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The authors describe a case of nylon foil implant infection caused by Fusarium brachygibbosum , and Lomentospora prolificans following medial orbital wall fracture repair in the setting of postoperative nasal methamphetamine use. A 61-year-old male presented with OS pain and swelling after a physical assault on his face. A CT of maxillofacial bones without contrast showed a moderately comminuted fracture of the medial wall of the left orbit with depression of fracture fragments into the left ethmoid air cells. Six days after repair of the medial wall fracture, the patient returned with a new onset headache, OS pain, and swelling to the left medial canthal area. He reported snorting methamphetamine approximately 48 hours before his current presentation. CT imaging showed fat stranding and soft tissue density in the extraconal space adjacent to the left medial rectus muscle and chronic fracture deformity of lamina papyracea with approximately 4 mm of medial displacement of the fracture fragments. The patient showed little clinical improvement after 48 hours of intravenous antibiotics, which led to the removal of the nylon foil implant by a left orbitotomy. Intraoperative tissue cultures grew coagulase-negative Staphylococcus , F. brachygibbosum , and Lomentospora (Scedosporium) prolificans . The patient was subsequently transitioned to oral clindamycin 600 mg three times daily and voriconazole 200 mg two times daily. To the authors' knowledge, this is the first case report to document an association between snorted methamphetamine and a fungal infection of an orbital implant.

Reconstructing the orbit following complex craniofacial fractures presents significant challenges. Throughout the years, several materials have been used for orbital reconstruction, taking into account factors such as their durability, compatibility with living tissue, cost efficiency, safety, and capacity to be adjusted during surgery. Nevertheless, a consensus has not yet been reached on the optimal material for orbital restoration. This study investigates the potential of a hybrid hydroxyapatite–collagen (HAp-COL) material 3D-printed on Ti mesh to be used as an implant for orbital wall reconstruction. HAp-COL powder was synthesized using a high-pressure hydrothermal technique. The powder was further used to 3D-print HAp-COL structures on titanium mesh, with the latter having potential uses in orbital wall reconstruction. Biocompatibility was assessed by evaluating the effects of the HAp-COL material on the adhesion and proliferation of fibroblasts (3T3) and mesenchymal stem cells (MSCs) in culture. In vitro and in vivo results showed that HAp-COL is highly biocompatible and has a good integration of the implant in the bone. The findings reported in this study offer convincing evidence to support the use of our designed HAp-COL for the restoration of orbital wall fractures, with a high level of safety. [ABSTRACT FROM AUTHOR]

Objectives: To assess the overall mental health of enucleated or eviscerated patients after high-density porous polyethylene OCULFIT implantation and external prosthesis over a 1-year follow-up. Methods: Patients with an indication of enucleation or evisceration with OCULFIT implantation were included in a prospective study. The patients completed four questionnaires regarding mental health at three different visits (baseline, 3–6 months, and 9–12 months post-surgery). The questionnaires used were the following: SF-12 for multidimensional health-related quality of life (scale 0–100); Rosemberg self-esteem scale (scale 0–40); Patients Health Questionnaire-4 (PHQ-4) (scale 0–6); and a Lifetime Major Depression and Anhedonia questionnaire (categorised in groups with/without symptoms). Results: A total of 33 patients (16 enucleations and 17 eviscerations) were included in the study. The physical domain of the SF-12 questionnaire did not change between visits, but the mental domain significantly improved from the baseline to the last visit (41.71 ± 12.72 vs. 46.80 ± 10.68, p = 0.04). The number of patients with high, moderate, and low self-esteem (Rosemberg scale) was similar between the baseline and the last visit. The depression and anxiety scores of the PHQ-4 were not significantly different among visits. The number of patients with no symptoms (depression or anhedonia) improved from the baseline (42.2%) throughout the follow-up (66.7% at the last visit). Conclusions: OCULFIT orbital implant and external prosthesis placement maintained and/or improved the quality of life related to mental health in eviscerated and enucleated eyes. The number of patients with no symptoms improved from the baseline throughout the follow-up. The patients' self-esteem was already high before implantation and remained stable over the follow-up. [ABSTRACT FROM AUTHOR]

AIM: To compare the exposure rate, infection rate, percentage of enhancement, and success rate between Medpor and the three-dimensional printed polyethylene (3DP-PE) orbital implant in a preliminary report. METHODS: This prospective, randomized, equivalence, controlled trial was conducted at two institutes. The equivalent margin was ±10%. The sample size for the equivalence trial was 174 participants per group. Patients who were eligible for enucleations received either Medpor or 3DP-PE implants based on a randomized block of six. The surgeries were performed by five oculoplastic surgeons. The assessor and patients were masked. The magnetic resonance imaging (MRI) of the orbit was performed at least 6mo after operation and the fibrovascular ingrowth was analyzed using the Image J software. Follow-up continued at least 1y after surgery. The intention to treat and per protocol approaches were used. RESULTS: Totally 128 patients met the criteria in the report. Fifty Medpor and 55 3DP-PE cases completed the trial. The most common cause of blindness was trauma. The mean follow-up times of Medpor and 3DP-PE were 33 and 40mo respectively. The exposure rate was not statistically significant between two groups (6.0% and 7.3%), P

