Estudo da reconstrução de órbitas enucleadas com dois tamanhos de implantes esféricos em comparação com a órbita normal através de novo modelo de medidas tomográficas e correlação clínica

Abstract

Purpose: To compare the orbital volume and intraorbital anatomic relations of enucleated orbits reconstructed with different spherical acrylic implants diameter (16 or 20 mm) with the contralateral orbit using new tomographic measurements, and evaluate the correlation of these measurements with clinical measurements of the anophthalmic socket. Methods: Thirty-two patients who had undergone ocular enucleation, with random selection of the diameter of the implant were enrolled in this prospective randomized double-blind controlled study. Computed tomography was performed ten months after surgery. Volumetric measurements of the entire orbital content and the soft tissues, and eight intraorbital linear and angular measurements were obtained in both the enucleated and contralateral orbits by the main researcher and a radiologist. Clinical measurements of the anophthalmic socket (exophthalmometry and implant motility) and of the artificial eye (thickness, weight, volume and mobility) obtained ten months after surgery were compared between the two groups and correlated with the tomographic measurements. Results: The tomographic measurements were reproducible (ICC ranged from 0.908 to 1.00). Significant differences between the enucleated and control orbits were detected in total volume (p<0.0001), and linear and angular parameters (p<0.05). The exophthalmometric values were significantly smaller (p<0.001) and motility of the implant was higher (p<0.05) when the 20-mm diameter implant was used. The artificial eye mobility was higher (p<0.05) and their lateral (p<0.001), superior (p=0,013) and inferior (p=0,013) borders were thinner in the 20-mm implant group; there were no difference of weight and volume between two groups. Conclusions: The proposed method for measuring volumetric and anatomic relations of the orbit is simple, reproducible, and precise. Eye sockets with the 20-mm implant had measurements similar to those of control subjects, more satisfactory volume, and the intraorbital anatomic relations were maintained closer to normal standards with a positive effect on clinical measurements.