Darbo tikslas – ištirti ir įvertinti anoftalminės akiduobės endoprotezavimo kosmetinio ir funkcinio efekto parametrus ir jų stabilumą intervaliniu dvejų metų stebėjimo laikotarpiu. Darbo uždaviniai 1. Įvertinti ir palyginti endoprotezuotos ir neendoprotezuotos akiduobės poenukleacinio sindromo išraišką ankstyvuoju pooperaciniu laikotarpiu. 2. Įvertinti ir palyginti tirtų ligonių grupių ankstyvojo pooperacinio laikotarpio dirbtinės ir porinės akies statinę simetriją. 3. Nustatyti akiduobės implanto įtaką dirbtinės akies judesiams. 4. Įvertinti ir palyginti abiejų ligonių grupių dirbtinės ir porinės akies dinaminę simetriją ankstyvuoju pooperaciniu laikotarpiu. 5. Įvertinti ir palyginti tirtųjų ligonių grupių kosmetinį ir funkcinį operacijos efektą, praėjus 6 mėn., 12 mėn. ir 24 mėn. po operacijos. 6. Palyginti pooperacinį kosmetinį ir funkcinį efektą, endoprotezavus akiduobę pirminiu ar antriniu būdu bei pašalinus akį skirtingais metodais. 7. Įvertinti operuotų ligonių subjektyvią nuomonę apie kosmetinį akiduobės endoprotezavimo efektą. / The removal of the globe creates anatomic and physiological alterations of orbital tissue and orbital bones. The main problems of anophthalmic socket are its contraction and volume deficit. Because of the latter the so-called postenucleation socket syndrome appears which may be characterized by deep upper lid sulcus, upper lid ptosis enophtalmus of the artificial eye and the lower lid laxity. The average size of the functioning eye is 6-7 cm3. After the removal of an eye it has to be restored. For this purpose the implants are used which are being sewed in the orbit, under the conjunctiva. Attachment of the extraocular muscles to the implant helps to save their function and improves the motility of the artificial eye.The endoimplantation of anophthalmic orbit in Lithuania is not implemented widely enough. Thus, assuming the rapid development of medical technologies it is relevant to evaluate the practical experience of the mentioned treatment method, its close and distal results in order to implement it to clinical practise more widely and successfully as well to improve the life quality of operated people.

Kirurgiskt borttagande av ett öga kan orsakas av trauma eller ögonsjukdom. I Sverige finns det drygt 7000 personer med ögonprotes. Borttagandet av ögat sker genom enukleation, evisceration eller exenteration. Det monokulära seendet inverkar på den visuella funktionen och därmed påverkas vardagliga aktiviteter och arbetsliv. Ögonsjuksköterskans omvårdnad inriktas på att ge stöd för att främja anpassning. Syftet med studien var att beskriva hur personer som bar ögonprotes upplevde sin livskvalitet efter att ha genomgått ett kirurgiskt borttagande av ett öga. Studien genomfördes som en systematisk litteraturstudie som baserades på 13 vetenskapliga artiklar. Artiklarna analyserades med latent innehållsanalys vilket utmynnande i kategorierna fysisk, psykisk och social påverkan samt påverkan på vardagslivet. Resultatet visade att livskvaliteten påverkades av faktorer som den allmänna hälsan, obehag från ögonhålan, utseende, synfunktion, psykiskt välbefinnande, självkänsla, relationer, rollbegränsningar, begränsade fritidsaktiviteter, arbetsförmåga samt tid. För att personer med ögonprotes ska kunna anpassa sig till den nya situationen krävs medvetenhet, bra copingstrategier och engagemang från individen. Denna studie ger ögonsjuksköterskor insikt i hur livskvaliteten påverkas så de kan ge ett riktat stöd till personer med ögonprotes. Vidare forskning bör inrikta sig på djupgående intervjuer för ökad kunskap inom ämnesområdet. / Surgical removal of an eye can be caused by trauma or eye disease. In Sweden there are over 7000 persons with an artificial eye. The removal of the eye is done through enucleation, evisceration or exenteration. The monocular vision affects the visual function and thereby everyday activities and work. The ophthalmic nurse’s care focus on providing support to promote adjustment. The aim of the study was to describe how persons wearing artificial eyes experienced their quality of life after going through a surgical removal of an eye. The study was carried out as a systematic literature study which was based on 13 scientific articles. The articles were analysed with latent content analysis which lead to the categories physical, psychological and social impact and impact on everyday life. The results showed that the quality of life was affected by factors such as general health, discomfort from the orbital cavity, appearance, visual function, psychological well-being, self-esteem, relationships, role limitations, limited leisure activities, work capacity and time. For persons wearing artificial eyes to be able to adapt to the new situation, awareness, good coping strategies and commitment from the individual are required. This study gives ophthalmic nurses insight into how the quality of life is affected so they can provide targeted support to people with artificial eyes. Further research should focus on indepth interviews for increased knowledge in the field.

