Expansion Device Helps Prepare Children for Ocular Prosthesis

An orbital tissue expander (OTE) facilitates the normal growth of orbital soft tissue and bone, helping to achieve facial symmetry in congenital anophthalmia and microphthalmia.

The integrated OTE is intended for use in infants with congenital anophthalmia, congenital microphthalmia, and acquired anophthalmia due to early ocular tumors or trauma. The system consists of a flexible combined balloon and expander device held in place by a titanium fixation plate, anchored to the lateral orbital wall by titanium screws. A slotted arm attached to the fixation plate extends through a slot that is formed within the OTE. The OTE is thus self-centered in the expanding orbital socket, maintaining its position as the orbit grows. There are two adjustments that are required periodically: inflation of the globe to stimulate bone growth, and confirmation of self-centering. The infant is carefully followed by the surgeon who decides the adjustment intervals required to facilitate the desired result of facial symmetry. The recommended use for the OTE is one year, but optimal removal time is at the surgeon's discretion.


Benefits of the OTE device are implantation using normal oculoplastic surgical techniques, with no further multiple surgeries required. Multiple fixation areas on the bone plate allow for changing fixation points to adjust to the child's growth pattern. The device can easily be inflated or deflated without surgery, as controlled by the doctor, and can also easily be removed and replaced. Inflation of the device is controlled using a 30-gauge disposable hypodermic needle connected to a 1 cc disposable syringe filled with sterile saline, that is inserted into the OTE through an injection port; the inflation effects pressure on the orbit of the patient, expanding it. The integrated OTE is a product of Innovia (Miami, FL, USA).

Anophthalmia and microphthalmia can occur as a secondary result of arrested development of the eye at various stages of growth of the optic vesicle. Anophthalmia, or anophthalmos, is the congenital absence of one or both eyes. Development of the orbital region, as well as the lids and fornices, is dependent upon the presence of a normal-sized eye in utero.

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