versão impressa ISSN 0004-2749versão On-line ISSN 1678-2925
Arq. Bras. Oftalmol. vol.53 no.3 São Paulo maio/jun. 1990
The author reports his experience (1968-1988) on the treatment of the poor aesthetic appearance and other deformities observed in the anophthalmic cavities. Accordingly of the clinical picture, 894 cases examined were classified in such an original way as that, to each group, there is a definite surgical procedure.
Having in mind what is considered an almast perfect result (a cavity with an inesthetic eye covered by a painted shell) the eviscerations and enucleations are performed by replacing the orbital volume with a primary implant in order to obtain the same results. Because these cases have not presented any problems, specially the conjunctival retraction, the treatment of the anophthalmic cavities was directed to the same goal. So, 331 cases were reconstructed by inserting a secondary implant alone or associated with the classical procedures (mucosal or dermal grafts).
The author uses acrylic balls covered by preserved sclera (including the cornea whenever is possible) as primary or secondary implants, completely buried in the Tenons capsule and fixed to the muscles. They provide good and everlasting volume replacement, mainly when the scleral tunic includes the cornea. The preservation of the cornea is probably an original contribution. Great satisfaction is attained by the excelent cosmetic results afforded by rebuilding the normal relationship and the normal functionality of the orbital structures. From the analysis of the material it is concluded that the treatment of the anophthalmic orbit must be indicated in the earlier stages, before the stablishment of the contaction process, where the results are as good as those of the primary implantations, and the complications much less frequent. When the retraction is present, the task of the treatment must not only be to increase the socket to hold a prosthesis again, for recurrence of the contraction frequently happens in time. Complete success in only possible when the implant (that l oks like the normal eye) set in the same place where it naturally should be (tenonian cavity), restores the anatomy and the functions of the orbit back to normal.
The good results and the follow-up studies have been proving that this technique fullfill the purposes of the treatment in more than 93% of the cases.