A Palliative Approach for Rehabilitation of a Pediatric Patient with Retinoblastoma
A 5-year-old female patient reported to the department of prosthodontics with the complaint of unaesthetic facial appearance due to absence of left eye []. Her parents gave history of retinoblastoma which was diagnosed at the age of 2 years, for which enucleation was done at 2.5 years of age. Patient also received chemotherapy and radiotherapy for treatment of her malignancy. At the age of 3 years, a stock artificial eye was placed in the patient's eye but, due to pain and irritation caused by artificial eye, patient used to remove the prosthesis and showed extreme resistance to wearing of the prosthesis.\nPatient's past experience with prosthesis precluded the use of stock ocular prosthesis. After careful examination of the area of the defect and treatment planning, it was planned to fabricate a custom ocular prosthesis for the patient. The procedure, including its maintenance and limitations, was explained to the patient/guardian to gain their co-operation. Patient/guardian consent was taken for making photographic records.\nThe procedure was initiated by the first making the impression of the socket with a thin mix of ophthalmic alginate (Opthalmic moldite, Milton Roy Company, Sarasota, FL, USA), then making a two-piece dental stone (Kalabhai Karson Pvt. Ltd., Mumbai, India) cast from the impression by double pour technique []. The wax pattern was formed on the cast using carving wax mixed with sticky wax, and tried in the patient's eye and checked for accuracy in the terms of retention, proper extension in all directions, scleral contour and convexity and finally positioning the iris, matching in size and color of contralateral eye, obtained from stock eye. The final wax pattern with iris button was evaluated in the patient's socket and modified accordingly [].\nAfter making necessary modifications, the wax pattern was invested, flasked, and de-waxing was done []. The next step was to reproduce scleral shade of the normal eye. For this, shade tabs were prepared by mixing and matching different shades and proportions of tooth-colored acrylic (SC 10, Pyrax, Roorkee, India) till the color of sclera of the other eye was replicated. To simulate the veins of the normal eye, veins were separated from the veined heat-cured poly-methyl methacrylate (PMMA; Trevalon, Dentsply India Pvt. Ltd., Gurgaon, India) and they were incorporated in the dough of the determined acrylic shade, followed by routine curing, finishing, and polishing. Finally, a thin film of the sclera was removed and replaced by a clear film of transparent heat-cured PMMAe resin (Trevalon, Dentsply India Pvt. Ltd.) to simulate corneal translucency.\nAfter processing, the properly finished and polished prosthesis was inserted in the socket [] after being disinfected with 0.5% chlorhexidine and 70% isopropyl alcohol for 5 min and lubricated with an ophthalmic lubricant (Ecotears, Intas Pharmaceuticals Limited, Ahmedabad, India) to maintain a tear film over the prosthesis and to improve eye movements. Minor adjustments were made at the time of delivery as per the patient's comfort and esthetics. Instructions were given to the patient regarding proper care and handling of the prosthesis as well as the maintenance of socket hygiene and the need for regular recall appointments was emphasized. As in the early childhood, orbital volume increases in a linear fashion,[] and a change of prosthesis is required between 18 and 26 months following prosthesis placement in children.[] So, the patient was recalled every 6 months for follow-up.\nIn the follow-up period of 6 months, the patient was able to wear a cosmetically acceptable ocular prosthesis without any discomfort. So, the patient was successfully rehabilitated by custom ocular prosthesis.