IMPROVEMENT OF SURGICAL MANAGEMENT IN ANOPHTHALMIA

Anophthalmia, resulting from the surgical removal of the eyeball (enucleation or evisceration), remains a serious medical and psychosocial problem worldwide. According to the World Health Organization (WHO) and Vision 2020 initiative, over 55 million people sustain ocular injuries annually, leading to blindness in 1.6 million patients (Foster A., Vision 2020). Despite advances in ophthalmology, enucleation remains one of the most commonly performed ocular surgeries, particularly in cases of trauma, inflammation, and malignancy. In Russia alone, up to 8,000 enucleations are performed annually due to severe trauma (Gundorova R.A. et al., 1994). Anophthalmic patients frequently experience significant psychological distress, functional limitations, and cosmetic disfigurement, which negatively affect their social integration and quality of life. It is reported that 80% of patients with anophthalmia are dissatisfied with their appearance and prosthetic outcomes, leading to reduced self-esteem and avoidance of social interactions (Haralampidi M.P., 2002). A major challenge in the management of anophthalmia is the formation of a stable, functional, and aesthetically acceptable orbital stump capable of supporting a mobile and well-positioned ocular prosthesis. However, modern surgical methods and implant materials still demonstrate limitations, achieving satisfactory results in only 20–25% of cases (Gundorova R.A. et al., 2009). Poor outcomes are often associated with incomplete formation of the motility-supporting complex, restricted prosthesis mobility, eyelid deformities, and socket contracture. Recent studies (Sorokina I.A., 2005; Beraya M.Z., 2006; Lavrentieva N.V., 2013) emphasize the importance of individualized surgical planning based on comprehensive assessment of the orbital stump, as well as the use of biointegrative implants to improve functional and cosmetic results. Moreover, the concept of quality of life has become a critical outcome measure in ophthalmic surgery, encompassing not only physical and visual parameters but also psychological and social well-being (WHO, 1993). This study aimed to improve surgical management in anophthalmia by developing standardized criteria for orbital stump evaluation, refining surgical indications, and conducting a comparative analysis of reconstructive techniques in order to optimize prosthetic outcomes and enhance patients’ quality of life.