Eye prosthetics by Medi-Vega - high quality eye prostheses, traditionally produced

Summary Ecto-prosthetics

Ladies and gentlemen,

I address the following presentation to you in order to introduce a craft that is rare but extremely useful and important for the mental and physical survival of many people the individual eye or facial prosthesis. All over the world, the number of eye prosthetists is 300 (three hundred).
The eye inocliation, no matter if it is a consequence of a trauma or of a cancer disease, is the fastest form of impairment that causes a severe psychological trauma to any person, and then an urgent restoration of tissues is necessary, with maximum closeness to the natural ones. The production of eye prosthesis is ten times more elaborate than the production of all other kinds of ecto-prostheses put together. The eye prosthesis is a volumetric body orientated in an unknown, closed, unique space, consistent with parts of the muscles preserved by the surgeon and in parameters (sagital, frontal, transversal and axial as location and color of the sclera). In this sclera, another three-dimensional body is mounted an iris. Six parameters are taken into consideration - sagital, frontal, transversal and axial, and the angle of the iris surface is conformed to the angle of the surface of the healthy iris, as well as its color. All this construction should be maximally symmetrical and it should imitate the closest possible features of the healthy eye.

The implementation of modern technologies and new materials increases the quality and the speed of prosthesis, which are vital for the patients and for their adaptation to the impairment and the surrounding environment.

The earliest data of an artificial eye is as old as 4800 years. In 1565, later developments on facial prosthesis are connected to the name of the French surgeon, Ambroise Paret. He described in detail the implementation of artificial eye, ear, nose, cheek, made of gold and silver. Later on, wood, wax and for an eye enamel, were used. In 1879, the introduction of celluloid was described, and in 1926, an artificial nose was attached to an optorator. In the recent years, facial surgery has reached perfection, which allows the restoration not only of anatomical forms, but also a part of their functions.
With maximum implementation of his/her clinical abilities and skills, and using the most up-to-date materials and technologies in facial prosthesis, the prosthetist must achieve:
1. Restoration of the aesthetical appearance of the face to an extent enough for the social integration of the impaired person.
2. Preservation and recovery to an optimal extent of biological and social functions of the facial and jaw area.
3. Diminishment of the psychological trauma of the impaired person, build up of a positive attitude to the facial prosthesis, as a chance to come back to the society.

The localization and volume of facial impairments determine some special features of the clinical and laboratory technology, and from their point of view the impairments could be systematized in the following groups:
1. Eye impairments lack only of an eye-ball, with preserved orbital cavity, or lack of an eye-ball as well as a part of its surrounding soft and hard tissues.
2. Nose impairments lack of the outer nose, with preserved upper jaw, and lack of the outer nose with a part of or the whole upper jaw bone and the soft tissues that cover it.
3. A combination of the listed impairments.
4. Lack of an external ear, with existing or missing hearing opening.
Although the eye is a double organ, and the healthy eye takes up a part of the functions of the missing one, the lack of an eye-ball has a very strong negative physiological impact on the patient (the same applies of the other impairments, but this one is the hardest to conceal, and it requires maximum precision):
- Accretions of soft tissues, turning of eyelids with the lashes down, which causes increased irritation and infection of soft tissues, penetration of foreign bodies and their direct contact with the operative area, which causes increased irritation and infection.
- Constant change of humidity and temperature of the operative area, which are influenced by outer factors.
- Changes in the symmetry of skull bones (especially of young people), leading in severe cases to changes in the brain functions.

During the last years, the standard eye prosthetics died out with its faults:
1. Unsuitable forms, heavier weight and bigger volume, causing atrophy of mussels, drooping of the eyelid, accretions, rotation and falling of the prosthesis.
2. Approximate colors of the sclera and the iris.
3. Low exploitation parameters fragility and one-year period of use, after which the prosthesis had to be replaced with a new one the reason was the precipitation of salt on the surface layer of the glass prosthesis.
4. Impossibility of form and color correction.
5. Impossibility of exact orientation of the artificial eye-ball.
6. Impossibility to envelop exactly the muscle groups preserved during the surgical intervention.
The method of individual eye prosthetics, combined with the new technologies for processing and coloration, has removed these faults. The opportunity to correct forms, colors, volumes and orientation gives optimal results in facial prosthetics. In case of preservation of tissue and muscle mass, almost 90 % identity with the healthy eye (color, volume, mobility) is achieved. Exploitation parameters are non-breakable prostheses of polymethylmetacril, with 5-year guarantee with refreshment once a year for the period the silicon and combined ones do not even need refreshment.
Individual eye prosthetics makes it possible to create prostheses of a completely healthy eye (for purposes of theatre, cinema, in order to create real and convincing images of vampires, ghosts, aliens, etc.), up to complete inocliation with removal of soft and hard tissues.
Individual eye prostheses are divided in several groups:
1. Common prostheses in cases of inocliation on the eye-ball.
2. Cosmetic flakes when the eye-ball is completely or partially preserved adaptation by an individual plan.
3. Surgical prostheses a series of prostheses is produced. The first one is surgically implanted, so that a bed is formed (fornix). Then, several prostheses are produced until the whole prostheses field is enveloped. The number and the adaptation are individual, and they are clinically determined by the intervention team.
4. Kerato-prostheses in cases of severe burns of the cornea and preserved eye-ball and physiological functions. It is made of titanium, human nail or Teflon, about 1 cm in diameter, extremely thin, in the form of a snow crystal, trefoil (middle 3 mm in diameter), adjustable optical system of plexiglass), clinically implanted.
5. Implants hard or elastic, round or oval, different sizes. They are implanted clinically by a doctor specialist, in order to increase with about 10% the mobility of the prosthesis. The skill of the surgeon to choose an implant of a suitable size, leaving enough room for the eye prosthesis, is extremely important for the final effect of the prosthesis.

NOTE: In cases with small children, the production of a series of prostheses is needed, parallel to the development of the child, in order to support the symmetrical growth of the soft and hard tissues of the skull.
Monitoring and control of the prosthesis field are done in parallel:
1. Clinical, by the specialist who performed the intervention before the relevant facial prosthesis was created, and in a period of time determined by him/her or the monitoring doctor.
2. Laboratory: obligatory according to the individual plan created by the prosthetist.
The appearance and implementation of contemporary materials has increased repeatedly the accuracy and the effect of facial prostheses. Their fixture, when a part of the soft tissues is missing, is strictly individual: biologically tolerable (theatrical clues, eyeglasses rims, crampons, magnetic suspensory mechanisms, and other special bearing constructions). The method and construction of the facial prosthesis is determined by the medical team, according to the specifics of the operative area. The production of a facial prosthesis in every separate case is an elaborate and difficult process characterized by an individual approach for the diminishment of the psychological trauma of the impaired person, the build-up of a positive attitude to the facial prosthesis, as an opportunity for him/her to come back and adapt into society. In order to improve the effect of such an attitude, several factors are very significant: the cosmetic result of the prosthesis, the attitude of the treatment team, the behavior of the impaired persons friends and family, as well as his/her communication with patients who have received prosthesis years ago. The achievement of an optimum result requires acquaintance with the patients psychical and emotional condition through communication with him/her, and a profound study of anatomical and patho-morphological characteristics of every single case.

Sincerely yours:
Emil Lyubomirov Balkansky