Objectives: To assess the overall mental health of enucleated or eviscerated patients after high-density porous polyethylene OCULFIT implantation and external prosthesis over a 1-year follow-up. Methods: Patients with an indication of enucleation or evisceration with OCULFIT implantation were included in a prospective study. The patients completed four questionnaires regarding mental health at three different visits (baseline, 3–6 months, and 9–12 months post-surgery). The questionnaires used were the following: SF-12 for multidimensional health-related quality of life (scale 0–100); Rosemberg self-esteem scale (scale 0–40); Patients Health Questionnaire-4 (PHQ-4) (scale 0–6); and a Lifetime Major Depression and Anhedonia questionnaire (categorised in groups with/without symptoms). Results: A total of 33 patients (16 enucleations and 17 eviscerations) were included in the study. The physical domain of the SF-12 questionnaire did not change between visits, but the mental domain significantly improved from the baseline to the last visit (41.71 ± 12.72 vs. 46.80 ± 10.68, p = 0.04). The number of patients with high, moderate, and low self-esteem (Rosemberg scale) was similar between the baseline and the last visit. The depression and anxiety scores of the PHQ-4 were not significantly different among visits. The number of patients with no symptoms (depression or anhedonia) improved from the baseline (42.2%) throughout the follow-up (66.7% at the last visit). Conclusions: OCULFIT orbital implant and external prosthesis placement maintained and/or improved the quality of life related to mental health in eviscerated and enucleated eyes. The number of patients with no symptoms improved from the baseline throughout the follow-up. The patients’ self-esteem was already high before implantation and remained stable over the follow-up.

Purpose: To describe our experience over 6 years using a new high-density polyethylene-based spherical integrated porous orbital implants (Oculfit). Methods: This is an observational retrospective case series study analyzing all cases requiring Oculfit implants between February 2015 and September 2021. Clinical information regarding the population included, the characteristics of the implant, and the outcomes and complications during the follow-up were noted. The success of the implant was defined according to anatomical and functional parameters. Results: The study analyzed 90 cases of anophthalmic patients. The main causes for enucleation or evisceration were ocular decompensations (36.7%) and neoplasms (27.8% uveal melanoma and 7.8% retinoblastoma). Anatomical success was identified in 63 (70.0%) cases, functional success in 79 (87.8%) and complete success (anatomical + functional) in 61 (67.7%) cases. Factors associated with the functional success were age and exposure of the primary orbital implant. Complications appeared in 11 (12.2%) cases, which were completely resolved without sequelae in 4 (4.4%). Orbital explant was required in 5 (5.6%) cases. Conclusion: In our experience, Oculfit can be considered a useful alternative among the currently available options for orbital implants and has a good efficacy/safety profile. [ABSTRACT FROM AUTHOR]

Purpose: Various materials have been proposed for reconstructing orbital fractures. The materials used must meet certain criteria to ensure their suitability for restoring the structure and function of the organ. These criteria include biocompatibility, ease of application, non-toxicity, hypo-allergenicity, and non-carcinogenicity. In this study, we systematically reviewed the studies regarding the biomaterials in orbital implants and their clinical application. Methods: A comprehensive search across various databases, including PubMed, Scopus, EMBASE, Cochrane Library, and Web of Science, was conducted until April 10th, 2023. After retrieving the search results and eliminating duplicates, final studies were included after screening through defined criteria. Human and animal studies assessing the clinical application of biomaterials in orbital implants were included. The quality of the case series and controlled intervention studies were evaluated using the NIH tool, and for animal studies, the risk of bias was assessed using SYRCLE's tool. Results: Seventeen studies were included according to defined criteria. These studies aimed to explore the clinical application of biomaterials and examine the associated complications in orbital implants. Conclusion: We found that using biomaterials did not result in elevated intraocular pressure (IOP). However, we did observe certain complications, with infection, residual diplopia, and enophthalmos being the most frequently reported issues. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cirugía Oral y Maxilofacial is the property of Sociedad Espanola de Cirugia Oral y Maxilofacial (SECOM) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Orbital wall fractures can result in changes to the bony orbital volume and soft tissue. Restoring the bony orbital and intraconal fat volumes is crucial to prevent posttraumatic enophthalmos and hypoglobus. We aimed to establish an evidence-based medical reference point for “mirroring” in orbital wall reconstruction, which incorporates three-dimensional (3D)-printing and navigation-assisted surgery, by comparing bilateral bony orbital volumes. Methods We retrospectively analyzed the data obtained from 100 Korean adults who did not have orbital wall fractures, categorized by age groups. The AVIEW Research software (Coreline Soft Inc., Seoul, South Korea) was used to generate 3D reformations of the bony orbital cavity, and bony orbital volumes were automatically calculated after selecting the region of interest on consecutive computed tomography slices. Results The mean left and right orbital volume of males in their 20 s was 24.67 ± 2.58 mL and 24.70 ± 2.59 mL, respectively, with no significant difference in size (p = 0.98) and Pearson’s correlation coefficient of 0.977 (p

Introduction: Ocular trauma is a significant cause of visual loss with long-term sequelae, including reduced quality of life and loss of productivity for young patients. Surgical treatment depends on the injury; enucleation and evisceration are viable options in nonrecoverable eyes. Our study aims to describe the epidemiological and clinical profiles of patients undergoing evisceration/enucleation due to ocular trauma in a tertiary care center in Medellin, Colombia, over 10 years. Methods: We conducted a cross-sectional descriptive study of eyes that were eviscerated or enucleated due to trauma at the SHospital Universitario San Vicente Fundación in Medellin, Colombia, between 2011 and 2021. We studied sociodemographic characteristics, factors related to ocular trauma, and the surgical procedure performed. Results: We studied 161 eyes of 160 patients, of which 2 were enucleated and 158 eviscerated due to ocular trauma. The male-to-female ratio was 7.9:1, and the mean age was 36.6 years (standard deviation = 18.3). 52.2% were due to aggression or violence; the most frequent mechanism was a gunshot wound (28.1%). 98.1% were classified as open ocular trauma, of which 84.5% were ruptured globes. Of the eyes with reported visual acuity, 93.3% did not perceive light. Of the 161 eyes, 58.4% suffered an orbital fracture, and 29.2% suffered cranioencephalic trauma. Primary evisceration was performed in 98.8%, with half of the patients operated in 2 days or less and 75% in 4 days or less. An orbital implant was used in 90.7%. Seventy-five percent of patients were followed up at 36 days. Conclusions: The majority of ocular trauma resulting in loss of the eyeball occurred in young men who had suffered aggression or violence and presented with ocular rupture, with primary evisceration and orbital implant being performed in most cases, in contrast to what is reported in international series where secondary evisceration is preferred, possibly due to the initial severity of the traumatized eyes. [ABSTRACT FROM AUTHOR]

