gms | German Medical Science

Purpose: Enucleation or evisceration of the eyeball is always a mutilating procedure for the patient. Therefore, the primary goal of surgery nowadays is to fill the orbit with an implant while preserving the function of all four rectus muscles. Various orbital implants made from different materials are used after enucleation of the eyeball. In the Czech Republic, Vanýsek's orbital prosthesis with four tunnels for muscles and a front circular edge improving the movement of the shell ocular prosthesis has become popular. In the 1950s, Vanysek made it from PMMA, and in the 1980s, Karel had it made from silicone. It has been used for over 30 years in sizes 16.5 (pediatric), 18.5 (female), and 20.5 mm (male). After the discontinuation of its production, we had Vanysek's orbital prosthesis made from soft hydrophilic acrylic at Wilens company.

Methods: Enucleation with the intention of implanting an orbital prosthesis is performed with facultative ligation of the optic nerve stump to prevent hematoma formation under the prosthesis. After carefully removing the implant from the transport solution, sutures are threaded through holes in the prosthesis, and muscle insertions are pulled out to the top of the prosthesis. The inferior rectus muscle is carefully anchored using nonabsorbable suture to the top of the implant, where a reinforcing polypropylene mesh is embedded. It is then connected to the superior rectus muscle and finally fixed to the cross above both mentioned muscles - the temporal and nasal muscles. The conjunctiva is sutured in two layers, with Tenon's tissue being absorbable, and the superficial layer continuing horizontally with nonabsorbable suture. Conformer of the conjunctival fornix is not used. Stitches will be removed in 10 days. A shell cosmetic acrylic or glass prosthesis is prescribed after 4 weeks.

Results: From 2016 to 2024, we successfully used the new elastic prosthesis in 15 patients after enucleation of the eyeball. All surgeries had a standard uncomplicated course. The follow-up period in our cohort ranges from 0 to 8 years. We did not observe signs of implant extrusion or orbit irritation in any case. The cosmetic effect of the shell prosthesis was always satisfactory; this type of prosthesis ensures good mobility of the cosmetic prosthesis horizontally.

Conclusions: The innovated Vanysek implant has proven itself both perioperatively and in the long term. The advantage is the minimal probability of muscle erosion in the prosthesis channels; the disadvantage is the potential perioperative fragility of the soft acrylic. Material calcification with this type of hydrophilic acrylic (used in WIOL lens production) is not described.