眶内植入物对眼眶畸形发育防治机制的研究

目的 探讨眶内植入物在眼眶畸形发育防治中的作用机制.方法 新西兰幼兔21只,随机分为眼球摘除组、眶内植入物组和正常对照组.1月龄时对眼球摘除组和眶内植入物组的兔分别行左侧眼球摘除、眼球摘除联合眶内植入物植入术,正常对照组左侧眼眶作为对照.2月龄时处死全部兔子,取左侧颧骨脱钙后制成石蜡切片.对比观察3组的眶骨组织学改变,并测量其骨吸收参数N.Oc/B.Pm.结果 眼球摘除组较其余两组的皮质骨表面边缘不规整,骨吸收现象明显,骨板排列不整齐,粘合线明显紊乱.眼球摘除组骨吸收参数N.Oc/B.Pm明显高于其余两组(P＜0 01),眶内植入物组和正常对照组N.Oc/B.Pm差异无统计学意义(P ＞0 05).结论 眼球摘除后眶骨骨吸收增强参与了眼眶畸形的发育过程,眶内植入物防治眼球摘除后眼眶畸形发育的作用至少部分是通过减弱骨吸收来实现的.     

义眼台植入对眶骨组织中转化生长因子－β1表达的影响

【摘要】背景义眼台植入是防治眼球摘除术后眼眶畸形发育的主要手段，但其作用机制尚不十分清楚。研究表明骨局部生长因子在骨组织的发生、发育、损伤修复等过程中具有重要作用，转化生长因子-β1（TGF-β1）的作用更值得关注。目的检测眼球摘除和义眼台植入后眶骨组织中骨局部TGF-β1．的表达情况，探讨眼球摘除后眼眶畸形发育防治的作用机制。方法选用同龄、健康、体质量相近的新西兰幼兔21只，按随机数字表法分为眼球摘除组、义眼台植入组和正常对照组。实验兔1月龄时对眼球摘除组和义眼台植入组分别行左眼球摘除或眼球摘除联合义跟台植入术，正常对照组左眼眶作为对照。术后1个月时处死全部兔，用酶免疫组织化学法和FITC免疫荧光标记法对眼球摘除组、义眼台植入组和正常对照组兔眶骨组织中TGF-β1蛋白表达情况进行检查，利用ELISA法测定兔眶骨组织中TGF—p，蛋白的表达水平。结果术后1个月义眼台植入组和正常对照组兔眶高和眶宽的数值均明显高于眼球摘除组，差异均有统计学意义（眶高：P=0．00、P=0．00；眶宽：P=0．00、P=0．00）。免疫组织化学检测发现，义眼台植入组和正常对照组兔眶骨组织中TGF-β1，的染色强度明显高于眼球摘除组，骨组织中着色细胞多，染色较深，而义眼台植入组和正常对照组兔眶骨组织中TGF-β1的染色强度相近。TGF-β1免疫荧光法染色结果表明，义眼台植入组和正常对照组兔眶骨组织中TGF--β1的荧光细胞数量多于眼球摘除组。ELISA检测结果显示，眼球摘除组兔骨组织中TGF-β1的质量分数较义眼台植入组和正常对照组低，差异均有统计学意义（P=0．00、P=0．00），义眼台植入组和正常对照组骨组织中TGF-β1，质量分数的差异无统计学意义（P=0．41）。结论TGF-β1参与了眶骨发育过程及义眼台植入防治眼球摘除后眼眶畸形发育的过程。     

眼台Ⅱ期植入对眼眶发育影响的实验研究

目的：探讨不同时间眼球摘除后对眼框发育的影响及眼球摘除眼台Ⅱ期植入对眼框发育的影响。方法：将18只同龄幼兔,随机分成两组,一组分别在不同兔龄行单侧眼球摘除术,另一组则均在相同兔龄行单侧眼球摘除术,并在眼球摘除后不同时间人别行Ⅱ期HA植入。两组兔均在4月龄时处死,直接解剖测量术眼和健眼的眶容积并进行对比研究。结果：眼的眶容积与术眼的眶的容积差值百分比与眼球摘除时间之间有密切的负相关（r=-0.988);健眼眶容积与眼台植入组眶容积差值百分比与眼台植入时间之间有密切的正相关（r= 0.978)。结论：在生长发育期,眼球摘除越早期眼眶发育越差;眼球摘除后眼台植入越早眼框的发育越好;眼球在眶骨发育过程中起到一种“生骨诱导中心”的作用,眼台也卢到一定的“生骨诱导中心”作用。     

