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The method of extraocular muscles fixation is presented, it consist in direct fixation to alloplant according to their physiological attachment to ensure stump movement after enucleation. A total of 54 patients aged 26-82 years were treated. Primary enucleation was performed in 46 patients and 8 patients were previously treated with brachytherapy. Surgery was performed under general anesthesia using microsurgical technique. After alloplant was fixed to the anterior surface of tenon's capsule a running suture was put horizontally and conjunctival suture had vertical orientation. A pressure dressing was applied for 2-3 days. Generally there were no technical difficulties, but in patients after brachytherapy separation of muscles and tenon's capsule was complicated because of scarring in the site of previous radiation.

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.

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 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.

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 this work was to determine the main trends in surgical rehabilitation of patients with anophthalmia and define the principles of treating patients with poor ocular prostheses. A total of 3345 interventions on the orbital cavity and eye appendages were carried out at plastic surgery and ocular prosthesis department in 1991-2000. Of these, 1535 patients (45.8%) were with anophthalmia. Analysis of disease structure in anophthalmia helped determine the priority trends of surgical rehabilitation of this group of patients: enucleation with plasty of the supporting motor stump, 36.6%; postradiation atrophy of orbital tissues after enucleation for retinoblastoma, 22.6%; anophthalmic syndrome, 11.7%; cicatricial deformation of the cavity, 11.5%; anophthalmia with concomitant eyelid deformation, 6.1%; anophthalmia with orbital deformation, 3.1%; denudation of orbital implants, 2.6%; congenital anophthalmia, 2.5%; prolapse of the inferior vault and upper eyelid ptosis, 1.8 and 1.4%, respectively. Individual methods of treatment and main rehabilitation principles were developed for each group of patients.

The role of systemic autoimmune reactions to organ-specific antigens (DNA and collagen) was studied in patients with anophthalmia before and after interventions on the stump and conjunctival cavity making use of autotransplants and synthetic implants. A total of 220 analyses of the serum were performed in the main group and 50 in the control. Autosensitization was detected in 10 (18.2%) patients. The data were processed using Statistica software. A series of previous reconstructive operations is a factor promoting the development of systemic autosensitization to collagen. A trend to an increase in the levels of antibodies to DNA and collagen was observed in the presence of cicatricial changes in adjacent tissues, foreign bodies, cartilaginous implants, and fistulas causing a latent fibrous reaction. The type of intervention (use of implants or autotransplants) does not affect the level of antibodies to DNA and collagen.

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.

Methods for conjunctival cavity plasty in anophthalmia and their advantages and drawbacks are discussed. The known methods do not always bring about satisfactory results (ensure a stable position of the prosthesis in the cavity). A method for conjunctival cavity formation with latex expanders is proposed. Original designs of expanders for the conjunctival cavity were used. The method is interesting and promising for conjunctival cavity plasty in anophthalmia when the cavity is shrunk.

This study was aimed at elucidating the diagnostic potentialities of computer-aided tomography (CAT) in congenital micro- and anophthalmia. Twenty-five young patients with various clinical manifestation of this abnormality were examined. Used in complex with the traditional diagnostic methods, CAT played the key role. It permitted imaging the entire complex of changes in the orbit and its contents, which helped choose adequate therapeutic measures. Surgical treatment was proven to be little effective or useless at all in cases with a more than 4 cm3 deficit of the orbital volume on the involved side; contrary to this, early staged fitting with prostheses is effective and creates favorable conditions for subsequent surgical correction in a less than 4 cm3 deficit of the volume.

The shape of the eye prostheses depends on the plastic surgery type. Standard prostheses with thin but not sharp edges are used to recreate the conjunctival cavity, prostheses with a deep retraction or flat ones are employed for a delayed introduction into the stump, prostheses with a 'swelling' at the upper edge are of use in surgery to correct the upper eyelid falling in, prostheses with a flattened lower edge and a 'shelf' at the upper edge are used to fortify the lower eyelid. Individual prostheses are recommended after plastic surgery. The prostheses should not prevent free closing and blinking of the eyelids, retaining the identical opening of the eyes. An inadequately chosen prosthesis brings to nothing the tremendous work made by the surgeon. Ocular prosthetics may be regarded as the final stage stabilizing the results of plastic surgery.