Expansion of the socket and orbit for congenital clinical anophthalmia.
BACKGROUND
Congenital clinical anophthalmia requires fitting an artificial eye, achieving a pleasing aspect of the palpebral apparatus, and stimulating growth of the orbit, as well as of the entire midface.


METHODS
Out of 25 patients with clinical anophthalmia, 22 were treated according to a new protocol (first described by Wiese et al. in 1999) and followed for up to 6 years. In 10 patients, anophthalmia was bilateral, in nine patients, it was on the right side only and in three it was on the left side only. Treatment consisted of implantation of an osmotic expander to first stimulate growth of the conjunctival sac and eyelids followed by serial implantation of osmotic expanders to stimulate growth of the orbit (and thus of the midface). The material used was a copolymer of methylmethacrylate and N-vinylpyrrolidone.


RESULTS
Fitting of an artificial eye was without any problem within the first year of life for the most part. Growth of the orbit was stimulated by more than 65 percent of a healthy one. Aesthetically, the results were very largely pleasing. Complications were encountered, especially when the wrong expander sizes had been implanted.


CONCLUSIONS
Using osmotic expanders of this type, through a staged therapy of minor operations, promises to achieve all goals before the child enters school.
Gundlach
Karsten Kurt Helmuth
KK
Department of Cranio Maxillofacial Surgery, University Hospitals, Rostock, Germany.
Guthoff
Rudolf Friedrich
RF
Hingst
Volker Hermann Martin
VH
Schittkowski
Michael Peter
MP
Bier
Ulrich Christian
UC
D000015:Abnormalities, Multiple; D000853:Anophthalmos / Q000601:surgery*; D002675:Child, Preschool; D002985:Clinical Protocols; D005137:Eye, Artificial; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008768:Methylmethacrylates / Q000627:therapeutic use*; D009915:Orbit / Q000254:growth & development; D011205:Povidone / Q000627:therapeutic use*; D019651:Plastic Surgery Procedures / Q000379:methods*; D015625:Tissue Expansion Devices
D008768:Methylmethacrylates; C037334:poly(methylmethacrylate-N-vinylpyrrolidone); D011205:Povidone