义眼台植入对兔眼眶骨细胞的影响

目的 观察眼球摘除和义眼台植入对兔眼眶骨细胞凋亡的影响,初步探讨义眼台植入对眼眶畸形发育防治的作用机制.方法 实验研究.选用同龄、健康、体重相近新西兰幼兔21只,随机分为眼球摘除组、义眼台植入组及正常对照组.1个月龄时对眼球摘除组和义眼台植入组的兔分别行左侧眼球摘除或眼球摘除联合义眼台植入术,正常对照组左侧眼眶作为参照.2个月龄时处死全部兔子,采用光镜、透射电镜和TUNEL法检测其眶骨骨细胞凋亡,并用TUNEL法计量分析3组骨细胞的凋亡情况,采用LSD法对3组骨细胞凋亡率间进行比较.结果 在3组眶骨组织中均可检测到凋亡骨细胞,用TUNEL法观察可见凋亡骨细胞呈散在不规则性分布;TUNEL法计数结果显示眼球摘除组、义眼台植入组及正常对照组骨细胞凋亡率分别为20.56%±2.13%、14.29%±3.60%、12.57%±2.40%,眼球摘除组骨细胞凋亡率与义眼台植入组及正常对照组骨细胞凋亡率之间差异有统计学意义(P<0.01),义眼台植入组和正常对照组骨细胞凋亡率之间差异无统计学意义(P>0.05).结论 眶骨细胞凋亡参与了义眼台植入防治眼球摘除后眼眶畸形发育的过程.(中华眼科杂志,2008,44:700-704)     

眼球摘除对眼眶发育的影响及其防治研究进展

在眼科手术中 ,平均眼球摘除率为 2 8/1 0万。在成人眼球摘除后 ,常导致眼球摘除后综合征。在儿童摘除眼球后 ,不仅会导致眼球摘除综合征 ,而且导致眶骨发育迟缓 ,严重者造成颜面畸形。为此 ,本文就眼球摘除适应证、眼球摘除综合征发生机制和防治、以及眶内植入物对眶骨发育影响等方面的系统研究加以综述。     

眶缘眶壁分层截骨术治疗眼眶及眶周畸形

目的 探讨眶缘眶壁分层截骨术治疗眼眶及眶周畸形所致的眼眶容积异常、眶缘错位、眼水平轴失衡、眼球凹陷及复视等的效果。方法 对眶距增宽症、双眼眶不对称、放疗后小眼眶、外伤后眼眶畸形等患者,取头皮冠状切口入路,按畸形发生的不同部位,选用眶缘部眶壁分层截骨、固定,或多个眶缘部眶壁复合分层截骨、固定。结果 44例患者中,眶上缘截骨5例,眶内壁截骨8例,眶下缘截骨3例,眶外缘截骨2例,眶外下缘复合截骨26例,术后无并发症。手术前后测量结果显示,骨性眶间距、双侧眼球突出度、双眶连线与双耳屏连线的交角、双眼外眦与双耳屏连线距离等均较手术前有明显改善。结论 眼眶壁和眼眶缘的分层截骨术可以有效矫正不同类型的眼眶畸形。     

