Indian Journal of Palliative Care
Open access journal 
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size Users online: 202  
     Home | About | Feedback | Login 
  Current Issue Back Issues Editorial Board Authors and Reviewers How to Subscribe Advertise with us Contact Us Analgesic Prescription  
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (409 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed1832    
    Printed13    
    Emailed0    
    PDF Downloaded80    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents 
LETTER TO EDITOR
Year : 2014  |  Volume : 20  |  Issue : 3  |  Page : 244-245

Esthetic conformers: Improving the quality of life of enucleated children


Department of Prosthodontics, King George's Medical University, Lucknow, Uttar Pradesh, India

Date of Web Publication8-Aug-2014

Correspondence Address:
Himanshi Aggarwal
Department of Prosthodontics, King George's Medical University, Lucknow, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1075.138404

Rights and Permissions



How to cite this article:
Aggarwal H, Kumar P, Singh RD, Baslas V, Grover R. Esthetic conformers: Improving the quality of life of enucleated children. Indian J Palliat Care 2014;20:244-5

How to cite this URL:
Aggarwal H, Kumar P, Singh RD, Baslas V, Grover R. Esthetic conformers: Improving the quality of life of enucleated children. Indian J Palliat Care [serial online] 2014 [cited 2021 Apr 14];20:244-5. Available from: https://www.jpalliativecare.com/text.asp?2014/20/3/244/138404


Sir,

Enucleation in a child, whether for tumors, chronic eye disease, or severe ocular trauma is extremely distressing for families. The commonest indication for enucleation in children is advanced intraocular retinoblastoma, and surgery is usually performed within a few days of diagnosis. In such cases, the distress caused by the diagnosis of such dreadful ailment is compounded by the inadequate time available for the family to prepare themselves for the postoperative appearance, which causes considerable upset to family and siblings. Of particular concern, is the cosmetic appearance of the child in the immediate postoperative period. So, allaying the anxiety of the family members during the postoperative period is of paramount importance.

Presently, most of the surgeons worldwide including India use a transparent conformer or shell postenucleation. The advantage of using transparent conformers is an easy visualization of the wound area by the clinician with minimal manipulation. But practically speaking, the ointments used to facilitate wound healing frequently conceal the wound area, making it impossible to examine the latter without removing the conformer. This transparency, however, can cause embarrassment; some patients consider visualization of the underlying socket unsightly added to which the conformer does not resemble the contralateral eye. [1] This usually forces the patients to get a final prosthesis fitted earlier than is optimal for wound healing.

The various benefits offered by the conformer such as protection of the wound, minimizing the changes in the socket size and conformation, preventing scar tissue contractures from distorting the socket bed [2] and maintaining the forniceal depth; [3] make their use indispensable following post enucleation. A commonsensical solution to overcome the cons of the transparent conformer [Figure 1]a] is the utilization of the so called prosthetic or cosmetic or esthetic conformer, which is a painted conformer with an iris button attached to it in addition to the fenestrations for drainage [Figure 1]b].
Figure 1: (a) Clear conformer. (b) Esthetic conformer with fenestration indicated by arrow

Click here to view


The prosthetic conformers are manufactured as stock prosthetic eyes and cost approximates that of the stock eye. The cost of clear conformers is around Rs. 150 whereas the cost of prosthetic conformers is Rs. 200. However, the various benefits offered by esthetic conformers outweigh its slightly increased cost as compared to clear conformers. As we expect that more and more ophthalmologists and surgeons will demand for esthetic conformers due to its various advantages over clear conformers, their cost will automatically come down due to its indigenous mass production by companies that supply acrylic stock eyes. An appropriately sized and color-matched conformer that will slide in easily, fill the fornices without being tight and allow lid closure can be placed in the socket at the end of surgery and kept for an average of 4-6 weeks. [4] The esthetic conformers decrease the psychological impact of enucleation, yet achieve the goals of an ideal conformer. In addition, the children are more comfortable as it avoids the use of patches and tape on the skin to cover their conformer, and helps the family to wait for an appropriate healing period of 6 weeks before the final prosthetic fitting. The role of the conformer and the cosmetic limitations of relative ptosis, enophthalmos, and slight color mismatch should be explained to the family prior to surgery. [5]

Ours is a tertiary-care centre and is registered as one of the hospital-based registry under national retinoblastoma registry project initiated by Indian Council of Medical Research. So, enucleation is routinely done for advanced retinoblastoma cases and we have found that the acceptance of esthetic conformers is much more as compared to the clear conformers, approximately 90%. The parents of children who had undergone enucleation reported that it was less traumatic for them to accept their child as appearance after enucleation when esthetic conformer was used as compared to clear conformer. As pediatric patient is the centre of attraction for both the medical team and the family, so providing them with an esthetic conformer is a highly positive approach with significant palliative effect, which improves rehabilitation and quality of life of the family and the enucleated child. Therefore, it is a humble appeal to all the concerned medical professionals to use esthetic conformers instead of clear transparent conformers in postoperative period, so as to provide a sigh of relief to the grieving patients.

 
  References Top

1.Avisar I, Norris JH, Quinn S, Allan D, McCalla M, Dugdale D, et al. Temporary cosmetic painted prostheses in anophthalmic surgery: An alternative to early postoperative clear conformers. Eye (Lond) 2011;25:1418-22.  Back to cited text no. 1
    
2.Sykes LM, Essop AR, Veres EM. Use of custom-made conformers in the treatment of ocular defects. J Prosthet Dent 1999;82:362-5.  Back to cited text no. 2
    
3.Custer P, Cook B. The team approach to the anophthalmic patient. Adv Ophthalmic Plast Reconstr Surg 1990;8:55-7.  Back to cited text no. 3
    
4.Vincent AL, Webb MC, Gallie BL, Héon E. Prosthetic conformers: A step towards improved rehabilitation of enucleated children. Clin Experiment Ophthalmol 2002;30:58-9.  Back to cited text no. 4
    
5.Brett J. Creating a treatment plan for enucleation or evisceration surgery. J Ophthalmic Prosthetics 2000;5:45-8.  Back to cited text no. 5
    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
Online since 1st October '05
Published by Wolters Kluwer - Medknow