Background: Orbital wall fractures can result in changes to the bony orbital volume and soft tissue. Restoring the bony orbital and intraconal fat volumes is crucial to prevent posttraumatic enophthalmos and hypoglobus. We aimed to establish an evidence-based medical reference point for "mirroring" in orbital wall reconstruction, which incorporates three-dimensional (3D)-printing and navigation-assisted surgery, by comparing bilateral bony orbital volumes. Methods: We retrospectively analyzed the data obtained from 100 Korean adults who did not have orbital wall fractures, categorized by age groups. The AVIEW Research software (Coreline Soft Inc., Seoul, South Korea) was used to generate 3D reformations of the bony orbital cavity, and bony orbital volumes were automatically calculated after selecting the region of interest on consecutive computed tomography slices. Results: The mean left and right orbital volume of males in their 20 s was 24.67 ± 2.58 mL and 24.70 ± 2.59 mL, respectively, with no significant difference in size (p = 0.98) and Pearson's correlation coefficient of 0.977 (p < 0.001). No significant differences were found in orbital volumes in other age groups without fractures or in patients with nasal bone fractures (p = 0.84, Pearson's correlation coefficient 0.970, p < 0.001). The interclass correlation coefficients (2,1) for inter- and intrarater reliability were 0.97 (p < 0.001) and 0.99 (p < 0.001), respectively. Conclusions: No significant differences were found in the bilateral bony orbital volumes among males of any age. Thus, the uninjured orbit can be used as a volumetric reference point for the contralateral injured orbit during orbital wall reconstruction. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Sociedad Colombiana de Oftalmología is the property of Sociedad Colombiana de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: This systematic review summarizes recent literature on the use of extended reality, including augmented reality (AR), mixed reality (MR), and virtual reality (VR), in preoperative planning for orbital fractures. Methods: A systematic search was conducted in PubMed, Embase, Web of Science and Cochrane on 6 April 2023. The included studies compared extended reality with conventional planning techniques, focusing on computer-aided surgical simulation based on Computed Tomography data, patient-specific implants (PSIs), fracture reconstruction of the orbital complex, and the use of extended reality. Outcomes analyzed were technical accuracy, planning time, operative time, complications, total cost, and educational benefits. Results: A total of 6381 articles were identified. Four articles discussed the educational use of VR, while one clinical prospective study examined AR for assisting orbital fracture management. Conclusion: AR was demonstrated to ameliorate the accuracy and precision of the incision and enable the better identification of deep anatomical tissues in real time. Consequently, intraoperative imaging enhancement helps to guide the orientation of the orbital reconstruction plate and better visualize the precise positioning and fixation of the PSI of the fractured orbital walls. However, the technical accuracy of 2–3 mm should be considered. VR-based educational tools provided better visualization and understanding of craniofacial trauma compared to conventional 2- or 3-dimensional images. [ABSTRACT FROM AUTHOR]

Eyeball loss due to severe ocular trauma, intraocular malignancy or infection often requires surgical treatment called orbital implant reconstruction to rehabilitate the orbital volume and restore the aesthetic appearance. However, it remains a challenge to minimize the postoperative exposure and infection complications due to the inert nature of conventional orbital implants. Herein, we developed a novel Ca–Zn-silicate bioceramic implant with multi-functions to achieve the expected outcomes. The porous hardystonite (Ca2ZnSi2O7) scaffolds with triply periodic minimal surfaces (TPMS)-based pore architecture and graded pore size distribution from center to periphery (from 500 to 800 μm or vice versa) were fabricated through the digital light processing (DLP) technique, and the scaffolds with homogeneous pores (500 or 800 μm) were fabricated as control. The graded porous scaffolds exhibited a controlled bio-dissolving behavior and intermediate mechanical strength in comparison with the homogeneous counterparts, although all of porous implants presented significant antibacterial potential against S. aureus and E. coli. Meanwhile, the pore size-increasing scaffolds indicated more substantial cell adhesion, cell viability and angiogenesis-related gene expression in vitro. Furthermore, the gradually increasing pore feature exhibited a stronger blood vessel infiltrating potential in the dorsal muscle embedding model, and the spherical implants with such pore structure could achieve complete vascularization within 4 weeks in the eyeball enucleation rabbit models. Overall, our results suggested that the novel antibacterial hardystonite bioceramic with graded pore design has excellent potential as a next-generation orbital implant, and the pore topological features offer an opportunity for the improvement of biological performances in orbital reconstruction.

