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C Hintschich, FW Zonneveld, LÝ Koornneef; Orbital fat in the acquired anophthalmic socket . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1464.
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Purpose: Atrophy of orbital fat has been thought to be a major contributing cause of the post-enucleation socket syndrome. However, this pathophysiologic mechanism has never been confirmed by scientific analysis in man. This study investigates volumetric changes of the orbital fat compartment in the anophthalmic socket. Method: Based on high resolutional CT scans with 1,5 mm contiguous slices (Philips tomoscan SR 7000) of both orbits, 3-D reconstructions of orbital fat compartments were performed in a surface rendering mode (Gyroview HP workstation, Philips Medical Systems with Gyroview software, version 5.0.3, ISG Technologies Inc.). The orbital fat volumes were analysed. Twenty-four patients with long-standing anophthalmia (median 16 y) and 7 patients * 4 y after enucleation and 8 controls were examined. Additionally, pre- and postoperative fat volumes of 11 patients were evaluated. Surgical procedures included enucleation with primary orbital implant (4), secondary implant (4) and implant exchange (3). Results: Reproducible volumetric data were obtained in all patients. In long-standing anophthalmia no reduction of orbital fat was observed in patients with orbital implants. Patients without orbital implants showed even a statistically significant increase of fat volume by 11.1% (p=0.03) compared to the uneffected orbit. In patients with short follow-up, 4 patients after dermo-fat grafting showed an enlargement of fat as expected. Severe fat volume reductions were observed in patients with long-standing chronic infection of the socket (-31.7%) and after proton beam irradiation (-34.4%). The comparison of pre- and postoperative fat volumes revealed a statistically significant reduction of orbital fat after secondary implantation, enhanced by redo surgery. Conclusion: In contrary to general assumptions these data show that in the acquired anophthalmic socket primarily there is no orbital fat atrophy. However, a reduction of orbital fat can be observed after secondary orbital implantation, chronic inflammation and radiation.
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