[The use of acoustic tomography in the diagnosis of certain orbital diseases].
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Seven children with congenital cytomegalovirus infection demonstrated a higher than expected incidence of "rare" ophthalmological abnormalities, including anophthalmia and Peters' anomaly. These data suggest that appropriate investigation for evidence of cytomegalovirus infection should be instituted in any child with congenital ocular defects.
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The anophthalmic socket is often contracted due to a deficiency of conjunctiva. The use of buccal mucosa to expand the socket is well known to ophthalmologists. However, this material often suffers shrinkage due to excessive scarring following surgery, leading to further contracture of the socket. RTV silicone (Medical Elastomer 382) has been found to be an excellent stent following buccal mucosal grafting. This paper deals with technical aspects of performing this procedure and discusses the complications. The results in 17 of 21 sockets have been excellent in allowing the conjunctival graft to take without further shrinkage and in allowing the patient to wear a prosthetic eye comfortably.
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Reconstruction of the conjunctival sac is never a simple procedure. It is a question of positioning a prosthesis in the orbital cavity which will have no anatomic support, as the eye has been enucleated, reduced to a stump (microphthalmos) or has been replaced by an implant that has just been expelled. All described techniques consist in enlarging the existing conjunctival sac, and then positioning a mucosal or dermo-epidermical graft in the orbital cavity maintained by a conformer. In order to limit the effects of the inevitable retraction during the first weeks following surgery, operative enlargement beyond the needs of the conjunctival sac is essential. The conformer should be supported by tarsorraphy until the phenomenon of retraction has reached an end (4 to 6 months). The problem of the "orbital cavity" must be understood so that indications for surgical remodelling of the conjunctival sac can be established. This is simple after enucleation, but more complex in the case of a microphthalmos, an injury, or an exenteration of the orbit where remodelling represents only the last operative stage after bone remodelling, or lids remodelling and sometimes transposition of the temporalis muscle in the socket.