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   Table of Contents      
Year : 1979  |  Volume : 27  |  Issue : 1  |  Page : 49-52

Ring prosthesis

A.M.U. Institute of Ophthalmology, Aligarh, India

Correspondence Address:
K Nath
A.M.U. Institute of Ophthalmology, Aligarh
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Source of Support: None, Conflict of Interest: None

PMID: 500183

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How to cite this article:
Nath K, Gogi R, Zaidi N. Ring prosthesis. Indian J Ophthalmol 1979;27:49-52

How to cite this URL:
Nath K, Gogi R, Zaidi N. Ring prosthesis. Indian J Ophthalmol [serial online] 1979 [cited 2021 Mar 9];27:49-52. Available from: https://www.ijo.in/text.asp?1979/27/1/49/31549

It is generally advocated that in cases of burns one should pass a glass rod in both the fornices twice daily along with plenty of ointment in order to prevent the collapse of the fornices, and subsequent adhesions.

Besides, when one performs any surgery in the fornices and canthi there is every danger of formation of flattened bands running centrally across. These are sometimes very ugly and the patient complains[8] of the bad cosmetic effect. In such cases, part of the fornix can become shallow, while the canthi may disappear.

To prevent the cornea from exposure, it is also advocated that a contact lens be put in. Our past experience has shown that it is extremely difficult to introduce and take out the lens in some cases and that it is all the more difficult to protect the cornea in such cases, as the toxic metabolic products accu­mulate under the contact lens which keep on damaging the corneal epithelium leading to its coagulation necrosis, infection and sloughing of the cornea. Due to the damage to the substance of the cornea it starts bulging even under the normal intraocular pressure, forming a descemetocele and finally it may melt away.

Cooper[2] was the first to describe scleral contact lens for the prevention and treatment of symblepharons and pterygia. These lenses were used as a splint for holding mucus membrane graft and to prevent their contraction.

Later on various other devices were used for this purpose such as, malliable silver bar Knapp[7], acrylic conformers Illig[6], Callahan[1], Hartman[4], Stallard[13], Mustarde[9], Walsar[14], Roper-Hall and Davidson[11], Kumar & Goel[8], paraffinized cardboard Weiner and Alvis[15], glass rod Spaeth[12], semilunar celluloid conformers Haitz[5], and flush fitting contact shells Ridley[10], and Gould[3].

We have already tried the glass rod and contact lens protection and concluded that both the techniques are hazardous and therefore we tried ring prosthesis in fourteen cases of different fornix pathology, which gave more satisfactory results as compared to the other techniques. Our observations and results have been reported in fourteen such cases.

  Material and Methods Top

Ring prosthesis, is a haptic contact lens, made of methyl acrylate. It has a central hole, 2 to 3mm. larger than the corneal diameter. Its shape and size can be varied according to the needs of the patient [Figure - 1].

In the present study, fourteen cases of different for­nix pathologies were studied. It included cases of dermolipoma of the orbit at lateral canthus (3 cases), symblepharon (4 cases), which included two cases of lime burns, combined conjunctival and orbital haeman­gioma (1 case), ectopic lacrimal gland (1 case), amy­loidosis of palpebral and bulbar conjunctiva (1 case), conjunctival neurofibroma (1 case) squamous cell carcinoma (1 case) and 2 cases of socket reconstruction.

In all these cases following excision of the symblepharon or the tumour, ring conformers of appropriate sizes, depending upon the size of the fornix to be re­constituted was inserted. Postoperatively daily dressing was done by antibiotic drops and the condition of the cornea was watched. The conformer was removed for cleaning twice a week. It was taken off 4 to 6 weeks after the operation depending upon the duration of healing and probability of contractures.