A pintura de íris protética é uma das fases mais delicadas durante o processo de confecção de uma prótese ocular e requer, do Cirurgião-Dentista especialista em Prótese Bucomaxilofacial, qualidades técnico-artísticas para uma dissimulação satisfatória. A reprodução fiel da íris do paciente é de fundamental importância para sua reabilitação estética e consequente reintegração social. Em função disso, o presente estudo desenvolveu uma escala de cores para pintura de íris em prótese ocular, a fim de ser utilizada como ferramenta auxiliar durante esta fase. Foram desenvolvidas sete matizes (castanho-avermelhado, castanho, ocre, verde, verde-azulado, azul e cinza) a partir de mistura de tintas acrílicas Acrilex®, levando como base os conceitos de formação da cor da íris para o proporcionamento das tintas, no intúito de mapear os tons presentes nas íris humanas. A escala foi testada em 145 indivíduos com íris saudáveis, por três observadores calibrados, verificando se algum tom da escala se aproximava à cor base dessas íris. A opinião de cada obeservador foi anotada em ficha de avaliação da íris e os dados seguiram para análise estatística. Foram avaliadas a associação entre matiz de escolha e observadores, a coerência inter-observador em relação ao matiz e a coerência inter-observador em relação ao tom. Os resultados apontaram alta concordância entre os obeservadores, o que garantiu a validação da escala proposta. / Artificial eye iris painting is one of the most delicate stages in the process of making an ocular prosthesis. The Oral and Maxillofacial Prosthodontics Specialist Dentist is required to have technical and artistic abilities for a satisfactory simulation. The accurate reproduction of the patient\'s iris is thoroughly important for his or her aesthetic rehabilitation and social reintegration. On that basis, the present study aimed to develop an iris painting color scale, which can be used as an auxiliary tool for this stage of production. In order to map out the present shades in human irides, seven hues have been developed (reddish-brown, brown, ochre, green, bluishgreen, blue and gray) by mixing Acrilex® acrylic paint, which were based on the concepts of iris color formation for the establishment of the paint mixtures. The scale has been tested by three calibrated observers in 145 individuals presenting healthy irides. The observers would verify if any of the shades in the color scale matched the subject\'s iris color base. Each observer\'s opinion was registered in an iris evaluation sheet and the data was then submitted to statistical analysis. Evaluated factors included the association of the selected hue by the observer; the consistency of the choice of hue among all observers; the consistency of the choice of shade among all observers. Results revealed substantial consensus among observers, ensuring the legitimacy of the proposed color scale.

