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Abstract
The author reports his experience (1968‐1988) in the treatment of the poor esthetic appearance and other deformities observed in the anophthalmic cavities. Depending on the clinical picture, a new classification system was applied to 894 cases and for each classification group a definite surgical procedure was indicated.
The author has used what is commonly considered to be an almost perfect result (an unesthetic eye covered with a painted shell) as a standard for reconstruction, after eviscerations and enucleations, which are performed by replacing the orbital volume by a primary implant. Because these cases had not presented any problems, especially conjunctival retraction, the same standard was applied to the treatment of anophthalmic cavities. So, 331 anophthalmic cavity cases were reconstructed by inserting a secondary implant alone or associated with mucosal or dermal grafts.
The author uses acrylic spheres covered with preserved sclera (including the cornea whenever possible) as primary or secondary implants, completely buried in Tenon's capsule and fixed to the muscles. They provide good and permanent volume replacement, mainly when the scleral tunic includes the cornea. The practice of preserving the cornea is probably an original contribution. Great satisfaction is obtained from the excellent cosmetic results afforded by rebuilding the normal relationship and the normal functionality of the orbital structures. From an analysis of the records it was concluded that the treatment of the anophthalmic orbit must be carried out as early as possible, before the onset of the contraction process. The results are as good as those with primary implants, and the complications much less frequent. When retraction is present, the goal of the treatment should not only be to increase the size of the socket to hold a prosthesis again, for recurrence of the contraction frequently occurs with time. Complete success is only possible when the implant (which looks like the normal eye), set in the exact place where it should naturally be (tenonian cavity), restores the anatomy and the functions of the orbit to normal.
The good immediate results and the follow-up studies have proven that this technique fulfills the purposes of the treatment in more than 93% of the cases.