先天性小眼球合并眼眶囊肿诊断与治疗

目的 探讨先天性小眼球合并眼眶囊肿的临床、影像诊断及治疗方法.方法 回顾分析19例(20只眼)先天性小眼球合并眼眶囊肿的临床表现、影像学资料、手术治疗过程及术后效果,研究该病的临床、影像诊断及治疗方法.结果 通过B超、彩超、CT及MRI等影像学检查,可发现先天性小眼球合并眼眶囊肿中发育异常的小眼球、眼眶内囊性肿物,典型病例两者之间存在沟通.10例患者同时摘除小眼球与囊肿并植入羟基磷灰石义眼台,有效改善外观,未影响眶骨发育.3例单纯摘除囊肿患者,保留小眼球可填充眶内容,外观影响较小,眼球有继续发育可能.2例术后缝合睑裂者,外观受影响.2例患者采用囊内液抽吸,术后复发.结论 先天性小眼球合并眼眶囊肿可通过临床表现和特征性的影像学检查(发现小眼球与囊肿的沟通)明确诊断.手术治疗宜选同时摘除小眼球与囊肿并植入羟基磷灰石义眼台,小眼球发育较好者宜选单纯摘除囊肿+眼球修补术.     

羟基磷灰石义眼台植入术的护理体会

眼球摘除或眼内容物剜除术后，眼窝凹陷畸形，儿童还会影响眼眶及同侧颜面部的发育。因此，应及时采取眶内填充物来矫治。羟基磷灰石义眼台是一种新型眶内植入物，它与以往的玻璃、塑料、金属物等填充物比较有明显的优势。1998年3月～2005年3月，我院共收治眼内容物剜除或眼球摘除术后植入HA患者96例，经过精心护理，疗效满意，现将资料报告如下。     

未成年人摘除眼球后眼眶的发育

目的探讨未成年人摘除眼球未植入义眼台的眼眶发育情况。设计回顾性病例系列。研究对象41例未成年时行单眼眼球摘除患者。方法回顾分析患者冠状位眼眶CT扫描影像资料,测量患侧及健侧的眼眶入口面积。主要指标眼眶入口面积。结果摘除眼球侧和健侧眼眶入口面积分别为(10.67±1.41)mm2和(12.03±1.41)mm2(P=0.000)。0~6岁摘除眼球组和7~12岁摘除眼球组两侧眼眶入口面积的差别均有统计学意义(P=0.000、0.018),13~18岁摘除眼球组二者的差别无统计学意义(P=0.09)。配戴义眼片组和未配戴义眼片组无眼球侧眼眶入口面积与健侧眼眶入口面积差存在统计学差异(P=0.004)。结论未成年人摘除眼球后影响该侧眼眶生长发育,摘除眼球时的年龄越小影响越大。摘除眼球后配戴义眼片可改善眼眶的发育。     

眼球摘除对眼眶发育的影响及其防治研究进展

在眼科手术中，平均眼球除率为2．8／10万。在成人眼球除后，常导致眼球除后综合征。在儿童除眼球后，不仅会导致眼球除综合征，而且导致眶骨发育迟缓，严重造成颜面畸形。为此，本就眼球除适应证、眼球除综合征发生机制和防治，以及眶内植入对眶骨发育影响等方面的系统研究加以综述。     

The pathophysiology of the anophthalmic socket. Part I. Analysis of orbital blood flow

A wide variety of complications of the anophthalmic socket develop in patients after enucleation, including enophthalmos, superior sulcus deformities, eyelid malpositions, implant migration and extrusion, poor prosthetic motility, and socket contraction. Changes in the orbital blood flow and metabolic activity of the socket tissues and atrophy of the orbital fat occurring after enucleation have been suggested as two theoretical mechanisms that result in the development of these clinical conditions. Lack of scientific evidence and a limited understanding of the pathophysiologic basis of the features of anophthalmos led us to evaluate the validity of these proposed mechanisms in an animal model. Selected parameters of the normal orbits were compared with the contralateral anophthalmic orbits at different time intervals after surgery. Orbital blood flow was studied with selective ophthalmic artery angiography and radioactive microsphere techniques. Ophthalmic arteriography demonstrated symmetric caliber and filling characteristics of the major orbital vessels of the control and experimental orbits, although their topographic course was slightly more tortuous in the anophthalmic socket. Results of radioactive microsphere analysis of capillary blood flow per weight of the different orbital tissue compartments of the animals in the long-term group showed no significant difference between the normal and anophthalmic sockets. These findings provide evidence that the circulation dynamics and blood flow to orbital tissues do not change after enucleation surgery.     