The purpose of this study is to execute an evidence-based review answering the following question (PICO): "Do patient-specific implants (PSI), manufactured or designed using computer-assisted technology, improve outcomes (orbital volume change, enophthalmos, diplopia, and operative duration) compared to conventional methods in orbital reconstruction following traumatic orbital injury in the adult patient population?" We performed a systematic review and meta-analysis in accordance with PRISMA guidelines. Inclusion criteria included any comparative paper whereby computer-assisted technology was used in the prefabrication or design process of implants for use in post-traumatic orbital reconstruction. Paediatric patient populations were excluded. Eight databases were systematically searched for relevant studies. Risk of bias was assessed through the NOS and RoB2 tools. Random-effects models were used to identify differences in outcomes between groups where possible. Analysis was performed using R 4.0.0. Eleven of 4784 identified studies were included, comprising 628 adult patients, with 302 and 326 patients in the patient-specific and conventional groups, respectively. Weighted mean difference between unaffected and post-operative orbital volume was 0.32 ml (SD 0.75) and 0.95 ml (SD 1.03) for patient-specific and conventional groups, respectively. Significant improvement was identified in post-operative orbital volume reconstitution with the use of PSI, compared to conventional implants, in 3 of the 5 reporting studies. Equally, post-operative enophthalmos trended towards lower severity in the patient-specific group, with 11.2% of patients affected in the patient-specific group and 19.2% in the conventional group, and operative duration was significantly reduced with the use of PSI in 3 of the 6 reporting studies. Despite a tendency to favour PSI, no statistically significant differences in key outcomes were identified on meta-analysis. Although there is some encouraging data to support improved outcomes with the use of patient-specific orbital implants in post-traumatic reconstruction, there is, at present, no statistically significant evidence to objectively support their use over conventional implants based on the currently available comparative studies. Based on the results of this study, the choice of implant used should, thus, be left to the discretion of the surgeon. [ABSTRACT FROM AUTHOR]

There are several barriers to patient adherence in glaucoma treatment, such as complex dosing regimens, side effects and difficulties with eyedrop administration. This article discusses these challenges, and how they have led to the development of novel sustained-release platforms for glaucoma medications. These platforms include extraocular and intraocular options, such as wearable ocular surface devices, punctal plug systems, subconjunctival injections and intracameral implants. In particular, we focus on the iDose® TR (Glaukos, San Clemente, CA, USA) sustained-release travoprost titanium implant. It is a particularly promising option, which continuously elutes travoprost at therapeutic levels over an extended period. Phase III trial results have shown its efficacy in lowering intraocular pressure. Notably, the implant typically lasts for around 4-5 years and can be safely exchanged with a new one after it finishes its therapeutic effect. This advancement in glaucoma treatment offers a new alternative to traditional treatment modalities. Real-world trials are needed to shed more light on the efficacy and safety profile of iDose TR. [ABSTRACT FROM AUTHOR]

Biocompatible ceramics, commonly known as “bioceramics”, are an extremely versatile class of materials with a wide range of applications in modern medicine. Given the inorganic nature and physico-mechanical properties of most bioceramics, which are relatively close to the mineral phase of bone, orthopedics and dentistry are the preferred areas of usage for such biomaterials. Another clinical field where bioceramics play an important role is oculo-orbital surgery, a highly cross- and interdisciplinary medical specialty addressing to the management of injured eye orbit, with particular focus on the repair of orbital bone fractures and/or the placement of orbital implants following removal of a diseased eye. In the latter case, orbital implants are not intended for bone repair but, being placed inside the ocular cavity, have to be biointegrated in soft ocular tissues. This article reviews the state of the art of currently-used bioceramics in orbital surgery, highlighting the current limitations and the promises for the future in this field.

This study aimed to identify and quantify the variations in PSI designs intended for an identical patient. Records from 10 patients with an orbital fracture involving two walls, for which a primary orbital reconstruction was indicated, were retrospectively included. Clinical engineers from two centers independently generated proposal designs for all patients. Following web meeting(s) with the surgeon from the same institute, the PSI designs were finalized by the engineer. A cross-over of the engineer with the surgeon of the other center created two new design teams. In total, 20 proposal and 40 final PSI designs were produced. A three-dimensional comparison between different PSI designs for the same patient was performed by computing a difference score. Initially, the design proposals of the two engineers showed a median difference score of 37%, which was significantly reduced to a median difference score of 26% for the final designs with different engineers. The median difference score of 22% between surgeons demonstrated that both parties introduced notable user variations to the final designs. Evidence supporting the advantages of an experienced design team was found, with significantly fewer modifications, fewer meetings, and less time required to complete the design (up to 40% time reduction). The findings of the study underline the dependency of PSI design on the surgeon and engineer, and support the need for a more evidence-based protocol for PSI design., Competing Interests: Declaration of competing interest The authors declare they have no conflicts of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Aim: To compare the exposure rate, infection rate, percentage of enhancement, and success rate between Medpor and the three-dimensional printed polyethylene (3DP-PE) orbital implant in a preliminary report., Methods: This prospective, randomized, equivalence, controlled trial was conducted at two institutes. The equivalent margin was ±10%. The sample size for the equivalence trial was 174 participants per group. Patients who were eligible for enucleations received either Medpor or 3DP-PE implants based on a randomized block of six. The surgeries were performed by five oculoplastic surgeons. The assessor and patients were masked. The magnetic resonance imaging (MRI) of the orbit was performed at least 6mo after operation and the fibrovascular ingrowth was analyzed using the Image J software. Follow-up continued at least 1y after surgery. The intention to treat and per protocol approaches were used., Results: Totally 128 patients met the criteria in the report. Fifty Medpor and 55 3DP-PE cases completed the trial. The most common cause of blindness was trauma. The mean follow-up times of Medpor and 3DP-PE were 33 and 40mo respectively. The exposure rate was not statistically significant between two groups (6.0% and 7.3%), P <0.05, 95%CI (-9.8%, +12.0%). The success rates were 94% (Medpor) and 92.7% (3DP-PE). No postoperative infection was reported. Nine patients had MRI tests and two had implant exposures with 66.3% enhancement at 75mo (Medpor) and 58% enhancement at 57mo (3DP-PE) postoperatively., Conclusion: There is no statistically significant difference in exposure rate and success rate between Medpor and 3DP-PE in enucleation in the report. However, we cannot conclude that they are equivalent in terms of the exposure rate and success rate because the 95%CI is wider than ±10%. The infection rate is equivalent in both groups., Competing Interests: Conflicts of Interest: Sintuwong S, None; Leelapatranurak K, None; Aryasit O, None; Preechawai P, None; Lumyongsatien M, None; Nimitwongsakul O, None; Kanokkantapong J, None; Bhaktikamala U, None; Tuachob Y, None; Bhuntuveh J, None; Thongtong P, None; Suvannapruk W, None; Suwanprateeb J, None., (International Journal of Ophthalmology Press.)