A pintura de íris protética é uma das fases mais delicadas durante o processo de confecção de uma prótese ocular e requer, do Cirurgião-Dentista especialista em Prótese Bucomaxilofacial, qualidades técnico-artísticas para uma dissimulação satisfatória. A reprodução fiel da íris do paciente é de fundamental importância para sua reabilitação estética e consequente reintegração social. Em função disso, o presente estudo desenvolveu uma escala de cores para pintura de íris em prótese ocular, a fim de ser utilizada como ferramenta auxiliar durante esta fase. Foram desenvolvidas sete matizes (castanho-avermelhado, castanho, ocre, verde, verde-azulado, azul e cinza) a partir de mistura de tintas acrílicas Acrilex®, levando como base os conceitos de formação da cor da íris para o proporcionamento das tintas, no intúito de mapear os tons presentes nas íris humanas. A escala foi testada em 145 indivíduos com íris saudáveis, por três observadores calibrados, verificando se algum tom da escala se aproximava à cor base dessas íris. A opinião de cada obeservador foi anotada em ficha de avaliação da íris e os dados seguiram para análise estatística. Foram avaliadas a associação entre matiz de escolha e observadores, a coerência inter-observador em relação ao matiz e a coerência inter-observador em relação ao tom. Os resultados apontaram alta concordância entre os obeservadores, o que garantiu a validação da escala proposta. / Artificial eye iris painting is one of the most delicate stages in the process of making an ocular prosthesis. The Oral and Maxillofacial Prosthodontics Specialist Dentist is required to have technical and artistic abilities for a satisfactory simulation. The accurate reproduction of the patient\'s iris is thoroughly important for his or her aesthetic rehabilitation and social reintegration. On that basis, the present study aimed to develop an iris painting color scale, which can be used as an auxiliary tool for this stage of production. In order to map out the present shades in human irides, seven hues have been developed (reddish-brown, brown, ochre, green, bluishgreen, blue and gray) by mixing Acrilex® acrylic paint, which were based on the concepts of iris color formation for the establishment of the paint mixtures. The scale has been tested by three calibrated observers in 145 individuals presenting healthy irides. The observers would verify if any of the shades in the color scale matched the subject\'s iris color base. Each observer\'s opinion was registered in an iris evaluation sheet and the data was then submitted to statistical analysis. Evaluated factors included the association of the selected hue by the observer; the consistency of the choice of hue among all observers; the consistency of the choice of shade among all observers. Results revealed substantial consensus among observers, ensuring the legitimacy of the proposed color scale.

En ögonamputation innebär en livslång begränsning av synfunktionen vilket kan förväntas påverka livskvaliteten. Syftet var att identifiera faktorer som påverkade livskvalitet på lång sikt efter en ögonamputation i vuxen ålder samt att beskriva hur livskvaliteten påverkades. Metod: Litteraturstudien följde niostegsmodellen av Polit och Beck (2017). Artiklarnas relevans bedömdes i tre urvalssteg: 1. Huruvida titel/ sammanfattningen matchade syftet. 2. Huruvida artiklarna i sin helhet matchade syftet samt in- och exklusionskriterierna. 3. Kvalitets­bedömning. Databearbetning: Faktorer som påverkade livskvalitet hos ögonamputerade protesbärare sorterades efter likheter och olikheter. Kategorier formulerades och tre karakteristiska teman identifierades bland dessa. Resultatet baserades på sju artiklar. Bland faktorerna som påverkade livskvalitet efter en ögonamputation identifierades tre teman ’Slutgiltig fysisk förändring’, ’Psykiska och känslomässiga påfrestningar’ samt ’Socialt undvikande beteende’. Temat ’Slutgiltig fysisk förändring’ tilldelades kategorierna ’Två blir ett: Enögdheten & monokulärt seende’ och ’Ett camouflerat operationsärr: Ögonhåla & protes’. ’Bearbetning av ögonförlusten’, ’Psykologiska problem’ samt ’Utmattning’ var de tre kategorierna tillhörande temat ’Psykiska och känslomässiga påfrestningar’. Temat ’Socialt undvikande beteende’ tillhörde kategorierna: ’Upplevd begränsad funktionsduglighet’ och ’Osäkerhet i mellanmänskliga relationer’. Slutsatsen: Studien sammanfattar kunskapsläget kring faktorer som påverkar livskvalitet efter en ögonamputation på lång sikt. Kunskap som behövs för att kunna optimera rehabiliteringsprocessen, ge god omvårdnad samt förhindra utanförskap. / Amputation of an eye results in life-long limitations of eye sight function which can be expected to affect quality of life (QoL). The aim of this study was to identify factors having long-term effects on QoL after amputation of an eye in adult patients and to describe in which way QoL was affected. Method: A litterature review following nine steps according to Polit and Beck (2017) was performed. Selection of relevant scientific articles was done in three steps: Evalutating relevance according to 1. title and abstract, 2. Article as a whole concidering aim of the review and criteria for in- and ex-clusion. 