This document discusses anophthalmic sockets, which are orbits that do not contain an eyeball but do contain orbital soft tissues. The most common cause of an anophthalmic socket is enucleation. It describes congenital and acquired causes, as well as the ideal characteristics of an anophthalmic socket. Key points include the use of orbital implants to replace volume after removal of the eye, rehabilitation with conformers and prosthetics, and complications that can arise like exposure or extrusion of implants. Treatment options for various complications are also outlined.
Update knowledge about Muntifocal IOL made by Asaduzzaman
Working as Associate Optometrist in Ispahani Islamia Eye Institute &Hospita, Dhaka 1215
Email:asad.optom92@yaho. com
Update knowledge about Muntifocal IOL made by Asaduzzaman
Working as Associate Optometrist in Ispahani Islamia Eye Institute &Hospita, Dhaka 1215
Email:asad.optom92@yaho. com
This presentation talks about the anatomy of facial nerve and the facial nerve palsy. Few diagrams and tables have been taken from Neligan's textbook of Plastic Surgery.
A brief presentation about the maxillofacial extra-oral defects, and the prosthesis used for the rehabilitation, as well as steps of fabrication.
Hossam Faisal - TA of Prosthodontics, Future University Egypt
Dr. Abhishek Gaur
BDS, MDS
Some of the slides may appear Blank/White/Black, those are the Videos that I added in the presentation.
Kindly Ignore those slides.
Goals of anophthalmic socket surgery are-
-Maximizing orbital implant volume with good centration within the orbit
- Achieving optimal eyelid contour, volume, and tone
- Establishing a socket lining with deep fornices to retain the prosthesis
- Transmitting motility from the implant to the overlying prosthesis
- Achieving comfort and symmetry
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
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The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
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The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
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http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
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This will be used as part of your Personal Professional Portfolio once graded.
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Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
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3. ANOPHTHALMOS
• Absence of the globe and ocular tissues from the
orbit.
ANOPHTHALMIC SOCKET
• orbit not containing an eye ball, but with orbital
soft tissues.
• Most common cause:enucleation
• CAUSES
• acquired
• congenital
4. CONGENITAL ANOPHTHALOMS
• rare (0.2–0.6 /10k births )
• Idiopathic/sporadic /AD,AR,X linked.
• Trisomy /Maternal infections,teratogens/syndromes
• optic vesicle fails to develop .
• ORBITAL FINDINGS –
• Small orbital rim,bony orbital cavity
• Small and mal developed optic foramen
• EOM ,Lacrimal gland –ve
5. EYELID FINDINGS –
• Foreshortening of the lids in all directions
• Absent/decreased levator function & poor lid folds
• Contraction of orbicularis oculi muscle
• Shallow conjunctival fornix, especially inferiorly.
ACQUIRED ANOPHTHALMOS
• After enuceation/evisceration/exenteration
6.
7. IDEAL ANOPHTHALMIC SOCKET
1.A centrally placed,well-covered,buried bio-inert
orbital implant of adequate volume.
2. A socket lined with healthy conjunctiva,fornices
deep enough to retain and move an artificial eye
3. Eyelids with n/l position,appearance and tone to
support a prosthesis,n/l lashes & lid margin.
4. supratarsal eyelid fold symmetric with c/l eyelid
5. Good motility from implantprosthesis
6. A comfortable ocular prosthesis that looks similar
to the sighted with c/l globe in the same horizontal
plane
8. REHABILITATION OF ANOPHTHALMIC
SOCKET
• orbital implant :along with evisceration /enucleation
• conformer :until placement of prosthesis
• ocular prosthesis :6 to 8 wks after.
IMPLANTS
• Nonintegrated – PMMA, Silicone
• Semi-integrated – Allen,Iowa
• Integrated - Cutler
• Biointegrated – Porous implant(HA,porousPMMA,Alo)
• Biogenic – Dermis Fat Graft,
cancellous bone
9. HOW TO PLACE AN IMPLANT
• Remove the eyeHemostasis is achieved .