Background: Evaluation of the number of enucleations and eviscerations performed in Germany and the orbital implants used., Method: Analysis of the quality reports of German ophthalmological clinics for the years 2012-2021 provided by the Federal Joint Committee (Gemeinsamer Bundesausschuss, G‑BA)., Results: Almost 10 times as many enucleations (8368) as eviscerations (975) are performed in Germany. After enucleation, alloplastic implants are used most frequently (44.6% alloplastic, no further specification, 30.0% alloplastic coated, no further specification; 14.1% microporous implants) and autologous dermis-fat grafts in 6.1% of the cases., Conclusion: In Germany, significantly more enucleations than eviscerations are performed. Alloplastic orbital implants are preferred for primary reconstruction following enucleation., (© 2024. The Author(s).)

Francesco M Quaranta-Leoni,1,2 Maria Grazia Fiorino,1 Flavia Quaranta-Leoni,3 Matteo Di Marino1 1Orbital and Adnexal Service, Villa Tiberia Hospital – GVM Care & Research, Rome, 00137, Italy; 2Oftalmoplastica Roma, Rome, 00197, Italy; 3Catholic University of the Sacred Heart, Rome, 00168, ItalyCorrespondence: Francesco M Quaranta-Leoni Email fquarantaleoni@gmail.comAbstract: 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.Keywords: orbital implants, socket surgery, contracted socket, phantom eye syndrome, congenital anophthalmia

Biocompatible ceramics, commonly known as "bioceramics", are an extremely versatile class of materials with a wide range of applications in modern medicine. Given the inorganic nature and physico-mechanical properties of most bioceramics, which are relatively close to the mineral phase of bone, orthopedics and dentistry are the preferred areas of usage for such biomaterials. Another clinical field where bioceramics play an important role is oculo-orbital surgery, a highly cross- and interdisciplinary medical specialty addressing to the management of injured eye orbit, with particular focus on the repair of orbital bone fractures and/or the placement of orbital implants following removal of a diseased eye. In the latter case, orbital implants are not intended for bone repair but, being placed inside the ocular cavity, have to be biointegrated in soft ocular tissues. This article reviews the state of the art of currently-used bioceramics in orbital surgery, highlighting the current limitations and the promises for the future in this field. [ABSTRACT FROM AUTHOR]

It is occasionally essential to surgically remove the damaged eye of the patient in the case of serious oculoorbital injuries, intraocular cancers, and other life-threatening diseases. An orbital implant is placed into the anophthalmic socket after the eye is removed to provide adequate volume reinstatement and revamp the cosmetic look of a normal eye. In the previous few decades, implant design and material selection criteria have progressed from basic nonporous polymeric spheres to devices with more complicated shapes and functions to ensure improved long-term clinical results. Because of their highly interconnected porous design, ceramic and polymeric porous implants have found popularity as a passive framework for fibrovascular ingrowth, with lower obstacle rates and the option of setting to improve prosthetic eye mobility. These materials, however, are not without flaws. The danger of migration and extrusion, infections after surgery, and poor motility transferred to the cosmetic ocular prosthesis are important elements of orbital implants of today. As a result, the development of novel biomaterials with improved functionalities (i.e., antibacterial effect, angiogenesis, and in situ moldability) that allow better eye replacement is more desirable than ever, highlighting one of the most challenging aspects of research topics in the field of ocular implants. This study highlights the history of orbital implants. It gives an outline of current advancements in the area, over and above some essential observations for materials design, selection, characterization, and transformation to clinical applications.

Introduction: Ocular trauma is a significant cause of visual loss with long-term sequelae, including reduced quality of life and loss of productivity for young patients. Surgical treatment depends on the injury; enucleation and evisceration are viable options in nonrecoverable eyes. Our study aims to describe the epidemiological and clinical profiles of patients undergoing evisceration/enucleation due to ocular trauma in a tertiary care center in Medellin, Colombia, over 10 years. Methods: We conducted a cross-sectional descriptive study of eyes that were eviscerated or enucleated due to trauma at the SHospital Universitario San Vicente Fundación in Medellin, Colombia, between 2011 and 2021. We studied sociodemographic characteristics, factors related to ocular trauma, and the surgical procedure performed. Results: We studied 161 eyes of 160 patients, of which 2 were enucleated and 158 eviscerated due to ocular trauma. The male-to-female ratio was 7.9:1, and the mean age was 36.6 years (standard deviation = 18.3). 52.2% were due to aggression or violence; the most frequent mechanism was a gunshot wound (28.1%). 98.1% were classified as open ocular trauma, of which 84.5% were ruptured globes. Of the eyes with reported visual acuity, 93.3% did not perceive light. Of the 161 eyes, 58.4% suffered an orbital fracture, and 29.2% suffered cranioencephalic trauma. Primary evisceration was performed in 98.8%, with half of the patients operated in 2 days or less and 75% in 4 days or less. An orbital implant was used in 90.7%. Seventy-five percent of patients were followed up at 36 days. Conclusions: The majority of ocular trauma resulting in loss of the eyeball occurred in young men who had suffered aggression or violence and presented with ocular rupture, with primary evisceration and orbital implant being performed in most cases, in contrast to what is reported in international series where secondary evisceration is preferred, possibly due to the initial severity of the traumatized eyes.

