quality of life and stress with socioeconomic level and clinical characteristics. The clinical difficulties and perceptions of patients after ocular rehabilitation were evaluated. Materials and Methods: Anophthalmic patients (at least 18 years of age) who were not users of ocular prostheses were recruited. The Medical Outcomes Short‐Form Health Survey (SF‐36) and Perceived Stress Scale (PSS‐10) questionnaires were administered before and after 3 and 6 months of prosthesis installation. Clinical characteristics, difficulties, and perceptions were evaluated by quantitative and descriptive analysis (7 days, 3 months, 6 months). Data were analyzed by the Friedman test and Pearson Correlation test (α = 0.05). Results: The final sample consisted of 26 patients. Quality of life showed improvement in the "Bodily Pain" and "General Health" domains. Wearing the prosthesis did not influence perceived stress. The clinical evaluation showed clinical discharge over 6 months and presence of pain only at 7 days. A weak correlation occurred between sociodemographic characteristics and the categories "Role‐Physical" (r = 0.423) and "General Health" (r = 0.494); cause of anophthalmia and "Role‐Physical" (r = –0.471); and type of surgery and "General Health" (r = –0.432). Conclusions: According to the results of this study, the provision of ocular prostheses showed positive influence in 2 domains of quality of life and weak correlations with socioeconomic level, type of surgery, and cause of loss. Ocular rehabilitation did not influence stress. The use and care of the prostheses did not affect tissue inflammation, but the discharge was continuous. [ABSTRACT FROM AUTHOR]

Accurate positioning of the iris is critical for the success of an ocular prosthesis. Precise duplication of size and location of the iris is essential for the establishment of realism, symmetry, and a natural‐appearing gaze. This article explores an alternative procedure for positioning the iris in a custom‐made ocular prosthesis using a pupillary distance ruler (PD ruler). The orientation and mediolateral dimension of the iris of the natural eye was measured from the graduated scale on a PD ruler and transferred on to the sculpted scleral wax pattern. The iris button was positioned in the marked area, and the established orientation was evaluated for symmetry and a natural‐appearing gaze. Accurate, predictable, and easy positioning of the iris with the transfer of these dimensions to the definitive prosthesis provided a good result in terms of patient esthetics and satisfaction. [ABSTRACT FROM AUTHOR]

Enucleation is the removal of the entire globe of the eye and a portion of the optic nerve, while evisceration involves the removal of the contents of the globe leaving the sclera, extraocular muscles, and optic nerve. Following enucleation or evisceration, intraorbital implants are routinely placed to enhance the prosthetic outcome in addition to restoring the lost orbital volume. Current practice employs intraorbital implants made of nonporous silicone, hydroxyapatite, or porous polyethylene. Intraorbital implant selection and placement, being a highly demanding procedure in terms of knowledge, skill, and expertise, may be associated with a multiplicity of technical and surgical errors. Complications are usually minimal with these implants, but they do occur. The literature reveals many articles related to intraorbital implants, their benefits, and complications; however, the literature regarding the effect of various intraorbital implant situations on the subsequent prosthetic rehabilitation is markedly scarce. Moreover, the need for interdisciplinary surgical and prosthetic interventions required for successful rehabilitation in cases of compromised implant situations has been underemphasized. Hence, this review aimed to evaluate the effect of different intraorbital implant situations on ocular rehabilitation and the required interdisciplinary surgical and prosthetic treatment approach for rehabilitation of enucleated/eviscerated sockets with compromised implant situations, to provide a critical appraisal, and to present a simplified management strategy. [ABSTRACT FROM AUTHOR]

The basic objective in prosthetic restoration of confluent maxillary and orbital defects is to achieve a comfortable, cosmetically acceptable prosthesis that restores speech, deglutition, and mastication. It is a challenging task complicated by the size and shape of the defects. The maxillary obturator prosthesis often satisfies the objective of adequate deglutition; however, orbital defects that are not obturated in the medial, septal, or posterior walls allow air to escape, negatively impacting phonation. This article describes a technique to achieve favorable prosthetic rehabilitation in a patient with a maxillectomy and ipsilateral orbital exenteration. The prosthetic components include maxillary obturator, orbital conformer, and orbital prosthesis connected using rigid magnetic attachments. [ABSTRACT FROM AUTHOR]

One of the most common tumors of the eye diagnosed in childhood is retinoblastoma, which mandates enucleation with adjunctive chemotherapy and radiotherapy to save the patient's life. The most common late enucleation complication is post-enucleation socket syndrome (PESS), which poses a management dilemma for the prosthodontist and surgeon, along with being a major esthetic concern for the patient. The reconstruction of such sockets is complex. The purpose of this clinical report is to describe the rehabilitation of such a pediatric patient with severe PESS. The patient was successfully rehabilitated by presurgical conformer therapy, socket reconstruction surgery with non-meshed intermediate split thickness skin graft (STSG)/Blair-Brown graft, and postsurgical conformer stent. This was followed by fabrication of a custom ocular prosthesis, to achieve favorable functional, physical, and psychological effects. [ABSTRACT FROM AUTHOR]

