Evolution of contracted socket reconstruction by ocular prosthesis & implants: A systematic review

Abstract

Anophthalmic socket contracture is a condition resulting from scar-induced shortening of the orbital tissues, which leads to a reduced surface area, shallow fornices, and difficulties with prosthesis retention. It often occurs after enucleation or evisceration, particularly without an implant or after significant scarring from irradiation. This article reviews surgical reconstruction techniques for contracted sockets, highlighting the role of ocular implants and prostheses in restoring depth and volume. A literature search focused on clinical studies reporting surgical outcomes revealed that autologous grafts, especially oral mucous membrane and dermis-fat grafts, achieve prosthesis retention rates of 70-90% in moderate cases. Alloplastic implants combined with mucosal grafts show success in severely resorbed sockets by providing volume and stability. Recent composite techniques, like using hard palate mucosa with dermis-fat grafts, have improved one-stage reconstructions for challenging cases. Common surgical challenges include graft shrinkage, necrosis, and socket re-contraction. However, advancements in methods have enhanced patient outcomes. The evolution of reconstruction techniques now integrates autologous grafts and modern implants, emphasizing the importance of adequate socket lining and volume for prosthesis retention. Innovations such as composite autografts and intra-orbital navigation enhance customization and improve success rates, although severe recurrent cases continue to be problematic.