• select an implant by measuring globe volume or axial
length of the c/l eye.
• cover the implant with wrapping material Insert orbital
implant.
• Attach the muscle to implant after create fenestrations in
wrapping material
• Draw Tenon’s fascia over implant
• Close Tenon’s facia in 1//2 layersconjunctiva
• Insert temporary ocular conformer prosthesis after 4–8
weeks .
• After implant vascularization(Technetium bone/
gadolinium-MRI) an optional secondary procedure can be
done to place a couple peg after 6 months .
11. IMPLANT SIZE
• Replace 70 – 80 % of globe volume
• Measure AL of eye after enucleation (-2mm)
• Measure Axial length of C/L eye by A scan(-1mm)
• Deduct addnl 2 mm from AL if implant is wrapped.
• Infants 16-18mm
• Older children 18-20mm
• Adults 20-22 mm
• WRAPPING
• a protective barrier against extrusion
• Enable attachment of muscles in non- integrated implants
• Homologous – sclera, fascia lata
• Autogenous – fascia lata, rectus abdominis sheath, p auricular muscle
• Heterologous – bovine pericardium
• Synthetic - vicryl mesh, e-PTFE
IMPLANT SIZE PBLMS
• Smaller – displace, migrate, sup sulcus deformity
• Larger – wound gape, implant exposure
12. DERMIS FAT GRAFT
• Primary –young patients,conjunctival scarring
• Secondary- exposure or extrusion of the implant
• Adv :Volume replacement with additional lining to
the socket
• Disadv - fat atrophy,hair growth
• C/I : Compromised vascularity
13. PROSTHESIS
• STOCK SHELL.
Prefabricated
readily available iwith diff corneal & sclera colours .
Not according to socket size
• SCLERAL SHELL
It is a thin shell with transparent sclera & coloured
cornea
• CUSTOM MADE SHELLS:
fabricated for each patient according to socket size
Its a high quality PMMA material.
Hand painted and fits snugly into the socket .
modifications possible
14.
15.
16.
17. CONGENITAL ANOPHTHALMOS :
• Tissue expansion is required to stimulate growth of
bony orbit to decrease midface asymmetry
• Various surgical options include:
• Insertion of conformers non expanding orbital
implants & have to be changed few times in order
to expand the palpebral fissure and bony orbit until
a suitable prosthesis can be retained.
• Inflatable balloon expanders regularly filled with
saline solution.
• Expandable hemispherical and spherical hydrogel
expanders .
• 3D osteotomies for small bony sockets
18. IMPLANTS &SOCKET EXPANDERS
1 hemispherical socket expander(0.4-2ml)
• sutured on the conjunctiva to expand palpebral fissure.
• diameters of 6, 8 ,9 mm (dry )11, 14 ,18mm (fully hydrated in 30 days).
2 spherical orbital expanders(1-5ml)
• if socket is adequate to fit a prosthesis kept for orbital expansion
• surgically placed in the deep orbital cavity and the overlying tissue covered
in two layers.
• various sizes .
• Correction of the superior sulcus deformity & Stimulates facial growth
3 Pin SETE’s (0.24ml)
• Residual enophthalmos/microphthalmos
spherical acrylic implants of increasing size.
• < 5 yrs-dermis-fat graft or orbital tissue expander.
• A large fixed-sized orbital implant > 5 years of age.
• Examine the child every monthly
21. EVALUATION OF ANOPHTHALMIC SOCKET
GOALS
• replace orbital volume, maximize motility and
provide the most comfortable and aesthetically
symmetric appearance.
• understand the changes :orbital fat atrophy and low
orbital circulation & tear production,discharge +ve .
• orbital implant placement complications & its
management .
• children:Enucleation/eviscerationdevelopment
of bony orbit,⁰ midfacial asymmetry
22. HISTORY
• Does the patient have pain with the prosthetic in?
• Does the prosthesis fall out?
• Is there discharge or bleeding from the socket?