The success of an ocular prosthesis depends largely on the correct orientation of the iris disk. Various methods have been put forth to achieve this. This article emphasizes one such simplified method, wherein a customized scale has been used to orient the iris disk mediolaterally, superoinferiorly, and anteroposteriorly in an ocular prosthesis. A scleral wax pattern was fabricated. The customized scale was used to measure the dimension and orientation of the natural iris. These measurements were then transferred to the scleral wax pattern with the customized scale. An iris disk was fabricated using black crayon on the scleral wax pattern according to the measurements. The scleral wax pattern, including the iris disk, was then placed in the eye socket to verify its dimension and orientation. A prefabricated iris disk was modified according to the measured dimensions and transferred to the final scleral wax pattern. The transfer of these dimensions to the definitive prosthesis was achieved successfully, ultimately improving the patient's social and psychological well being. [ABSTRACT FROM AUTHOR]

A contracted eye socket is a cosmetic blemish to the patient. It not only renders patients unable to wear an eye prosthesis, but also becomes a source of chronic discharge and irritation. Orbital implants allow for cosmesis and volume replacement of an enucleated or eviscerated eye. Alloplastic orbital implants are associated with potential complications, including exposure and extrusion. A dermis-fat graft offers the advantages of relative availability and an autologous nature. This article reports on a patient suffering from severe postenucleation socket syndrome after enucleation of the bulbus with postoperative irradiation of the orbit due to retinoblastoma and its subsequent management by a dermal-fat graft and ocular prosthesis. The purpose of this article is to emphasize the usefulness of dermal-fat grafting as a safe and stable orbital volume replacement following enucleation. [ABSTRACT FROM AUTHOR]

Maxillofacial prosthetic (MFP) rehabilitation can be especially challenging in a young, precooperative, or behaviorally compromised child presenting with an enucleated eye. Retinoblastoma is the most common intraocular malignancy in childhood and is one of the most common pediatric cancers. Treatment consists of enucleation (or removal of the entire globe) followed by placement of orbital implants. Unrestored anopthalmic sockets exhibit growth retardation and can lead to facial disfigurement. This report describes the challenges faced during rehabilitation of a 6-month-old girl with an anophthalmic socket due to enucleation for retinoblastoma. The objective of the MFP team was to provide a custom-built, acrylic ocular prosthesis in as comfortable and atraumatic manner as possible. The case was a success and underscores the value of a multidisciplinary dental approach for the treatment of children with very special needs. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the color stability, surface roughness, and surface porosity of acrylic resins for eye sclera polymerized by different heat sources and submitted to accelerated artificial aging (AAA). Materials and Methods: Three groups of ten specimens each were formed according to the heat source used during the polymerization cycle: GI—short cycle, GII—long cycle, and GIII—dry-heat oven. The groups were submitted to color spectrophotometry through the CIE L*a*b* system and to surface roughness and porosity analysis using a Surfcorder IF 1700 profilometer. After the tests, specimens were submitted to AAA, with a maximum aging time of 384 hours, corresponding to a year of clinical use. After aging, the color and roughness of each group were assessed. Results: The results showed that the variability of ΔE was clinically unacceptable for all groups but the method of polymerization was insignificant ( p > 0.05) for color change. For roughness, polymerization cycle was significant for the results. GIII (0.23 ± 0.06) presented the highest roughness difference (before and after AAA), statistically significant ( p < 0.05) from GII. No statistically significant difference could be found among groups when considering the porosity test. Conclusion: It may be concluded that irrespective of the type of heat used for polymerization, there was an intense color alteration, to clinically unacceptable levels, when the specimens were submitted to AAA. For the other properties, alterations were less intense. [ABSTRACT FROM AUTHOR]

We report two cases of ocular prosthesis fabrication that make use of a transparent graph grid for positioning the iris disk. The custom-made ocular prostheses achieved intimate contact with the tissue bed enabling ideal fit. As asymmetry may result in a squint-eyed appearance, proper positioning of the iris disk in the scleral wax pattern is vital to fabricating the custom-made artificial eye. The position of the iris disk in the custom-made ocular prosthesis was in symmetry with that of the natural eye, restoring esthetics of the patient. [ABSTRACT FROM AUTHOR]

An alternative technique for achieving predictable iris positioning and symmetry for ocular and orbital prostheses using a mounted graph grid is proposed. [ABSTRACT FROM AUTHOR]