Evaluation of an integrated orbital tissue expander in an anophthalmic feline model

PURPOSE: To evaluate the anatomical effects and tissue biocompatibility in a feline model of an integrated orbital tissue expander (OTE) designed to stimulate bone growth in an anophthalmic socket. DESIGN: An animal study was performed in cats to assess orbital bone growth with and without an OTE. METHODS: The OTE is an inflatable (0.5 to >6.0 cm(3)) polymeric globe sliding on a titanium T plate secured to the lateral orbital rim with screws. Eight cats had left eye enucleation at age two weeks, with five orbits receiving an OTE and the remaining three serving as nonimplanted controls. Serial transconjunctival implant inflation was performed by injecting normal saline solution into the OTE to a final volume of 3.5 ml. Serial computed tomographic scans were obtained to assess socket growth. All eight cats were euthanized at 18 weeks and dry skulls prepared. The effective orbital volume was measured by inflating an OTE in the orbit of a dry skull until it filled the cavity completely. RESULTS: Three cats periodically scratched open the tarsorrhaphy and conjunctiva to rupture the OTE, which resulted in implant exchanges. At 18 weeks, the OTE expanded orbital volume was approximately 18% smaller than the normal contralateral side. In the control animals, the anophthalmic orbital volume was approximately 66% smaller than the contralateral orbit. Histopathology of orbital tissues showed no evidence of foreign body reaction. CONCLUSIONS: This proof-of-concept pilot study demonstrated implant efficacy in cats, and no implant-related adverse effects were observed. OTE has the potential to stimulate bone growth in human anophthalmic orbits.     

Orbital growth after unilateral enucleation in infancy without an orbital implant.

PURPOSE: To measure the volume of the anophthalmic orbit in adults who had undergone enucleation during infancy and to determine its growth. METHODS: The orbital volume in 5 adults who had undergone unilateral enucleation during infancy without an orbital implant was measured on x-ray computed tomography images. Comparisons were made between the anophthalmic and normal sides. In addition, we evaluated the morphology of the orbits showing growth retardation and the association between the prosthesis, if present, and orbital growth. RESULTS: In adults who underwent unilateral enucleation as infants, without an orbital implant, orbital growth was more retarded on the anophthalmic side than on the normal side. The difference was most marked in the area corresponding to the equator of the eyeball. This growth retardation was more severe in patients whose prosthesis was not replaced during childhood than in those who had regular replacement of their prosthesis. CONCLUSION: For orbital growth in anophthalmic orbits, an intraorbital volume that replaces the eyeball is necessary. An orbital implant at the time of enucleation and the replacement of the prosthesis with growth are important.     

Rabbit orbital measure evaluations after enucleation and evisceration

PURPOSE: To assess orbital volume in weaned rabbits, submitted to enucleation and evisceration, with orbital volume reconstitution using porous polyethylene (PP) spheres, analyzed by computed tomography, by the water displacement test and external orbital measures using Image-J software. METHODS: This experimental randomized study consisted of 48 albino rabbits, with 42 days of life, submitted to enucleation (EN) and evisceration (EV), with (WI) or without (NI) implantation of a 10 mm PP sphere. After 1 month (M1), 3 months (M2) and 6 months (M3), 4 animals of each group were sacrificed. The skulls were prepared for dry bone study using the maceration technique. The orbital volume was calculated by computed tomography and by the water displacement test. The results suggest that orbital development in rabbits above 42 days of life is not different regarding evisceration or enucleation, or when an orbital implant is used. The water displacement test showed similar results compared with computed tomography, making a morphometric method in experimental studies worthwhile.     