• How old is the current prosthetic and when was the
last time it was polished?
• Does the patient have polycarbonate glasses to
protect the seeing eye?
• Is the patient happy with the cosmesis and
movement of the prosthetic?
23. COMPLICATIONS:ANOPHTHALMIC SOCKET
• post-enucleation socket syndrome (PESS)
Clinical features :
• Enophthalmos & upper eyelid sulcus deformity
• Ptosis or eyelid retraction
• Laxity of the lower eyelidshelved inferior fornix
• Implant extrusion / exposure.
• Contraction of socket and associated abn/l.
• Migration of implant
• A backward tilt of the ocular prosthesis
24. TREATMENT OF COMPLICATIONS
ENOPHTHALMOS & SUPERIOR TARSAL SULCUS DEFORMITY
CAUSES : poor orbital volume
:inadequate volume replacement at the time of sx
:due to atrophy of fat & inferior migration of implant.
Enophthalmos :
• if no implant :placement of a 2⁰ implant.
• non-surgical fix, placing a +2 D sphere or higher i/l magnify the
eye socket enophthalmos less noticeable
• if primary implant + : fat grafting & autologous/non autologous
floor implants
• Associated surface contracture :Dermis fat graft (DFG) .
Superior sulcus deformity
• loss of orbital volume + traction of fascial attachments of SR to
levator complex and sagging of lower eyelid.
• implantation of fascia lata / sclera / bone / fat/ alloplastic material
in upper eyelid.
25.
26.
27. ANOPHTHALMIC PTOSIS:
• drooping eyelid.
Results from
•Inadequate implant size & Supero temporal migration of implant .
• Poorly fit prosthesis
• Cicatricial tissue in upper fornix.
• Damage to levator or its nerve by orbital injury/sx/Senile dehiscence
• secondary to enophthalmos or volume deficiency.
• Lower lid laxity
• Frequent manipulation to insert and remove the artificial eye stretches the
upper eyelid .
Management:
• Mild ptosis
– Prosthesis modification
− correction of socket volume deficiency prior to ptosis surgery
– Fasanella servat
• Moderate ptosis
– Levator tightening
– Frontalis suspension – less satisfactory
28.
29. ANOPHTHALMIC ECTROPION:
Results from
-poor prosthesis or lower lid laxity.
Managed by:
- if the prosthesis is >5 years old, replace a new one.
- less bulky thinner/lighter prosthesis corrects eyelid
malposition
- Lower lid tightening at lateral/medial canthal tendon depending
on laxity.
- Correction of eyelid retraction by recession of IR/grafting of mucus
membrane tissue in inferior fornix
LASH MARGIN ENTROPION:
• due to contracture of fornices/cicatricial tissue near lash margin.
Managed by:
– Tarsal rotation procedure (Weis)
– Marginal mucous membrane graft
30. LAX SOCKET OR INFERIOR FORNIX SHELVING
• Results from
• shifting of tissues within the orbit (involutional
relaxation of the supporting tissues of the inferior
eyelid).
• weight and pressure effect of the prosthesis
inability to retain the prosthesis.
Management
• Horizontal lid laxity :eyelid tightening by Lateral
tarsal strip procedure +/- fornix formation sutures
to increase the depth of inferior fornix.
• fornix shelving ( - ) lid laxity, fornix formation
sutures by either closed method or with open
method
34. IMPLANT EXTRUSION/ EXPOSURE
• early post operative period :inadequate surgical closure or
infection.
• Late exposures : fibrous contraction/pressure atrophy of
tissues overlying the implant as closing the wound under
tension
• mechanical or inflammatory irritation from the speculated
surface of the porous implant
• Delayed ingrowth of fibrovascular tissuetissue
breakdown
• Porous orbital implants have a lower incidence.
• Preventive measures :
• proper placement 2 layered Tenon’s capsule &
conjunctival closure.
• The rectus muscles attached to the wrapped implant
35. MANAGEMENT
• if few weeks:
• small exposure: conservative treatment /close the defect
with graft.
