Step 2: A dental stone or plaster model is made from the impression and is used as the basis for fitting and making the prosthesis.
Over the past few years impressive advances in keratoprosthesis design have been made by Professor Legeais in Paris. His keratoprosthesis uses a synthetic polymer optic similar to a contact lens, which has a flexible woven PTFE polymer 'skirt' (haptic) intimately bonded to its edge. The microporous skirt allows invasion of the patient's tissue into the material and achieves an improved level of biocompatibility between the synthetic 'cornea' and the eye. Since the optical part of the Legeais keratoprosthesis is thin and shaped like the natural cornea, this prosthesis design offers a much wider field of vision than was possible with the older style 'nut and bolt' prosthesis.
GRAFT MOUNTED OCULAR PROSTHESIS
I commend the authors of the article entitled “Total upper and lower eyelid reconstruction using deltopectoral flap,” for their courageous attempt of utilizing deltopectoral flap for eyelid reconstruction following orbital exenteration. The aesthetic outcome achieved in this case by painstaking reconstructive surgery is fairly good. However, being a prosthodontist, actively involved in the prosthetic rehabilitation of patients with ocular and orbital defects, I would like to discuss another treatment modality that is prosthetic rehabilitation.
Orbital exenteration: indications, techniques and ..
The basic objectives of treatment are to address functional, psychological, aesthetic and social issues associated with the disease. Unfortunately, whenever orbital exenteration is planned for any patient, the functional aspect of preservation of vision becomes impossible and target shifts mainly to aesthetic, psychological and social issues. All these issues can be effectively addressed by an orbital prosthesis. In my opinion, subjecting the patient to multiple surgical procedures is a complicated, time consuming and highly demanding procedure in terms of surgical expertise in addition to its inherent disadvantages, i.e., donor site morbidity, psychological trauma, risk of graft rejection etc. Moreover, it eliminates the possibility of keeping vigilance over disease reoccurrence in early stages and anyway, even after the complex reconstruction surgery, patient will have to use ocular prosthesis if not orbital prosthesis.
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The major risk with keratoprosthesis surgery is infection in the eye - endophthalmitis. This may arise at the time of surgery, or later due to erosion of the mucous membrane, or through spread of infection through the blood stream. Patients are given systemic antibiotics at the time of surgery, and should take prophylactic antibiotics if they are undergoing any further surgery such as tooth extraction.
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Sir, in my opinion, the creation of palpebral aperture of 15 mm with 32 mm cavity inside, as mentioned by Gujjalanavar and Girish, will result in inadequate hygiene maintenance of the pouch. Furthermore, the absence of eyelashes, lack of fornix formation and colour mismatch of reconstructed area are other problems with the described surgical procedure that require critical appraisal. Although, the prosthetic rehabilitation lacks the sensation of a normal or reconstructed periocular region, but it has the obvious advantage that it does not require the multiple procedures of surgical reconstruction and the accompanying loss of time for healing and rehabilitation. Such a life-like prosthesis may fulfil the aesthetic and psychological needs of patients to look like everybody else, with two eyes and a beautiful face to face the public without embarrassment.