Purpose: Our aim was to determine if intraoperative navigation (ION) improved radiographic outcomes in patients undergoing delayed primary/secondary orbital reconstruction for inferomedial defects, as measured by volume restoration, enophthalmos correction, and positional accuracy of implants. Patients and Methods: A prospective quasiexperimental study was performed to compare two groups of patients requiring orbital reconstruction. Use of ION was the exposure evaluated. Outcome measures were (i) intraorbital volume and enophthalmos evaluated radiologically, (ii) implant position accuracy, and (iii) procedural duration. Data were analyzed statistically to compare variance between groups. Results: Forty patients (6 females and 34 males) were recruited into the study with a mean age of 27.3 years. The study group demonstrated a greater reduction of intraorbital volume (0.49 cu.cm; p  = 0.02) and enophthalmos (0.72 mm; p  = 0.001). Implant positioning was more accurate using ION, with less mediolateral ( p  = 0.006) and yaw ( p  = 0.04) deviations. Surgical time for implant positioning was shorter by 17 min, with navigation ( p  < 0.001). Conclusion: The use of ION demonstrated radiographic improvements in volume restoration, enophthalmos correction, as well as accuracy of implant positioning, in patients requiring delayed primary/secondary orbital reconstruction.

Objectives: To retrospectively investigate clinical characterization and the long-term postoperative outcomes of retinoblastoma (RB) patients receiving enucleation with primary orbital implantation in early infancy (0-6 months old)., Methods: The clinical and follow-up data of 42 RB patients receiving enucleation with primary orbital implantation in early infancy at Beijing Tongren Hospital from December 2009 to January 2020 were analysed. The average follow-up time was 83 months. The patient group included 24 males and 18 females, 30 unilateral and 12 bilateral cases. A total of 44 eyes with 10 in stage D and 34 in stage E underwent 40 unilateral and 2 bilateral surgeries. 17 RB eyes received hydrogel and 27 RB eyes received hydroxyapatite implants. This study was performed by following the guideline of STROBE., Results: Enucleation combined with primary orbital implantation promoted survival and was safe with few and minor complications such as increased secretion, upper eyelid ptosis, and sunken eye sockets which were not affected by stages, lateralities, or implant materials. 55-80% RB patients exhibited satisfactory appearance and obvious or moderate motility of orbital implants according to the evaluation by doctors and family members. Family members were likely more optimistic about the appearance and more pessimistic about motility of the orbital implantation than doctors did.The quality of life was high as indicated by PedsQL3.0 or PedsQL4.0 scores ( ≧ 90 for > 75% patients). It was not affected by the stages, laterality, and implant materials, nor affected by the appearance and motility of the implants., Conclusions: The outcomes of the combination of enucleation and primary orbital implantation for pertinent RB patients in early infancy are generally satisfactory with few and minor complications, high safety, appearance, and overall quality of life. Enucleation combined with primary orbital implantation in early infancy benefits pertinent RB patients in appearance, survival, and quality of life., (© 2024. The Author(s).)

A 28-year-old female presented with a slowly enlarging, left cheek mass over two years. She underwent neuroimaging and was found to have a well-defined, low attenuating lesion with thickened vertical trabeculation of the left zygoma, consistent with intraosseous hemangioma. To minimize the risk of severe intraoperative hemorrhage, the patient underwent embolization of the mass by neuro-interventional radiology two days prior to resection. The patient subsequently underwent a left anterior orbitotomy and partial zygoma resection followed by reconstruction of the lateral orbit with a custom porous polyethylene zygomaxillary implant. The postoperative course was uneventful with a good cosmetic outcome.

Competing Interests: The authors have no financial or conflicts of interest to disclose.

Purpose: To evaluate the complications of anophthalmic socket in retinoblastoma patients at a tertiary centre in Malaysia., Design: Retrospective study., Methods: Patients who underwent enucleation for retinoblastoma were reviewed from 2004-2020. Details were recorded, including demographics, diagnosis, surgical techniques, implant types, additional therapies, and complications., Results: Of 250 patients with retinoblastoma managed over the period, the anophthalmic sockets of 160 eyes who underwent enucleation were analysed. The mean age at enucleation was 2.03 years (26 days to 9.18 years). The follow-up periods after enucleation range from 5 days to 16.83 years. Porous polyethylene (Medpor) implants were used in 135 patients (84.4%), as were Bioceramic in 9, glass balls in 7, acrylic in 7, dermis fat grafts in 1, and silicone implants (Aurosphere) in 1. The overall complications in our study were 28.8%. Complications seen in the study included implant exposure (12.5%), shallow inferior fornix (10.6%), granuloma formation (3.1%), discharge (2.5%), implant migration (1.9%), ptosis (0.6%), and orbital dystopia (0.6%). Implant exposure is solely found in Medpor, more common in those with donor sclera caps, and exposure times range from 28 days to 11.42 years. The suturing of the Tenon and conjunctiva in separate layers significantly reduced the rate of implant exposure. Six out of seven radiation patients had shallow inferior fornixes., Conclusions: Long-term post-enucleation complications were not uncommon. Luckily, most had good outcomes, with a few needing surgical intervention. Meticulous suturing technique on the Tenon and conjunctival layer is essential to prevent implant exposure., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Orbital walls are one of the most common sites of midface fractures and account for ~40% of traumatic injuries in this region. These fractures are often associated with changes in the anatomy of the orbital cavity and frequently affect the orbital inferior wall, infraorbital groove and canal, and medial orbital wall, which leads to changes in its pattern and volume as well. Generally, the forces required for brake superior and lateral walls are greater than those required for thin medial and inferior walls. Disruption of any of these structures leads to the expansion of orbital volume that brings to the appearance of enophthalmos, diplopia, and impaired ocular mobility. The gold standard in the treatment of orbital wall fractures is surgical reconstruction, that includes fracture site exposure, freeing tissue prolapsed into the fracture site, and re-approximating the orbital wall support, usually with an orbital implant. It usually could be achieved by the usage of such as transconjunctival, subciliary, and coronal approaches and implementation of graft and reconstructive materials, including bones, cartilage, titanium, and resorbable mesh. Today, the gold standard in orbital floor reconstruction is the application of titanium mesh orbital plates. However, their implementation could be associated with a number of postoperative complications, such as mispositioning and orbital adherence syndrome. Orbital adherence syndrome is a poorly described and understood phenomenon and appears to occur after the use of large-pored titanium mesh for orbital reconstruction. It usually appears as limited eye movement that appears 1 to 2 weeks after reconstructive procedure. Prevention is possible through careful patient selection and the placement of a smooth interface medium in the initial surgery. The aim of the current study is to present the outcomes of orbital reconstruction done by both orbital mesh and customized ​​smooth-surfaced titanium orbital implants., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Mutaz B. Habal, MD.)

