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    Acrylic conformers effective in congenital anophthalmia

    Treatment requires close collaboration among patient, ophthalmologist, ocularist

     

    Using acrylic expanders

    By contrast, Dr. Johnson descried a series of 8 patients in whom he and his colleagues treated 14 sockets with acrylic expanders. These patients did not need surgery until they reached a mean age of 5.73 years when an adult-sized orbital implant was placed.

    Of these patients, two required further surgery, in both cases to graft mucous membrane. In one case, the surgery was needed because of a car accident.

    “In the other, we may have been too aggressive” in expanding the socket rapidly, he said.

    The risk of adverse events from the conformers is small, he said. Acrylic is very inert and very few people develop allergies to it.

    Dr. Johnson first became aware of the possibility of using acrylic conformers in 1997 when he read an article by Merritt and Trawnick in the Journal of Ophthalmic Prosthetics describing a similar approach.

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    While living in Saudi Arabia, Dr. Johnson collaborated with an ocularist, Yasser Bataineh, who was skilled in creating such acrylic conformers for these patients. Bataineh moved to Florida, and when Dr. Johnson took a position there at Bascom Palmer, the two resumed their collaboration.

    In their series of patients, they placed an average of about 20 successively larger conformers in each socket before implanting an orbital implant.

    “Usually the conformers are changed very quickly when the child is very young, then you continue gradually expanding them,” Dr. Johnson said. “The ocularist decides how fast to proceed with enlarging the conformers.”

    The conformers start out flat and become progressively more rounded. Convexities on their posterior aspect stimulate an indentation in the socket called the pit.

    “We think this pit plays a role in causing the socket expansion,” Dr. Johnson said. “In some of these other techniques the pit may not be respected, and that’s why we think the expansion may not be as good.”

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