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Enucleation with primary orbital implantation and the use of ocular prosthesis does not exclude the risk of post-enucleation socket syndrome (PESS). Correction of such conditions requires modern visualization methods and software for calculation, modelling and control of the surgery.To demonstrate the capabilities of modern computer technologies in diagnostics and treatment of patients with worsening post-enucleation enophthalmos.The retrospective study included 6 patients (4 male and 2 female) aged 29-68 years who exhibited signs of PESS in 2017-2018. To define the orbital condition, patients underwent multispiral computed tomography (MSCT) and magnetic resonance imaging (MRI) followed by image analysis with computed exophthalmometry and step-by-step computed exophthalmometry. Results of these examinations helped construct 3D-models of patients' orbits, which were then used to calculate the parameters of the silicone implants. Patient-specific silicone implants were implanted into their orbits during surgery under general anesthesia.Implantation of the patient-specific silicone implant resulted in increase of the volume behind orbital prosthesis and correction of post-enucleation enophthalmos in all patients allowing them to use thinner, more mobile ocular prosthesis, and restore normal eyelid position. The patients also noted better appearance of the eye and personal comfort.Modern visualization methods along with computer analysis and modelling, as well as technologies to produce medical products enable creation of the best suitable patient-specific orbital implants. This allows achieving better clinical results and better quality of life for patients with monolateral anophthalmos.Удаление глазного яблока с первичным формированием опорно-двигательной культи и индивидуальное глазное протезирование не исключают риска развития анофтальмического синдрома и постэнуклеационного энофтальма. При коррекции этих состояний особенно актуальны современные методы визуализации и программное обеспечение, позволяющие рассчитывать, моделировать и контролировать результаты хирургического вмешательства. Цель исследования - продемонстрировать возможности современных компьютерных технологий при оказании медицинской помощи пациентам с прогрессирующим постэнуклеационным энофтальмом. Материал и методы. В ретроспективное исследование включили 6 пациентов (4 мужчины, 2 женщины) в возрасте от 29 до 68 лет, обратившихся в период 2017-2018 гг. с признаками постэнуклеационного энофтальма. Для определения состояния содержимого глазницы пациентам выполняли мультиспиральную компьютерную томографию или магнитно-резонансную томографию глазниц с последующим анализом изображения и проведением компьютерной экзофтальмометрии и пошаговой компьютерной экзофтальмометрии. Используя полученные данные, изготавливали трехмерную модель глазниц, на основании которой рассчитывали необходимые параметры силиконового имплантата. Индивидуально изготовленный скульптурно моделированный силиконовый имплантат имплантировали в глазницу в ходе операции под общей анестезией. Результаты. У всех пациентов имплантация в глазницу индивидуально рассчитанного и скульптурно смоделированного силиконового имплантата позволила увеличить объем тканей позади опорно-двигательной культи и скомпенсировать постэнуклеационный энофтальм. Это позволило уменьшить толщину глазного косметического протеза, увеличить его подвижность и восстановить правильное положение век. Кроме этого, все пациенты, наряду с улучшением внешнего вида, отмечали снижение дискомфорта. Заключение. Современные методы визуализации в сочетании с компьютерными технологиями анализа и пространственного моделирования, а также современными технологиями производства медицинских изделий, позволяют изготавливать индивидуальные орбитальные имплантаты. Это обеспечивает оптимальные клинические результаты и повышение качества жизни пациентов с односторонним анофтальмом.

To develop a comprehensive classification system of distinctive clinical and anatomical features of congenital microphthalmia and anophthalmia in children and to specify indications, contraindications, and optimal timing of the primary and subsequent prosthetic treatment.A total of 70 patients with congenital micro- or anophthalmia aged from 1 month to 12 years were examined. Besides the routine ophthalmic examination, all patients underwent eye and orbit ultrasound (axial length measurement and B-scan), computed tomography of the orbits and skull, and immunological tests for infectious diseases (enzyme-linked immunosorbent assays).Basing on the examinationwe have determined the common types of congenital micro- and anophthalmia in children. We have also developed a stepwise prosthetic treatment aimed at better cosmetic rehabilitation. Indications and contraindications for the use of ocular prostheses in children with congenital micro- and anophthalmia have been identified.The proposed method of stepwise prosthetics is the principal option for conservative rehabilitation of children with congenital micro- or anophthalmia.Цель - обобщить клинико-анатомические особенности врожденного микрофтальма и анофтальма у детей, разработать классификацию, определить показания и противопоказания к протезированию, сроки первичного и последующего протезирования детей. Материал и методы. Обследованы 70 детей с врожденным микрофтальмом и анофтальмом в возрасте от 1 мес до 12 лет. Помимо традиционного офтальмологического обследования, проведены ультразвуковые исследования глаза и орбиты (измерение переднезадней оси и В-сканирование), компьютерная томография орбит и черепа, иммунологические исследования - серологическая диагностика различных инфекций методом иммуноферментного анализа. Результаты. На основании результатов комплексного клинико-инструментального обследования определены виды врожденного микрофтальма и анофтальма. Предложен метод ступенчатого протезирования для косметической реабилитации детей. Определены показания и противопоказания к протезированию у детей с врожденным микрофтальмом и анофтальмом. Заключение. Метод ступенчатого протезирования является основным методом консервативной реабилитации детей с врожденным микрофтальмом и анофтальмом.

