RESUMO
PURPOSE: To evaluate the use of orbital polyacrylamide gel injection for the correction of anophthalmic enophthalmos. METHODS: Noncontrolled clinical trial of 21 patients (14 with ocular implants, 5 with phthisis bulbi, and 2 with dermis-fat graft). Orbital CT was performed to estimate the volume of polyacrylamide gel needed to restore orbital volume. Polyacrylamide gel was injected using a 22-gauge (30 x 0.7 mm) needle transcutaneously inserted in the lateral third of the lower eyelid, directed to the orbital muscle cone. A second injection was administered 15 days later, if necessary. CT was repeated 30 days after the last procedure. Exophthalmometry was performed before and 90 days after the procedure. RESULTS: The mean total volume injected per orbit was 2.4 +/- 0.7 ml (range, 1-3.5 ml). The volume of the enophthalmic orbit increased from 26.9 +/- 5.0 ml to 29.3 +/- 4.9 ml (p < 0.001). The mean difference in exophthalmometry readings was 3.3 +/- 1.6 mm (range, 1.5-8.0 mm) before the procedure and 1.0 +/- 0.9 mm (range, 0.0-3.0 mm) after 3 months (p < 0.001). Adjustment of the ocular prosthesis or fabrication of a new one was necessary in 11 patients (52.4%), and the mean volume of the ocular prosthesis was reduced from 2.0 +/- 0.6 ml to 1.6 +/- 0.6 ml (p = 0.003). All patients were satisfied with the aesthetic results. No serious adverse events were observed. The initial results were maintained 1 year after the procedure. CONCLUSIONS: Polyacrylamide gel injection in the orbital space effectively reduces enophthalmos in ocular prosthesis wearers.
Assuntos
Resinas Acrílicas/administração & dosagem , Anoftalmia/terapia , Enoftalmia/terapia , Órbita/efeitos dos fármacos , Tecido Adiposo/transplante , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Enucleação Ocular , Evisceração do Olho , Olho Artificial , Feminino , Géis/administração & dosagem , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Órbita/diagnóstico por imagem , Implantes Orbitários , Estudos Prospectivos , Tomografia Computadorizada por Raios XRESUMO
O objetivo deste estudo foi o de avaliar o efeito da injeção do gel de poliacrilamida em 21 pacientes com órbita enoftálmica e usuários de prótese ocular seguidos no Ambulatório de Cirurgia Plástica Ocular do HC-FMUSP. Foram estudadas as causas da perda ou atrofia do globo ocular, cirúrgia(s) anterior(es), tempo de uso e o volume da prótese ocular antes e após o tratamento. Foram realizadas documentação fotográfica, exoftalmometria e tomografia computadorizada para cálculo do volume orbitário antes e após a aplicação do gel. Os pacientes receberam injeção do gel de poliacrilamida no cone muscular da órbita. O volume injetado variou de 1,0 a 3,5 ml. Os defeitos órbito-palpebrais foram corrigidos em todos os casos. O gel de poliacrilamida demonstrou ser um produto seguro, econômico, de fácil obtenção e aplicabilidade / The object of this study was evaluating the effect of polyacrylamide gel injection in 21 patients presenting unilateral enophthalmic orbit with ocular prosthesis, assisted in the Oculoplastic Surgery Ambulatory of HC-FMUSP. Causes of ocular globe loss or atrophy, previous surgeries and length of use of ocular prosthesis and its volume have been evaluated. Photograph documentation, exophthalmometry and computerized tomography were studied for calculating the orbital volume before and after the application. Patients received injection of polyacrylamide gel in the muscular cone of the orbit. Volume injected varied from 1,0 ml to 3,5 ml. Orbito-palpebral defects have been corrected in all cases. The use of polyacrylamide gel has shown that it is a product which is safe, cost-effective, easy to obtain and to apply...