Functional anatomy of the anophthalmic socket: insights from magnetic resonance imaging

PURPOSE. Changes in anophthalmic socket anatomy can significantly compromise esthetics and motility after enucleation. This study evaluated such changes by using magnetic resonance imaging (MRI) of enucleated and fellow orbits. METHODS. High-resolution, surface coil MRI was performed in five patients after enucleation for uveal melanoma. Images were analyzed quantitatively to determine extraocular muscle (EOM) volume, maximum diameter, and length; orbital, optic nerve (ON), and orbital fat tissue (OFT) volume; and implant position. The fellow orbit was used as the control. Patients evaluated their satisfaction with the surgical results and were clinically examined. RESULTS. Rectus EOM volume was slightly but not significantly reduced on the surgical compared with the control side. Oblique EOM and OFT volumes were unchanged. Rectus EOM length was significantly reduced in the surgical side, but maximum EOM diameter in central gaze position was slightly but not significantly greater on the enucleated side. Rectus EOM paths were not qualitatively changed by enucleation and continued to exhibit the influence of the connective tissue pulleys, which retained motility, as appropriate to EOM contraction. Implants were located significantly posterior to the normal globe location. CONCLUSIONS. Enucleation does not significantly change EOM volume, but shortens EOM paths, a change that would be expected to alter their mechanical properties. EOM pulleys appear to retain their functional role in enucleated orbits.     

羊膜包裹人造骨片修复眼眶爆裂性骨折的实验研究

目的 探讨羊膜对眼眶爆裂性骨折导致的软组织损伤粘连的预防作用.设计 实验性研究.研究对象 26只新西兰兔.方法 建立兔眼眶爆裂性骨折模型,20只动物右眶通过包裹羊膜的人造骨片进行修复(实验组),左眶直接应用羟基磷灰石(HA)进行修复(对照组),6只动物不进行任何修复(空白对照组).分别在置入骨片后1周、1个月取骨片周围组织,比较三组的不同.主要指标 软组织与骨片间粘连程度分级,组织炎症反应评分.胶原评估,TGF-β免疫组化分析.结果 术后1周,HE和免疫组化显示实验组与对照组炎症反应差异无统计学意义(P=0.351,P=0.413),空白对照组与实验组差异有统计学意义(p=0.012,P=0.041);术后1个月,HE和免疫组化显示实验组与对照组炎症反应差异有统计学意义(P=0.037,P=0.048),空白对照组与实验组差异无统计学意义(P=0.285,P=0.472).结论 羊膜包裹人造骨片修复眼眶燥裂性骨折早期未见明显抗炎作用,中晚期则有明显抗炎抗粘连作用.     

兔同种异体眶骨移植研究

目的探索兔同种异体眶骨植入眶骨缺损的可行性和有效性。方法日本大耳白兔24只,8只兔用于制备经深低温冷冻同种异体眶骨,16只兔通过手术造成双眼眶上壁15 mm×5 mm×2 mm大小的骨缺损模型,左右眼眶上壁分别植入同种异体眶骨和自体骨。植入同种异体骨的一侧眼眶设为实验组,对侧植入自体骨为对照组。术后2、4、8、12周处死实验兔后分别进行大体观察、CT检查、组织学检查及免疫组织化学染色测定骨形态发生蛋白-2（BMP-2）的表达。结果 2组切口愈合良好,术后第2周、第4周,2组愈合情况未见明显差异;术后第8周、第12周,实验组2例未愈合,对照组愈合程度好于实验组,植入骨与宿主骨已成一整体。影像学检查：术后分别在2、4、8、12周测得植入骨与宿主骨结合部平均CT值对照组均高于实验组。组织学检查：术后第2周、第4周,植入骨与宿主骨可见大量炎性细胞浸润,新生骨痂形成,2组无明显差异;术后第8周、第12周,对照组新骨形成较实验组多。免疫组织化学染色测定BMP-2的表达：术后第2周、第4周,异体骨周围的骨痂中可见阳性表达,术后第8周、第12周,异体骨、皮质骨及周边成熟的骨单位可见阳性表达。结论兔同种异体眶骨在眶骨组织缺损修复中与自体骨移植形成骨性愈合程度接近,在修复眶骨组织缺损中效果较好。