Results of complex ultrasonic examination in different time after socket reconstruction using biomaterial "Alloplant" are presented. Modified technique of primary socket reconstruction showed good cosmetic result.

The article is devoted to the problems of eye prosthetics that develops since ancient times till today. Indications for eye prosthesis and its role in rehabilitation of anophthalmic patients are determined. The process of glass prostheses production is described in details, technology is discussed and illustrated. This article is of great interest for opthalmologists and prosthetic technicians as it is proved that glass prostheses are more physiologic and have a number of advantages compared to plasticones.

Reconstructive orbital procedures are often associated with the use of different implant materials, that may sometimes cause complications resulting in surgery efficacy impairing and need of reoperation. At the present time in Russia and abroad various orbital implants are used though there are no experimental or clinical studies comparing implant materials used In this study comparative experimental morphological investigation of biointegrative characteristics of 6 current orbital implant materials was performed, tissue reactions in response to implantation is described in details in laboratory animals, recommendations for implant use in clinic are given.

Results of retrospective analysis of medical charts of 328 patients after enucleation due to uveal melanoma (UM) are represented. Our study showed that recurrent tumor occurs in 2.44% cases. The main reasons of recurrence are scleral invasion or tumor damage during surgery. After enucleation due to juxtapapillary UM recurrence is rare and occurs after long-term follow-up. Thus after enucleation due to UM implant insertion is possible in case of scleral integrity and absence of macroscopically apparent tumor extension beyond sclera.

The study covered 1980 patients with anophthalmos and a cosmetically poor blind eye, who were followed up in the ocular prosthesis room, Helmgoltz Institute of Eye Diseases. The optimal periods of primary and stepwise prosthetic replacement are defined and standard ocular prostheses of the most appropriate shape and size are recommended depending on the specific features of the conjunctival cavity and stump in this period. Recommendations are given on the application of ocular prostheses in congenital pathology and subatrophy.

Plastic repair operations in ophthalmic surgery frequently require the use of various biological and artificial implants. The biointegrative properties of implants are provided by the physicochemical characteristics of the material that is used to make them, by the three-dimensional structure of an implant and its immunological characteristics. The authors comparatively studied the three-dimensional structure of a Carbotexim-M carbonic felt, porous polyethylene, polytetrafluoroethylene, demineralized bone alloimplant, and marine coral hydroxyapatite, which are employed in orbital surgery and also examined the adhesion of fibroblasts to their surface. Comparative study using scanning electron microscopy could reveal the specific features of the relief and parameters of the threshold space of the study implant materials. A method was developed to estimate cell adhesion to the implant materials, by taking into account three-dimensional structure of their surface.

By analyzing a clinical case with inadequate surgery tactics in the use of an unstandard orbital implant, the authors discuss possible errors in surgical techniques and in the choice of an implant. Furthermore, by analyzing problems in the use of various implants, including those unstandard ones, they discuss possible causes of complications, consider the optimal time for resurgeries, and propose the ways of solving the problems associated with the occurrence of complications, including treatment policy.

The paper provides the results of a 15-year following-up of 91 patients with exposed orbital implants made from synthetic and biological materials. Surgery was made in the patients treated at different health care facilities. The authors analyze the causes of implant exposure in different periods. Early after surgery the most common causes of implant exposure are surgical equipment failure (inadequate implant coating with adjacent tissues), a too large implant arching the tissues, and mismatch of an artificial eye. In the late period, the more common cause is secondary infection or the toxic properties ofa material itself, which cause a persistent chronic inflammatory reaction. Moreover, the authors consider the mechanism of implant exposure and rejection depending on the material of an implant. The paper describes medical and surgical treatments in patients of this group.

This paper presents the outcomes of 230 primary, advanced, and secondary implants of polytetrafluoroethylene orbital inserts manufactured by the closed joint stock company "Nauchno-Proizvodstvennyi Kompleks (Scientific-and-Production Complex) "Ekoflon" (Saint Petersburg). The duration of a follow-up was 6-36 months (mean 15.9 +/- 037 months). The accumulated experience suggests that polytetrafluoroethylene orbital inserts are noted for their biocompatibility, easiness of manual treatment, and simplicity of implantation. Thus, porous polytetrafluoroethylene orbital inserts are promising medical articles designed for the prevention and treatment of the anophthalmic syndrome.

