Expansion of the human microphthalmic orbit

Area of Science:

• Ophthalmology
• Pediatric Plastic Surgery
• Craniofacial Surgery

Background:

• Microphthalmia is a congenital condition characterized by incomplete eye development, often leading to significant orbital asymmetry.
• Associated bony and soft tissue deficits in the microphthalmic orbit present challenges for reconstructive surgery and aesthetic outcomes.
• Current management strategies aim to stimulate orbital growth and improve eyelid contour in affected children.

Purpose of the Study:

• To evaluate the efficacy of long-term, incremental orbital tissue expansion in addressing bone and eyelid growth deficits in pediatric microphthalmia.
• To quantify the changes in orbital dimensions and eyelid fissure length following tissue expander use.

Main Methods:

• A prospective case series involving five pediatric patients with unilateral microphthalmia.
• Surgical placement of an orbital tissue expander followed by gradual saline inflation over an extended period.
• Pre- and post-expansion measurements of midorbital width via CT scans and eyelid fissure length, with deficits calculated as percentages relative to the contralateral normal side.

Main Results:

• Incremental expansion to an average diameter of 22 mm reduced orbital dimension deficits from 14.6% to 3.8%.
• Eyelid length deficits decreased from an average of 17.5% to 2.3% post-expansion.
• The average expansion period was 56.8 weeks, requiring two outpatient procedures per patient.

Conclusions:

• Gradual, incremental inflation of orbital tissue expanders is an effective method for stimulating osseous and eyelid growth in microphthalmic orbits.
• This technique successfully ameliorates major stigmata associated with pediatric microphthalmia, improving both functional and aesthetic outcomes.
• Tissue expansion offers a viable reconstructive option for managing orbital volume and contour deficiencies in microphthalmia.