Orbital Implants
Loss of an eye to tumor, trauma, or end-stage ocular disease may be devastating. There is a loss of binocular vision, reduced peripheral visual field, and loss of depth perception. Job limitations may arise, and affected individuals may experience a sense
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David R. Jordan and Stephen R. Klapper
Introduction Removal of an eye may be indicated due to the presence of a malignant tumor, following severe penetrating trauma, or because of degenerative changes resulting from end-stage ocular disease. Loss of binocular visual function with reduced peripheral field and loss of depth perception may result in difficulties with activities of daily living and impose various vocational restrictions [1–6]. Individuals may experience a sense of facial disfigurement and poor self-esteem as a result of the lost body part [3, 4, 6]. Because eye contact and facial appearance are an essential part of human interaction, it is important for the anophthalmic patient to maintain a natural, normal appearing prosthetic eye. Characteristics of the ideal anophthalmic socket include [7]: 1. A centrally placed, well-covered, buried implant of adequate volume, fabricated from a bioinert material that transmits motility from the implant to the overlying prosthesis.
D. R. Jordan (*) Department of Ophthalmology, University of Ottawa Eye Institute and the Ottawa Hospital, Ottawa, ON, Canada S. R. Klapper Klapper Eyelid and Facial Surgery, Carmel, IN, USA © Springer Nature Switzerland AG 2019 C. J. Hwang et al. (eds.), Clinical Ophthalmic Oncology, https://doi.org/10.1007/978-3-030-13558-4_21
2. A socket lined with healthy conjunctiva and fornices deep enough to retain the prosthesis and permit horizontal and vertical excursions of the artificial eye. 3. Normal eyelid and eyelash position, appearance, and tone. 4. A supratarsal eyelid fold that is symmetric with that of the contralateral eyelid. 5. A comfortable ocular prosthesis that looks similar to the sighted, contralateral globe and in the same horizontal and anterior-posterior plane. Currently, no surgical procedure satisfies all of the above criteria. Over the past three decades, there have been numerous developments and refinements in anophthalmic socket surgery with respect to implant material and design, implant wrapping, implant-prosthesis coupling, and socket volume considerations. Successful anophthalmic surgery is achieved when the anophthalmic patient obtains a painless, noninflamed eye socket with adequate volume restoration and an artificial eye that looks and moves almost as naturally as a normal eye.
Historical Perspective In 1884, P. H. Mules inserted a hollow glass sphere into the scleral cavity following removal of the intraocular contents [8]. A year later W. A. 275
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Frost introduced a similar implant into Tenon’s capsule following an enucleation procedure [9, 10]. The Mules sphere revolutionized anophthalmic socket surgery by replacing lost orbital volume with a buried orbital implant. Complications including migration, extrusion, and implant shattering became evident as use of these novel implants increased [9, 11]. Sponge, rubber, paraffin, ivory, wool, cork, bone, cartilage, silver, gold and many other buried orbital implant materials were utilized with little success over the next several decades [10]. The i
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