The purpose of the study was to analyze the pattern and frequency of complications following 230 implants of porous polytetrafluoroethylene (PTFE) orbital inserts. The total frequency of the complications to be treated was 7.4%. Among them there were pointed conjunctival perforations during enucleation (1.3%); early exposures of orbital inserts due to surgical defects (2%); late exposures caused by the planned replacement of an old prosthesis by a new one that had proved to be poorly adjusted (1.4%); significant bleapharoptosis (2%); lower eyelid atony (0.7%). Noteworthy is the fact that there were no infectious complications. Thus, implantation of PTFE orbital inserts is attended by a very narrow range of the complications, which are typical of this branch of ophthalmosurgery, whose frequency is not greater than the use of implants made from other porous materials.

The authors performed histological studies of a grown carbon felt implant and its adjacent tissues in late postoperative studies. During planned operations (cavity or stump correction), pieces of a grown implant with its adjacent tissues were taken for examination from 25 patients in whom carbon had been earlier implanted during enucleation and delayed stump plastic repair. Morphological studies indicated that mature connective tissue had grown between the fibers of the implant, that a connective tissue capsule had formed around the whole implant, and that there was no inflammatory reaction in both the implant itself and its adjacent tissues. By taking into account the fact that there is a good tissue basis and vascularity, the authors present the results of additional simulation of an implant in late postoperative periods and those of additional correction of the implant's volume.

The paper analyzes complications due to 500 orbital plastic repairs for traumatic deformities. Biomaterials (cadaveric cartilage/bone, allograft for orbital wall plastic repair, or xenopericardium) were applied in all cases. The lost orbital volume was also compensated for by Carbotextim-M. Damage to the inferior oblique muscle was the severest intraoperative complication. The bulk of complications in the early postoperative period were transient and implant displacement in the late periods required its position correction only in 4% of cases. The implant displacement-associated risk factors were as follows: male sex, childhood, application of a solid material (cartilage, bone), and its attachment failure. Purulent processes were local and encountered in 2% of cases. The low incidence of severe complications, as well as permanently high functional and cosmetic outcomes (during as long as 98.2 months) suggest that biografting of the lower orbital wall is effective.

The synthetic hydroxyapatite made in Russia was applied as an insert-implant to 4 rabbits (6 eyes, 6 eviscerations). These included 2 implants having a porosity of 40% and a pore size of 0.03-1.5 microm and 2 with a porosity of 63% and a pore size of 0.05-3.0 microm. The hydroxyapatite that is made in Russian and that has preferably a porosity of 40% and a pore size of 0.03-1.5 microm can be successfully used to make a locomotor stump after removal of the eyeball. The hydroxyapatite having these parameters more rapidly intergrows around the periphery with fibrovascular tissue and its vascular components mainly reduce by month 8. Our data suggest that the synthetic hydroxyapatite made in Russia may be used in ophthalmological care.

The key issues related with rendering the ocular prosthetic aid to patients with anophthalmos and with cosmetically inferior, i.e. a smaller-size, blind eye, are in the focus of attention. Around 320,000 persons need ocular prostheses in the territory of the Russian Federation, hence adequate prosthetic measures are taken to cope with the cosmetic, medical and social rehabilitation of patients. The ocular prosthetics service deals with issues related with prostheses manufacturing technologies as well as with other therapeutic and surgical aspects which call for working out a unified policy with its subsequent commissioning into the practice of ophthalmologic institutions.

Congenital anophthalmia and microphthalmia were responsible for 1.7-1.8% cases of all cases treated at laboratory of plastic surgery and ocular prostheses. Clinical picture of the condition is described. The philosophy of rehabilitation of patients with congenital anophthalmia and microphthalmia is as follows: 1) no operations during the first years of life; 2) early staged fitting with prostheses; 3) surgical treatment in older age, when the resources of conservative extension of the cavity are exhausted. The authors emphasize that active conservative treatment should be preferred. Method for nonsurgical extension of the conjunctival cavity by staged insertion of prostheses is described. Positive and negative aspects of surgical treatments are discussed. The authors emphasize that surgical activity in early age is extremely harmful. Results of surgical treatment of 27 patients are presented. The patients were divided into 2 groups differing by the tasks of surgery: repair of consequences of previous operations (59.2% cases) and typical correction of the eye lids (40.8%). Clinical examples are offered.

A complex of surgical operations making use of Alloplant biomaterials, performed in 47 patients with initial posttraumatic subatrophy and 79 patients with well-developed and far advanced stages of this condition, helped preserve the eye as anatomical organ in 97.5% patients, with enlargement of the eyeball in two-thirds of patients and stabilization in one-third. Optic reconstructive operations were later performed and visual acuity improved in patients with the initial stage of subatrophy. Use of allotransplant for eyeball bandage in order to create a carcass for the sclera helped conceal the cicatricial deformation of the sclera and repair the shape and volume of the eyeball in patients with initial subatrophy, due to which a good cosmetic result was attained. In well-developed and far advanced subatrophy use of biomaterial for bandage created optimal conditions for thin-wall cosmetic prostheses, ruled out the irritating effect of the prosthesis in cases when corneal sensitivity was retained and/or there were coarse corneaoscleral cicatrices, and thus extended the indications for cosmetic prostheses of subatrophic eyes.