• Oculoplastics/Orbit

    Investigators of this multicenter study evaluated long-term outcomes of a progressively enlarging prosthesis with dermis fat grafting for congenital anophthalmia.

    Study design

    This retrospective analysis comprised 20 patients with unilateral and 2 patients with bilateral congenital anophthalmia. Each received progressively enlarging cosmetic customized prostheses early after birth, followed by dermis fat graft for socket rehabilitation. Differences in vertical palpebral aperture (VPA) and horizontal palpebral length (HPL) between affected and unaffected eyes were measured at the first prosthesis fitting, as well as before and after dermis fat graft. Satisfaction with cosmetic results, prosthetic retention and complications were assessed. An MRI of the orbit was performed before and after dermis fat graft surgery.

    Outcomes

    This strategy for treatment of congenital anophthalmia resulted in a significant decrease in the difference between the normal and treated side in VPA and HPL. Families were "very satisfied" and physicians were "satisfied" with the results. Excellent prosthesis retention was observed in all cases.

    Limitations

    The study has the common short-comings of a retrospective study. Ideally, this strategy would be compared in a randomized, prospective study to other treatment protocols for this condition. The use of more quantitative measurements such as ImageJ software and volume quantitation from the MRIs would provide more exact data.

    Clinical significance

    Although a relatively rare condition, congenital anophthalmia and microphthalmia have been addressed by a number of treatment strategies, including expanding orbital implants and orbital expansion devices. This study supports the general consensus from physicians treating this condition that conservative expansion with conformers/prostheses followed by placement of a "living implant" (dermis fat graft) gives a satisfactory result. In addition, complications were rare and prosthesis retention was excellent.