RESUMEN
PURPOSE: To develop a standardized and universally reproducible grading scale for artistic outcome of a custom ocular prosthesis. METHODS: A retrospective review of photographs of patients with custom ocular prosthesis. From the ocularistry database of a tertiary eye care hospital, photographs of patients with custom ocular prosthesis (30 random photos with additional 18 repetitions, total n = 50) were selected. Two independent oculoplastic surgeons, on the basis of characteristics of limbus, vascularity, and pigmentation, graded these photos. The photos were adjusted for confounders like magnification and illumination, and both graders used the same display system. The surgeons were blinded to each other. The characteristics were graded on a scale of 0 to 2 and total score was calculated for each photo. Inter-observer and intra-observer agreement was calculated using the kappa statistic. RESULTS: The inter-observer kappa coefficient for the three characteristics (95% confidence interval) were as follows: limbus 0.7 (0.55-0.85), vascularity 0.76 (0.58-0.94), and pigmentation 0.6 (0.34-0.85). The intra-observer kappa coefficient for the first surgeon was as follows: limbus 0.88 (0.7-0.95), vascularity 0.88 (0.73-0.95), and pigmentation 0.82 (0.54-0.93). The intra-observer kappa coefficient for the second surgeon was as follows: limbus 0.8 (0.44-0.93), vascularity 0.55 (0.13-0.8), and pigmentation 0.76 (0.6-0.84). CONCLUSIONS: A good intra- and inter-observer agreement was demonstrated. In view of no existing grading for prosthesis, this is a unique system to objectively grade the outcome of custom ocular prosthesis and can be incorporated in ocularistry teaching modules for standardization of outcomes.
Asunto(s)
Ojo Artificial/clasificación , Ojo Artificial/normas , Oftalmopatías/cirugía , Enucleación del Ojo , Evisceración del Ojo , Humanos , Variaciones Dependientes del Observador , Implantes Orbitales , Fotograbar , Ajuste de Prótesis , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
Several ocular and orbital disorders require surgical intervention that may result in ocular defects. Immediate intervention is required to preserve the anophthalmic socket size and prevent scar tissue contractures that may follow surgery. Unfortunately, immediate fitting of an anophthalmic socket with an artificial eye may not always be possible, and a delayed prosthesis delivery may result in settling and sinking of the prosthesis into the socket, therefore requiring orbital cavity conformation. This article presents a short review of the most commonly used techniques for processing an ocular prosthesis, while suggesting a practical transition to the application of some of them. A technique for fabricating a custom-made provisional ocular prosthesis using digital imaging technology is described. This technique may be considered in order to avoid costly procedures that might be required as a result of delayed artificial eye insertion. The technique described in this article provides a cost-effective choice for optimal orbital cavity conformation and serves as a diagnostic aid for predicting the patient's compliance to ocular prosthetic treatment. The esthetic advantages and the relative ease of fabrication of this interim prosthesis allow it to be considered a first step in the management of untreated anophthalmic sockets.
Asunto(s)
Ojo Artificial , Diseño de Prótesis , Resinas Acrílicas , Ojo Artificial/clasificación , Humanos , Órbita/cirugía , Implantes Orbitales/clasificación , Fotograbar , Polivinilos , Coloración de Prótesis , Diseño de Prótesis/instrumentación , Diseño de Prótesis/métodos , Ajuste de Prótesis , Siloxanos , Propiedades de SuperficieRESUMEN
We propose a new approach to the quantitative determination of the iris colour through the spectroradiometric measurement of a set of 72 artificial irises under controlled illumination and geometry. The spread of these samples in the CIELAB colour space indicates no clearly distinguished groups within the set analysed. Colour measurements for different points of these irises and for the overall irises (pupil and specular image of the light source included) are well correlated. Complementary colour measurements were also performed for the irises of 25 ocular prostheses and 40 real observers. All these colour measurements appear to be quite consistent, the average standard deviation of any of the three a*, b*, L* co-ordinates being lower than 1.0 units. In a visual experiment where 11 normal observers matched the 25 ocular prostheses using the 72 artificial irises, the results indicate that a simple criterion based on the lowest colour-difference agreed with the observers' judgements in only 18% of the cases. This result suggests that, although colour appears to be a major parameter in the overall characterization of the human iris, additional factors such as patterns or textures should also be considered.