Dr. Núria Ibáñez, head of the ICR Orbit and Oculoplastics Department, has realized, with the collaboration of Dr. R. Secondi and Dr. E. Becerra, a study to evaluate the effectiveness of the use of a pericranial graft together with a large orbital implant in patients with a contracted orbital cavity and with a significant orbital volume deficit. The study, titled Autologous pericranium grafts for large orbital implants, has been published in the prestigious European Journal of Ophthalmology.
Disadvantages of limited orbital volume
Insufficient orbital volume in an anopthalmic cavity is a substantial problem when placing an ocular prosthesis. To fix this, one option is the placement of a large ocular prosthesis to compensate for the inadequate volume, but this results in a worse motility of the prosthesis, more secretions, a greater risk of palpebral malpositions and a poor aesthetic result. Another option is the insertion of an appropriately sized orbital implant to avoid post-tenuclear socket syndrome. However, this is not always possible due to insufficient conjunctivation or contraction of the conjunctival sac, which makes the complete lining of the implant difficult or even impossible. In addition, anatomical changes in the cavity, such as tissue retraction and adhesion, make it difficult to perform a secondary implant.
Contributions from the study
The study carried out by the ICR Orbit and Oculoplastics Department wants to prove the effectiveness of the use of an autologous pericranial graft in association with a large primary or secondary orbital implant in patients with a contracted cavity and a significant orbital volume deficit. To carry out the study, 13 patients with a contracted cavity, volume deficit and insufficient conjunctivation to cover the new implant participated. Patients were divided into two groups, according to the basal condition of the cavity. The surgery consisted of primary evisceration (only in one of the groups) and the placement of a large orbital implant followed by an autologous pericranial graft on the implant (in both groups).
The average follow-up time of the patients was 9 and a half months and the complete epithelialization of the pericranial graft took place after 47 days of observation. According to the doctors, no cases of exposure or contraction of the implant were observed during the follow-up and all patients were satisfied with the aesthetic result.
Therefore, according to the study conducted by Dr. Ibañez, Dr. Secondi and Dr. Becerra, the autologous pericranial graft was effective in reconstructing the contracted cavity so that the anophthalmic cavity could accommodate a larger or secondary orbital implant. However, they claim that the effectiveness of this procedure should be confirmed by a larger group of patients.