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    Acrylic conformers effective in congenital anophthalmia

    Treatment requires close collaboration among patient, ophthalmologist, ocularist

    Take-home message: Acrylic expanders may be an option for the management of patients with congenital anophthalmos and microphthalmos.

    Reviewed by Thomas E. Johnson, MD

    Baltimore—Fitting patients who have congenital anophthalmia or extreme microphthalmia with successively larger acrylic conformers can prepare space for ocular prostheses with minimal complications, according to Thomas E. Johnson, MD.

    “This works as well as, if not better than, a lot of the other techniques that have been used or reported,” said Dr. Johnson, professor of clinical ophthalmology, Bascom Palmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore.

    Anophthalmia is extremely rare, affecting only 0.18 to 0.4 in 10,000 births. Microphthalmia is only slightly more common, affecting about 1.5 in 10,000.

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    Causes include genetic disorders; gestational infections, such as toxoplasmosis, rubella and some strains of influenza; gestational exposure to thalidomide or x-rays; or gestational vitamin A deficiency, Dr. Johnson said. In the absence of a normal eye, sockets will not expand properly leading to a disfigured appearance.

    Treatment “is mainly cosmetic,” he said. “It helps patients with their esteem to be able to wear an artificial eye and look normal.”

    Ophthalmologists have used a variety of techniques to avoid this problem. One approach is a surgically implanted hydrogel ball implant that expands by osmosis of fluid in the socket, reaching about 10 times their original volume in 2 to 6 weeks. Hydrogel balls are surgically replaced with successively larger sizes.

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