INTRODUCTION pattern. A digital photograph of the patient’s

INTRODUCTION

             Eye is a vital organ not only for vision but
also a remarkable feature of individual’s personality and appearance. Loss of
an eye caused by trauma, tumour, infection, or congenital defects can cause an
intense physical and psychological impact on one’s personal, social, and
professional life 1. These patients are rehabilitated either with stock
prosthesis or custom made ocular prosthesis. The custom made ocular prosthesis
have several advantages over stock ocular prosthesis like better fit in
anopthalamic socket, better cosmetic results because of control over the size
and colour of iris and sclera, and more comfortable to the patient in the long
term 2.  This article describes
different clinical techniques for fabrication of custom ocular prosthesis.

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CASE
SERIES

PATIENT
1

A
28-year-old male patient was referred to the Dept of Prosthodontics with loss
of right eye due to an accident 6 month back wherein he sustained blunt trauma
to eye followed by loss of sight and shrinkage of globe. Patient was diagnosed
as a case of Phthisis bulbi (Fig 1a). After clinical examination of the
patient, a custom-made ocular prosthesis with digital iris was planned.
Impression tray was fabricated by duplicating conformer in self cure acrylic
and hollow plastic handle was attached to inject impression material into the
socket. Petroleum jelly was applied onto the eyelashes, and impression was
made. The patient was instructed to carry out the eye movements while the
impression was being made. After removal, the impression was evaluated for any
defects. A two-piece master cast with indexing was prepared and a wax pattern
was fabricated in white carving wax. The wax pattern was evaluated for contour,
opening and movements after placing it in anopthalamic socket. The patient was
instructed to keep his eyes fixed on one point and the centre of the pupil was
measured with digital Vernier’s calliper and transferred to the wax pattern. A
digital photograph of the patient’s iris was made with the help of fundus
camera (Fig 1b). After adjustment of the colour and brightness of the
photograph, images of the remastered iris in 1:1 ratio (life-size) were printed
on good-quality photo-paper by using proprietary graphics software (Fig 1c). The
iris was cut from the photo paper and attached to the corneal button and placed
at predetermined position of pupil in wax pattern and tried in.  After successful try-in and confirmation of
position, prosthesis was flasked. Dewaxing was done, and the mould was packed
with heat cure scleral acrylic resin. After processing and bench cooling
prosthesis was retrieved, finished, and polished. To simulate veins of
contralateral eye, rayon flocks were utilised. The mono-poly syrup was used to
simulate thin layer of clear conjunctiva and give life like appearance. The
Final custom-made prosthesis was delivered to the patient (Fig 1d), post
insertion instructions were explained.

PATIENT
2

 A 62-year-old male patient was referred with
enucleated left eye (Fig 2a). The defect was secondary to surgical management
of choroidal melanoma treated one year back. The steps in the fabrication of
wax pattern and marking position of pupil were same as for first patient. A
black iris disc of 1mm smaller size (diameter) of iris of contralateral eye was
selected and painted with acrylic paints (Fig 2b & 2c). After matching the
colour of painted iris disc with that of patient’s iris, it was attached with
corneal button by cyanoacrylate resin and embedded in wax pattern at previously
marked position of pupil and tried in. Afterwards wax pattern and corneal
button iris disc assembly was processed, and characterization was done similar
to that for the first patient. Finishing and polishing of prosthesis was done
and delivered (Fig 2d). Post insertion instructions were given, and patient
followed up for 6 months.

PATIENT
3

A
30-year-old male patient was referred to department as a case of
enucleated right eye. History of present illness revealed he had an accident 2
year back, in which he sustained penetrating injury to his right eye which was
followed by surgical enucleation (Fig 3a). After surgery, eye conformer was
placed to maintain the space for prosthesis and prevent shrinkage. Local
examination of anopthalamic socket was done and custom made ocular prosthesis
was planned. All steps for fabrication of prosthesis were followed like those
in previous cases, except for selection of iris. After wax pattern try in, iris
of similar size and colour was selected from stock eye, removed, and placed in
wax pattern and try in was done to confirm position of iris and pupil Fig 3b
& 3c). After minor adjustments, prosthesis was processed. After finishing,
polishing and characterisation, prosthesis was inserted (Fig 3d), and post
insertion instructions were given.

 DISCUSSION

The
selection, fabrication and positioning of the prosthetic iris is an important, challenging,
and critical step during the construction of custom ocular prosthesis 3. Several
variations exist in the fabrication technique of prosthetic iris either by
painting, taking iris from stock eye or replicating iris by digital technology.
The digital photographic iris fabrication presents good aesthetic results
because it replicates the patient’s iris with minimal colour modifications and
less complicated compared to the conventional method of hand painting. 4 The
described technique is simply a practical and less time-consuming method of
making custom-made ocular prosthesis with minimal artistic skills. However, it
presents challenges of macro photography and preventing image of flash or
camera in the Iris. The second technique of iris painting requires skill and
patience to paint and simulate colour of natural iris. It is a time consuming
and technique sensitive procedure but if followed diligently excellent aesthetic
results can be achieved. The third technique of acquiring iris from stock eye
is simple straightforward method to fabricate custom ocular prosthesis in
limited time period while still achieving good results.

CONCLUSION

 An accurate iris reproduction is fundamental
for the best aesthetic results in patients with an ocular defect. Custom-made
ocular prosthesis gives better aesthetic and functional in comparison to stock
prosthesis. To prevent potential problems that may come with long-term use of
the custom-made prosthesis, further follow-up is necessary to check the
condition and fit of the ocular prosthesis.

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