Purpose: This review aims to compare and evaluate the outcomes achieved by integrating technological aids and the influence of different implant designs in the reconstruction of post-traumatic orbital defects., Methods: Electronic searches of the MEDLINE, Embase, Cochrane Library, and Google Scholar databases until March 2023 were conducted. Clinical controlled trials, observational studies, cohort studies, and retrospective studies were identified and included. The predictor variables were the integration of technological aids namely, computer-assisted surgical planning, mirror image overlay, and intraoperative navigation with the utilization of different orbital implant designs (standard orbital meshes, preformed implants, prebent implants, and patient-specific implant [PSI]) during post-traumatic orbital reconstruction. The primary outcome variables were orbital volume, diplopia, and enophthalmos. Weighted or mean difference and risk ratios at 95% confidence intervals were calculated, where P ＜ .05 was considered significant and a random effects model was adopted., Results: This review included 7 studies with 560 participants. The results indicate that the difference in postoperative orbital volume between affected and nonaffected eye showed no statistically significant difference between PSI and prebent group (mean difference, -0.41 P = .28, I 2  = 46%). PSI group resulted in diplopia 0.71-fold less than that of the standard orbital mesh group but was not statistically significant (P = .15). Standard orbital mesh group is 0.30 times at higher risk of developing enophthalmos as compared to PSI group (P = .010). The literature suggests PSIs are preferred for patients with large defects (Jaquiéry's III-IV), whereas prebent implants are equally effective as PSIs in patients with preserved infraorbital buttress and retrobulbar bulge., Conclusion: PSIs are associated with improved outcomes, especially for correcting enophthalmos. The data suggests the potential efficacy of prebent implants and PSIs in orbital volume corrections. There is a lack of randomized studies. This review should serve as a recommendation for further studies to contribute to the existing literature., (Copyright © 2024 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess long-term outcomes and reinterventions for exposed and nonexposed intraconal orbital implants after single-stage socket revisional surgery., Methods: Retrospective case-note review of patients with exposed or nonexposed orbital ball implants, who underwent a single-stage ball exchange (Group I) or ball removal with dermis-fat graft (Group II); Group I was subdivided as having either exposed (A) or nonexposed (B) implants. Outcomes were compared with similar cohorts undergoing multistage surgery., Results: Of 172 patients (54% male), 153 (89%) underwent ball exchange (Group I) and 19 (11%) had dermis-fat graft (Group II). With a mean follow up of 7.8 years, Group I patients without ball exposure (Group IB) had a slightly higher rate of reintervention for persistent volume deficit (21% vs. 9%; p = 0.163) and implant migration (6% vs. 0%; p = 0.091), while Group IA patients-having surgery for exposed implants-had more reexposures (7% vs. 3%; p = 0.270). Single-stage and 2-stage surgery had similar reintervention rates, with the exception of a trend toward fewer volume enhancements for those with nonexposed implants (17% vs. 30%; p = 0.380), and a shorter time to (re)exposure for exposed implants after 2-stage procedures (mean 0.33 vs. 3.5 years; p = 0.571). Group II patients required further volume enhancement in 32% of 1-stage procedures, and one patient needed graft removal., Conclusion: Single-stage volume modification is effective and the results are comparable to staged surgery for either exposed or nonexposed implants. Most patients report a stable prosthesis and satisfactory cosmesis, after a faster rehabilitation., Competing Interests: The authors have no financial or conflicts of interest to disclose., (Copyright © 2024 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.)

