Recurrent contracted sockets treated with personalized, three-dimensionally printed conformers and buccal grafts.

PURPOSE: Recurrent contracted sockets are complex situations where previous surgeries have failed, disabling the wear of an ocular prosthesis. A combined method of surgery and long-term fixation using custom-made, three-dimensional (3D) printed conformers is evaluated. METHODS: Retrospective case series of nine patients with recurrent excessive socket contraction and inability to wear a prosthesis, caused by chemical burns (n = 3), fireworks (n = 3), trauma (n = 2) and enucleation and radiotherapy at childhood due to optic nerve glioma (n = 1) with three average previous socket surgeries (range 2-6). Treatment consisted of a buccal mucosal graft and personalized 3D-printed conformer designed to be fixated to the periosteum and tarsal plates for minimal 2 months. Primary outcome was the retention of an ocular prosthesis. Secondary outcome was the need for additional surgeries. RESULTS: Outcomes were measured at final follow-up between 7 and 36 months postoperatively (mean 20 months). Eight cases were able to wear an ocular prosthesis after 2 months. Three cases initially treated for only the upper or only the lower fornix needed subsequent surgery for the opposite fornix for functional reasons. Two cases had later surgery for cosmetic improvement of upper eyelid position. Despite pre-existing lid abnormalities (scar, entropion, lash deficiency), cosmetic outcome was judged highly acceptable in six cases because of symmetric contour and volume, and reasonably acceptable in the remaining two. CONCLUSIONS: Buccal mucosal transplant fixated with a personalized 3D-designed conformer enables retention of a well-fitted ocular prosthesis in previously failed socket surgeries. Initial treatment of both upper and lower fornices is recommended to avoid subsequent surgeries for functional reasons

Meta-analysis of ocular axial length in newborns and infants up to 3 years of age.

In pediatric ophthalmology it is often necessary to obtain axial length in young children. For children older than 3 years, noncontact biometry can be used. For younger children this is usually not an option, and the clinician needs to rely on other imaging modalities. Depicted data curves in textbooks elaborate on few studies and limited number of subjects. The existing literature regarding normal axial length for preterm infants and term newborns is summarized and critically appraised for number of subjects, relevance, measurement method and error, gender and retinopathy of prematurity. We obtained axial length measurements for a total number of 6,575 eyes in 27 papers published from 1964 to 2018 (9 papers with 2,272 eyes for preterm children, 24 papers with 4,303 eyes for term children). Initially, axial length increases rapidly: from a mean 5.1-16.2 mm in week 12 to week 37 gestational age. From 38 weeks, growth rate decreases from 16.2 mm to a mean of 21.8 mm at 3 years old. Male infants have a larger average axial length than females at birth; the difference is 0.24 mm (95%CI: 0.15-0.33, P < 0.001). We present a useful growth curve and formula that may serve as a reference for diagnosing abnormal growth

3D orbital reconstruction in a patient with microphthalmos and a large orbital cyst: a case report

Background: Orbital cysts are rare developmental anomalies that can occur in microphthalmic and anophthalmic patients. Such cysts can promote orbital growth and subsequently markedly increase the size of the orbit, which is commonly underdeveloped in these patients. Cyst removal is therefore generally dissuaded (at least) in the first 5 years. Clinical case: A 6-year-old boy with a microphthalmos and a cyst developed protrusion of his prosthetic eye and a swelling of the lower eyelid. MRI showed a large cyst causing distortion of the right orbit. Due to the expansive orbital growth and subsequent misfitting of the prosthesis, cystectomy and orbital floor reconstruction was performed using 3D technology. Conclusion: 3D imaging and printing enables exact delineation of orbital cysts and the adjacent bony structures. Furthermore it offers the possibility to plan an individual surgical approach and to design and fabricate a custom fit orbital floor implant