EXPERIENCE OF COSMETIC REHABILITATION IN PATIENTS WITH POST-TRAUMATIC EYEBALL’S SUBATROPHY

Purpose: to estimate the indications for prosthesis in patients with eye’s subatrophy without pre-enucleation or evisceration and after it.

Patients and methods: There were 152 patients with post-traumatic subatrophy (av.age — 46,1 years) under supervision since 2010 till 2017. Group I — 102 patients (67,1%) with locomotory stump after enucleation: 56 (55%) — after enucliation, 46 (45%) — after eviciration. Group II — 50 patients (32.9%) with prosthesis without prior enucliation or eviciration. All patients underwent visometry, biomicroscopy, ultrasonic biometry, ultrasound B scan, tonometry, radiography and computed tomography of cranium, as well as an im-munological examination of the blood to detect the presence of sensitization to the tissues of the eye. The indications for enucliation in group I were I stage of subatrophy combined with post-traumatic subacute uveitis and sympathetic ophthalmia threatened the second eye [38 (37,2%) eyes] and II and III stage of eyeball’s subatrophy with fast and slow progressive form [64 (85,3%) eyes]. There were 58 (56.8%) men, 41 (40.2 %) women и 3 (3.0%) children in I group. Prosthesis was made for 22 patients (44%) with 2 stage of subatrophy and 28 (56%) with 3 stage. There were 44 (84.3%) adults [28 (66.7%) men, 16 (33.3%) women] и 6 (15,7%) children. The remaining sensitization to the vascular antigen with the background of steroid therapy is an absolute indication for eyeball’s removal in posttraumatic subatrophy. Contraindications to prosthetics of subatrophic eyes without preliminary enucleation or evisceration are positive results of immunological examination of blood, clinical manifestations of slow uveitis, high intraocular pressure and recurrent giphemes. According to our observations, it was possible to perform cosmetic rehabilitation without removing the eyeball in the late post-traumatic period (10–12 months after injury) in the absence of sensitization to the S-antigen of the eye tissues in 32.9% patients with posttraumatic subatrophy.

Conclusion. Enucleation was and remains a radical treatment method of posttraumatic subatrophy. For the best cosmetic results of prosthetics, eye removal should be performed with the formation of the locomotor stump and implantation of the orbital inserts.

1. Цурова Л.М., Братко О.В., Татаренко И.Г., Муриева И.В., Ишкулова Н.А., Мальцева И.А., Юдаков А.В. Глазопротезирование пациентов с посттравматической субатрофией глазного яблока. Медицинский вестник Башкортостана. 2016;1(1); 99. [Tsurova LM, Bratko O.V., Tatarenko I.G., Murieva I.V., Isckulova N.A., Malceva I.A., Yudakov A.V. Eye prosthesis patients with posttraumatic subatrophy of the eyeball. Bashkortostan Medical Journal= Meditsinskiy vestnik Bashkortostana 2016;(1);1:99. (in Russ.)].

2. Канюков В.Н., Санеева Ж.Х. Современные возможности профилактики и лечения травматической субатрофии глазного яблока у детей с применением биоматериала «Аллоплант». Научно-практический журнал. Точка зрения. Восток-Запад. 2015;1:228. [Kanjukov V.N., Saneeva Zh. Kh. Current possibilities of prevention and treatment of traumatic subatrophy of the eyeball in children with the use of biomaterial «Alloplant». Scientific and practical journal. Point of view. East-West = Nauchno-prakticheskii zhurnal. Tochka zreniya. Vostok-Zapad. 2015;1:228. (in Russ.)].

3. Гундорова Р.А., Степанов А.В., Курбанова Н.Ф. Современная офтальмо-травматология. М. Москва. 2007. с. 256. [Gundorova RA, Stepanov A.V., Kurbanova N.F. Modern ophthalmotravmatology. Moscow. 2007. p. 256. (in Russ.)].

4. Балабанова В.Н., Куликова М.П. Отдаленные исходы тяжелых проникающих ранений глазного яблока. Вестник офтальмологии. 1975;2:72-73. [Balabanova V.N., Kulikova M.P. Remote outcomes of severe penetrating wounds of the eyeball. Annals of Ophthalmology=Vestnik oftal’mologii 1975;2:72-73.(in Russ.)].

5. Гундорова Р.А., Нероев В.В., Кашников В.В. Травмы глаза. М. Москва. 2009. c. 383-394. [Gundorova RA, Neroev VV, Kashnikov VV Injury of the eye. Моscow. 2009. p. 383-394. (in Russ.)].

6. Аскерова С.М., Ибрагимзаде Г.Т. Формирование опорно-двигательной культи при различных стадиях субатрофии. Альманах клинической медицины. 2011. с.24. [Askerova S.M., Ibragimzade G.T. Formation of the stump in various s tages of subatrophy. Almanac of Clinical Medicine. 2011.р. 24. (in Russ.)].

7. Hyun Kyung Kim, Tac Yoom La. Treatment of intractable orbital implant exposure with a large conjunctival defect by secondary implant insertion after preceding dermis fat graft. Int. J. Ophthalmol. 2013;2:193. doi: 10.3980/j.issn.22223959.2013.02.17

8. Вериго Е.Н., Гундорова Р.А., Пряхина И.А. Психологические аспекты в реабилитации пациентов с анофтальмом. Офтальмология. 2012; 81. [Verigo E. N.,Gundorova R. A., Pryakhin, I. A. Psychological aspects in rehabilitation of patients with anophthalmos. Ophthalmology. 2012; 9(3):81-85]. DOI: http://dx.doi.org/10.18008/1816-5095-2012-3-81-85

9. Лузьянина В.В. Особенности офтальмопластики для глазного протезирования. Тихоокеанский медицинский журнал. 2016;3:32. [Luzyanina V. V. Рeculiarities of ophthalmoplastic for ocular prosthetics. Pacific Medical Journal=Tikhookeanskii meditsinskii zhurnal. 2016;3:32.]. DOI: 10.17238/PmJ16091175.2016.3.32–36

10. Гундорова Р.А., Вериго Е.Н., Садовская Е.П., Пименова Т.И. Основные направления организации службы глазного протезирования. Вестник офтальмологии. 2003;3;3–6. [Gundorova RA, Verigo EN, Sadovskaya EP, Pimenova TI. The main directions of the eye prosthetics service organization. Annals of Ophthalmology=Vestnik oftal’mologii. 2003;3;3–6. (in Russ.)].

11. Филатова И.А. Оптимальный подход к реабилитации пациентов с врожденным анофтальмом и микрофтальмом. Российская педиатрическая офтальмология. 2014;2:44-48. [Filatova I.A. The optimal approach to the rehabilitation of patients with congenital anophthalmos and microphthalmos. Journal Russian pediatric Ophthalmology=Rossiiskaya pediatricheskaya oftal’mologiya. 2014;2:4448. (in Russ.)].

12. Бараш А.Н., Шаршакова Т.М., Малиновский Г.Ф. Медико-социальные проблемы при анофтальмическом синдроме. Проблемы здоровья и экологии. Минск. 2015. c. 5. [Barash AN, Sharshakova TM, Malinovsky GF. Medicosocial problems in the anophthalmic syndrome. Problems of health and ecology. Minsk. 2015. p. 5. (in Russ.)].