Objective: To reveal the long-term outcomes of enucleation and secondary orbital implantation surgeries employing nonabsorbable surgical mesh-wrapped acrylic orbital implants for various reasons., Methods: A retrospective interventional study of 48 eyes that underwent primary or late primary enucleation and secondary orbital implantation using polyester mesh-wrapped acrylic orbital implants, between 2012 and 2021. Patient demographics, diagnosis, prior ophthalmic surgery, implant size, follow-up periods, and implant-associated complications were evaluated., Results: The records of 36 patients who underwent primary or late primary enucleation and 12 who underwent secondary orbital implantation due to sphere extrusion were evaluated. Patients' mean age was 38.7 (range: 2-75) and the mean follow-up period was 48.3 months (range: 24-72 mo). Major causes for surgeries were trauma and malignancies (54.1% and 33.3%, respectively). No complications, such as conjunctival dehiscence, implant exposure or extrusion, contracted socket, or fornix insufficiency were observed in any patient during the long-term follow-up period postsurgeries., Conclusion: Using polyester mesh-wrapped acrylic orbital implants in enucleation and secondary orbital implantation surgeries proves to be a successful, safe, and cost-effective option., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The aim of the study was to assess factors leading to revision surgery and implant position of primary orbital fracture reconstructions. A retrospective cohort included patients who underwent orbital floor and/or medial wall fracture reconstruction for recent trauma. Demographics, fracture type, surgery and implant-related variables, and postoperative implant position were analyzed. The overall revision surgery rate was 6.5% (15 of 232 surgeries). The rate was highest in combined midfacial fractures with rim involvement (14.0%), lower in zygomatico-orbital fractures (8.7%), and lowest in isolated blowout fractures (3.8%). Fracture type, orbital rim fixation and implant malposition predicted revision. The best positioning was achieved with patient-specific milled titanium implants (mtPSI) and resorbable materials, whereas the poorest with preformed three-dimensional titanium plates. Combined midfacial fractures with rim involvement in particular have a high risk for orbital revision surgery. Within the limitations of the present study, mtPSIs should be preferred in the reconstruction of primary orbital fractures if possible. [ABSTRACT FROM AUTHOR]

Objective: This systematic review and meta-analysis aimed to review the recent literature on the technical accuracy of surgical navigation for patient-specific reconstruction of orbital fractures using a patient-specific implant, and to compare surgical navigation with conventional techniques., Materials and Methods: A systematic literature search was conducted in PubMed (Medline), Embase, Web of Science, and Cochrane (Core Collection) databases on May 16, 2023. Literature comparing surgical navigation with a conventional method using postoperative three-dimensional computed tomography imaging was collected. Only articles that studied at least one of the following outcomes were included: technical accuracy (angular accuracy, linear accuracy, volumetric accuracy, and degree of enophthalmos), preoperative and perioperative times, need for revision, complications, and total cost of the intervention. MINORS criteria were used to evaluate the quality of the articles., Results: After screening 3733 articles, 696 patients from 27 studies were included. A meta-analysis was conducted to evaluate volumetric accuracy and revision rates. Meta-analysis proved a significant better volumetric accuracy (0.93 cm 3 ± 0.47 cm 3 ) when surgical navigation was used compared with conventional surgery (2.17 cm 3 ± 1.35 cm 3 ). No meta-analysis of linear accuracy, angular accuracy, or enophthalmos was possible due to methodological heterogeneity. Surgical navigation had a revision rate of 4.9%, which was significantly lower than that of the conventional surgery (17%). Costs were increased when surgical navigation was used., Conclusion: Studies with higher MINORS scores demonstrated enhanced volumetric precision compared with traditional approaches. Surgical navigation has proven effective in reducing revision rates compared to conventional approaches, despite increased costs., Competing Interests: Declaration of Competing Interests None. The authors declare that there are no conflicts of interest regarding this analysis., (Copyright © 2023 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Purpose: Orbital implant exposures, infections, and extrusions can occur many years following enucleation or evisceration. This study analyzes complication rates following porous orbital implant wrapped with a posterior auricular muscle complex graft (PAMCG)., Methods: This is a retrospective study of patients who underwent orbital implantation following enucleation using this technique between 1992 and 2013. Only cases with a minimum of 18 months of follow-up were included. No patients underwent peg implantation. Patient's demographics, follow-up time, type of implant, complications including wound dehiscence, exposure, postoperative infection, and extrusion were recorded., Results: This study included 36 orbits of 36 patients with a mean age of 39.3 ± 23.2 years (range, 3-84 years). Thirty patients had hydroxyapatite implants and six had porous polyethylene. The average follow-up time was 12.6 ± 5.6 years (range, 1.5-31.0 years). There were no implant extrusions, and only one exposure resulting in orbital infection that necessitated implant removal (2.8%)., Conclusion: Wrapping porous orbital implants with PAMCG had favorable long-term outcomes over a thirty-one-year period.

Purpose: To assess which signs and eye prosthesis care habits are related to subjective discomfort in patients with dry anophthalmic socket syndrome (DASS), using standardized tools from daily practice., Methods: 62 anophthalmic sockets were compared with their healthy fellow eye using the Standard Patient Evaluation of Eye Dryness (SPEED) score. The correlations between SPEED questionnaire and the prosthesis care, discharge characteristics score, conjunctival inflammation score, meibomian gland dysfunction (MGD) scores and Schirmer I test were studied., Result: The anophthalmic sockets group achieved a higher SPEED test score (p < 0.01), discharge score (p < 0.01), conjunctival inflammation score (p < 0.01), MGD scores (p < 0.01) and lower Schirmer I test (p < 0.01) compared with their fellow, healthy eye. Patients with a prosthesis replacement of one year or less, those with a current fit time of one year or less and those with a cleaning frequency above one month reported better SPEED, (p < 0.01), conjunctiva inflammation (p < 0.01) and MGD scores (p < 0.01)., Conclusion: Most anophthalmic patients suffer mild to severe DASS, which seems related to discharge, conjunctival inflammation and MGD. Moreover, certain practices related to the care of the prosthesis such as replacing with a frequency lower than yearly, current fitting time inferior to one year and a removing and cleaning regime above one month, were related to a lower discomfort sensation, conjunctival inflammation and MGD. Clinicians should consider the DASS when facing patients with anophthalmic socket and discomfort symptoms., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)