• large exposures /frank extrusion:implant removal &
replacement.
• In a clean socket :in single stage, replace the extruded
implant with smaller implant close tissues in layers.
• If infection is suspected treat vigorously with topical and
systemic antibiotics, avoid extrusion and removal of the
implant .
• in infected socket :remove the implant wait for the
infection to settle 2 ⁰ implant later by Careful dissection
of tissues & good haemostasis
36.
37. • patch grafting :in conjunctival shortening
:fascia lata /sclera to cover defect.
:Tenons and conjunctiva is anchored to
A graft surface in layers.
:mobilise conjunctiva to cover the patch
for graft viability.
:sandwitch a scleral graft between
tenons & conjunctiva to decrease scleral melt
38. ORBITAL PAIN IN THE ANOPHTHALMIC SOCKET
• prosthetic irritation or migration/ extrusion of the implant to
depression
• lacrimal insufficiency,
• inflammation (scleritis, sympathetic ophthalmia,7 and GPC)
• recurrent tumors.
• Amputation neuromas (pain with movement)
• Brain and sinus diseases(referred socket pain )
• Reflex sympathetic dystrophy(burning socket pain associated
with facial trauma/infection/tumor)
• Psychogenic factors(drug-seeking behavior)diagnoses of
exclusion
• management
• referral to ocularist 4 assessment,prosthetic modification
/polishing.
• If the etiology is not clear/persists after prosthetic polishing
and lubrication:needs CT scan to aid in diagnosis
39. CONTRACTED SOCKET
• A socket unable to retain a prosthesis is called Contracted socket.
• Causes for Contracted Socket
• congenital /acquired
• Etiology related ・Alkali burns
・Radiation therapy
• Surgery related
• Fibrosis from the initial injury
• Poor surgical techniques during previous sx
• Excessive sacrifice of conjunctiva and tenons capsule
• Traumatic dissection within the socketscar
• Multiple socket operations
• Site related
• Poor vascular supply
• Severe ischemic ocular disease in the past
• Cicatrizing conjunctival diseases
• Chronic inflammation and infection
• implant and prosthesis related
• Implant migration
• Implant exposure
• Not wearing a conformer/prosthesis • Ill fitting prosthesis
45. GRADING: CONTRACTED SOCKET
• Four categories
• Grade 1-Minimal /no actual contraction
Inability to retain the prosthesis for a long time
Large implant/anteriorly placed implant
• Grade 2 -Mild contracture of upper and/or lower fornix
• Grade 3- Advanced scarring of both upper and lower fornices
• Grade 4 -Severe palpebral phimosis both vertically and horizontally
46.
47. • Mild socket contraction:
• shortening of the inferior fornix :Prosthesis is still retained.
• Moderate socket contraction:
• Inferior & superior both fornices are shortened.
• Signs & symptoms
• Inability to retain prosthesis
• Poor motility of prosthesis
• Non-closure of eye
• Loss of normal lid fold
• Persistent discharge and irritation
• Enophthalmos with posteriorly displaced prosthesis if
volume loss +
• Severe socket contracture
50. Severe socket contracture:
• Mucosa is often inadequate .
• Split thickness skin grafts alone or combined with buccal
mucosa.
severe / recurrent scarring contracted sockets
• flaps with intact vascular supply such as radial artery forearm
flap with minimal risk of loss of viability of the forearm.
• Temporalis fascia flaps
• Temporalis muscle transfer
• Orbital osteotomies
• orbital /spectacle prosthesis is the only option.
Conformer is placed at the end and replaced by artificial
eye later.
• Localized symblepharon & fibrous bands :Z-plasty or V-
y plasty.
51.
52.
53.
54. MAINTENANCE OF OCULAR PROSTHESIS
• Wash hands before handling the prosthesis
• Cleaning can be done once in a month
• Use light soap/Johnsons baby shampoo for cleaning
• Eye lubricants can be used to smoothen lid
movements and ensure closure of lids.
• Polishing must be done once a year.