  Results and Comments Top

Out of the 14 cases treated by this method & 12 cases showed satisfactory results. [Figure - 2],[Figure - 3],[Figure - 4],[Figure - 5],[Figure - 6]. The first two cases both of symblepharon following lime burn, developed peripheral corneal ulcers, because the inner corneal ring had sharp margins. Therefore spe­cial care was taken to get the margins of inner ring rounded and to increase the size of ring by 2 to 3mm. than the corneal diameter. Following these alterations we did not have further complications. We have notic­ed the following advantages.

  1. Contact between the epithelial surfaces of the conjunctiva is constantly prevented.
  2. It does not rub against the cornea.
  3. Discharge and other metabolic products are not retained over the cornea.
  4. Cornea remains easily accessible for the exami­nation.
  5. Size of the peripheral ring can always be reshap­ed and changed.
  6. The edges can go right into the fornices and its post-operative shape can be maintained.
  7. The same prosthesis can be used in cases of contracted sockets, thus avoiding retention of the secre­tions under the prosthesis.
  8. It can be left for longer periods as compared to the contact lens.

In conclusion we wish to add that the ring pros­thesis is a very easy and practical way of preventing adhesions of the conjunctiva and to reshape the fornices in various types of surgery.

  Summary Top

The use of "Ring Prosthesis" in the preven­tion and treatment of symblepharons due to various causes has been advocated. The results in fourteen cases is described.

  Acknowledgement Top

Our thanks are due to Mr. Devendra Kumar of Premier Contact Lens Centre, Aligarh, for supplying us the prostheses.

  References Top

Callahan, A., 1950, Surgery of the Eye, (Injury) 11, 12, Charles C. Thomas. Springfield, First ed.  Back to cited text no. 1
Cooper, W.W., 1859, Quoted by Duke Elder (1972) System of Ophthalmology, 14 Part 2, 1049, Henry Kimpton, London.  Back to cited text no. 2
Gould, H.L., 1967, Proceedings of the II International Symposium of Plastic and Recons­tructive Surgery of the Eye and Adnexa, 420, Edited by Smith B. and Converse, J.M.C.V. Mosby Co. Saint Louis.  Back to cited text no. 3
Hartman, D.C., 1964, Ophthalmic Plastic Surgery, ed. W. L. Hughes et al A.A. of Ophth. & Otolary. p. 210, Rochester. 2nd ed.  Back to cited text no. 4
Haitz quoted by Meller, J., 1963, Ophthalmic Surgery, 102, Blackiston Co. New York, 6th ed.  Back to cited text no. 5
Illig, H., 1917, Quoted by Arruga, H., 1962, Ocular Surgery, 312, McGraw Hill Book Co., New York. 4th ed.  Back to cited text no. 6
Knapp, P., 1908, Klin. Monatsbl f. Augenta., 46, 317.  Back to cited text no. 7
Kumar, D. & Goel, B.S., 1974 Contact lens Practical, 45, Kothari Book Depot, 1st ed., Bombay.  Back to cited text no. 8
Mustarde, J.C., 1966, Repair and Reconstruction in the Orbital region, 94, E. & S. Livingstone Ltd. Edinburg.  Back to cited text no. 9
Ridley, F., 1963, Arch. Ophthal., 70, 740.  Back to cited text no. 10
Roper-Hall, M.J. and Davidson, S.I., 1972, Modern Ophthalmology, Ed Sorsby, A. 478, 1165, 1167, 3, 4, Butterworths. London, 2nd ed.  Back to cited text no. 11
Spaeth, E.B., 1948, Principles and practice of Ophthalmology, 315. Lea & Febiger, Philadelphia. 4th ed.  Back to cited text no. 12
Stallard, H.B., 1965, Eye Surgery, 257, John Wright & Sons Ltd., Bristol. 4th ed.  Back to cited text no. 13
Walser, E., 1967, Plastische Chirurgie der Orbita, 99, Walter de Gruyter & Co Berlin.  Back to cited text no. 14
Wiener, M. & Alvis, B.Y., 1939, Surgery of the Eye, W.B. Saunders, Philadelphia.  Back to cited text no. 15


  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10], [Figure - 11], [Figure - 12]


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