3. Study quality. Data analysis: Factors affecting QoL due to eye-amputation and wearing of an artificial eye were sorted according to similarities and differences. That way different categories were formed and among those main themes were identified. The result was based on seven articles. The three main themes that could be identified among factors influencing QoL after amputation of an eye were: ’Definitive physical changes’, ’Mental and emotional strains’ and ’Social avoidance’. Characteristic categories for the theme ’Definitive physical changes’ were ’Two become one: Monocularism & monocular sight’ and ’A camouflaged operation scar: Eye socket & prosthesis’. ’Processing the loss of an eye’, ’Psychological problems’ and ’Fatigue’ were three categories belonging to the theme ’Mental and emotional strains’.  The theme ’Social avoidance’ included categories like ’Experienced limited functioning’ and ’Uncertainty in interpersonal relationsships’. Conclusions: The review tries to sum up available ’recent’ research on factors with long-term effect on QoL after amputation of an eye. Knowledge which is necessary to improve rehabilitation- and caring-interventions as well as to prevent alienation in such patients

I nuläget finns det begränsat med forskning hur det går för de personer som opererar bort ett öga. Detta kan medföra att ögonsjuksköterskan ger otillräcklig information till patient och anhöriga i samband med att det är aktuellt att bära protes. Därför var det av intresse att undersöka den synrelaterade livskvaliteten hos personer som genomgått en ögonamputation. Syftet var att belysa synrelaterad livskvalitet hos personer som genomgått en ögonamputation och har en ögonprotes. Studien är en tvärsnittsstudie med deskriptiv design. Datainsamlingen omfattade frågeformuläret NEI-VFQ-25 med tilläggsfrågor, där deltagarna var vuxna personer som genomgått en ögonamputation de senaste fem åren. Resultatet visade att deltagarna hade lägre synrelaterad livskvalitet än personer i kontrollgruppen från H70-studien 2014/2015 med och utan påverkan på synförmågan. Mest besvär hade deltagarna med sidoseende och aktiviteter både på nära och långt håll. Resultatet av studien kan ge ögonsjuksköterskan fördjupad kunskap som kan användas i personcentrerad vård som stöd för att uppmuntra personen som genomgått en ögon amputation och att på bästa sätt hantera sin nya livssituation. Forskning omfattande synrelaterad livskvalitet hos samtliga vuxna personer i Sverige som genomgått en ögonamputation och har ögonprotes vore av intresse, eftersom resultatet baseras på en grupp patienter vid en ögonklinik. / At the moment there is little research about the outcome of people who have had an eye surgically removed. This may result in an ophthalmic nurse giving insufficient information to patients and relatives. Therefore, it would be interesting to investigate the vision related quality of life in relation to the eyesight of persons who have undergone an eye amputation. The purpose was to illustrate the vision related quality of life of people who have been subject to an eye amputation and have an eye prothesis. The study is a cross-sectional study with a descriptive design. The data collection was conducted using the questionnaire NEI-VFQ-25 together with supplementary questions which was sent to adults who have undergone an eye amputation in the last five years. The results showed that eye amputees had lower vision-related quality of life than participants in a control group from the H70 study 2014/2015 with and without visual symptoms. The biggest inconvenience for the participants was peripheral vision and both near activities and distance activities. The results of the study can provide the ophthalmic nurse with a deeper knowledge to be used working with personcentered care and provide thourough information to support persons how has went through an eye amputation to manage their new life situation. Further research on eye amputees vision-related quality of life nationally is needed because the result is based on a limited study group.