# Trends in the management of anophthalmic sockets and external ocular prostheses among oculoplastic surgeons: a web-based study

## TL;DR

This study compares how oculoplastic surgeons in Brazil and Spain manage anophthalmic sockets and ocular prostheses, highlighting differences in implant choices and cleaning practices.

## Contribution

The study identifies country-specific variations in surgical and post-operative management practices for anophthalmic sockets among oculoplastic surgeons.

## Key findings

- Brazilian surgeons prefer polymethyl methacrylate implants, while Spanish surgeons favor porous polyethylene implants.
- Differences in cleaning frequency and recommendations for prostheses removal at night were observed between the two countries.
- The most common reasons for prostheses replacement were edge damage and loss of volume.

## Abstract

This study aimed to evaluate the practices employed by oculoplastic surgeons
in the assessment and management of anophthalmic sockets and external ocular
prostheses.

Oculoplastic surgeons from two countries, who specialized in the management
of anophthalmic sockets, participated in a web-based survey. Data collected
included demographics, types of surgery, implant use, external ocular
prostheses management (including fabrication and cleaning), complications
encountered, and follow-up times. The frequencies and distributions of the
responses were statistically analyzed.

A total of 177 oculoplastic surgeons participated, 113 (63.8%) from Brazil,
the remainder from Spain. Evisceration was the preferred surgical procedure
of 149 (84.2%) surgeons. The most commonly reported indication for
enucleation was a painful blind eye (n=103, 58.1%; both Brazil and Spain,
p<0.001). Brazilian surgeons preferred polymethyl methacrylate implants
(n=65, 57.5%), while Spanish surgeons favored porous polyethylene implants
(n=53, 82.8%; p<0.001). Discharge was the most frequently observed
clinical feature during socket evaluation (n=164, 92.6%; p<0.001).
Brazilian surgeons recommended daily (n=53, 46.9%) or weekly (n=41, 36.2%)
cleaning of exter nal ocular prostheses, while Spanish surgeons more
commonly recommended monthly cleaning (n=31, 48.4%; p<0.001). The
majority of Brazilian surgeons (n=83, 73.4%) advised patients to remove
their external ocular prostheses at night. Only a small number of Spanish
surgeons (n=3, 4.6%) suggested this practice (p<0.001). Overall, the
follow-up recommendations varied, with 70 (39.5%) surgeons recommending
follow-up based on indivi dual case needs, and 59 (33.3%) suggesting annual
visits (p<0.001). The primary indications for external ocular prostheses
replacement were edge damage (n=75, 42.3%) and loss of volume (n=68, 38.4%).
The replacement intervals given typically ranged from 1 to 5 years (n=92,
51.9%; p<0.001).

Oculoplastic surgeons in Brazil and Spain demonstrated similar practices in
the management of anophthalmic sockets. However, notable differences were
observed in the choice of implant materials, cleaning protocols, and
recommendations regarding external ocular prostheses removal during
sleep.