羟基磷灰石义眼座植入术后眼座暴露原因及处理

目的 探讨羟基磷灰石(Hydroxyapatite,HA)义眼座,植入术后暴露的原因及处理.方法 对40例义眼座植入患者进行随访分析.术后发生义眼座暴露8例(20％).针对暴露的程度及原因采取不同的治疗方法.结果 3例轻度患者经保守治疗愈合,4例中重度患者经羊膜移植愈合,1例重度患者经取出义眼座后愈合,随诊3月至3年无复发.结论 羟基磷灰石义眼座植入术后暴露的原因与多种因素有关,恰当地处理可以使之恢复.羊膜移植是治疗中重度结膜裂开、眼座暴露的有效方式.     

羟基磷灰石义眼座植入后暴露原因分析与处理

目的 探讨分析羟基磷灰石(HA)义眼座植入后暴露的原因及处理。方法 对 11例 HA义眼座植入后发生暴露的患者进行回顾性总结分析。结果 HA义眼座轻度暴露<5mm,一般不须处理,2～9个月可以愈合。中度暴露≤10mm,可药物观察治疗,也可行结膜修补术。重度暴露10～25mm,巩膜溶解HA义眼座大面积暴露,行HA义眼座取出,结膜囊修补,自体真皮脂肪瓣修补缺损区。结论 义眼座暴露为HA义眼座植入术后较严重并发症,真皮脂肪瓣,保存人羊膜都可用于结膜囊形成与修复,双层袋状巩膜缝合,置于HA义眼座前,可有效减少植入物的脱出。     

生物型硬脑膜补片在义眼座暴露修补术中的应用

目的探讨生物型硬脑膜补片在义眼座暴露修补术中应用的可行性以及临床效果。设计回顾性病例分析。研究对象2007年10月至2009年4月间，就诊于中山大学附属中山眼科中心的10例（10眼）义眼座暴露患者。方法采用生物型硬脑膜补片行义眼座暴露修补联合结膜囊成形术。主要指标术后结膜愈合情况，术后复发和并发症的发生率。结果术后随访6～24个月，平均16．2个月，术后结膜愈合好，无发生义眼座再次暴露，植片无收缩、感染、排异等并发症，术后3-6个月植片均被结膜覆盖，结膜囊大小深度合适，并成功戴义眼。结论采用生物型硬脑膜补片行义眼座暴露修补术是一种安全有效的手术方法。     

羟基磷灰石义眼座植入后暴露原因分析与处理

目的 探讨分析羟基磷灰石（HA）义眼座植入后暴露的原因及处理。方法 对11例HA义眼座植入后发生暴露的患进行回顾性总结分析。结果 HA义眼座轻度暴露＜5mm，一般不须处理，2－9个月可以愈合。中度暴露≤10mm，可药物观察治疗，也可行结膜修补术。重度暴露10－25mm，巩膜溶解HA义眼座大面积暴露，行HA义眼座取出，结膜囊修补，自体真皮脂肪瓣修补损区。结论 义眼座暴露为HA义眼座植入术后较严重并发症，真皮脂肪瓣，保存人羊膜都可用于结膜囊形成与修复，双层袋状巩膜缝合，置于HA义眼座前，可有效减少植入物的脱出。     

羟基磷灰石义眼台植入后暴露原因分析及处理

目的探讨羟基磷灰石义眼台植入后义眼台暴露的原因及处理方法。方法对本院2002~2004年收治的32眼羟基磷灰石义眼台暴露患者的治疗方法及效果进行回顾性分析。结果义眼台暴露的发生时间为术后3d~6月,暴露范围为3~14mm,义眼台暴露能自行愈合者5眼;手术修补27眼,其中2眼伴有慢性感染最终手术取出义眼台。术后随访。结论义眼台暴露的原因与炎症、手术方法、手术时机、术后感染和义眼台的型号等因素有关。其处理可根据暴露范围不同采用不同方法,义眼台暴露范围在5mm以内的可采用保守治疗,暴露范围超过10mm的应尽早手术修补,处理过程中应尽量消除可能再次引起义眼台暴露的危险因素。     

羟基磷灰石义眼台植入后义眼台暴露的处理

目的：探讨羟基磷灰石眶内义眼台植入后义眼台暴露的处理方法。方法：回顾本中心１９９４年７月至１９９８年６月期间收治的羟基磷灰石义眼台暴露４１例的治疗方法及效果。结果：义眼台暴露的发生时间为术后７天至６月,暴露范围内２ｍｍ至１５ｍｍ,有１５例义眼台暴露能自行愈合;２６例需手术修补,其中２例伴有慢性感染者需手术取出义眼台。结论：义眼台暴露的处理可根据暴露范围采用不同方法处理,义眼台暴露范围在５ｍｍ以内的     

羟基磷灰石眼座植入后暴露的原因分析及处理

目的分析羟基磷灰石跟座植入后暴露的原因及眼座暴露的处理方法.方法根据HA暴露程度不同,分别采用观察、结膜囊修补、同种异体保存人羊膜移植部分结膜囊成形、HA取出后再植入的方法.结果HA轻度暴露(≤5mm12例),平均6.2个月,结膜上皮自行愈合,HA中度暴露(＞ 5 mm,≤10mm,8例)2例观察1.2～1.5年,结膜上皮自行愈合,6例行结膜囊修补术后愈合;HA重度暴露(＞10mm7例,其中＞20mm 4例),3例行结膜囊修补术,4例行HA取出再植入后愈合.结论HA暴露的原因主要是筋膜缝合张力过大及眼座包裹材料处理不当;HA轻中度暴露可自行愈合,中重度暴露须行结膜囊修补或取出再植入.     

义眼座植入及全厚皮片移植眼窝再造术

目的探讨无眼球重度眼窝狭窄行义眼座植入及全厚皮片移植眼窝再造术的效果。方法8例8眼无眼球重度眼窝狭窄，行一期或二期羟基磷灰石义眼座植入术。术后3—8个月，行全厚皮片移植眼窝再造术。结果随访6个月至3年。7例义眼座位置良好，1例感染而取出。7例皮片完全存活，1例上穹窿部皮片坏死，形成新的上穹窿狭窄，3个月后再次行全厚皮片移植上穹窿成形术，术后效果良好。结论无眼球的重度眼窝狭窄患者行羟基磷灰石义眼座植入术后，二期行全厚皮片眼窝再造术，取材来源广泛，操作简便，术后效果良好。     

用结膜Müller氏肌瓣修补义眼座暴露

羟基磷灰石义眼座(HA)具有良好的相容性、活动性,已广泛应用于眼眶整形,效果良好.但仍存在以义眼座暴露为主的并发症,特别对于各类经修补仍复发的顽固性义眼座暴露临床处理较棘手.我们采用Müller肌瓣转移修补术取得了良好效果.     

义眼座植入联合羊膜移植结膜囊重建术疗效观察

目的 观察义眼座植入联合羊膜移植结膜囊重建术的疗效.方法 对30例（30眼）眼窝凹陷合并Ⅰ、Ⅱ度结膜囊狭窄行义眼座植入联合羊膜移植结膜囊重建术.术后上下睑缘褥式缝合,3月后拆除眼睑缝线,定制义眼.结果 术后12眼Ⅰ度结膜囊狭窄全部治愈;18眼Ⅱ度结膜囊狭窄中15眼治愈,3眼好转.30眼均无义眼座暴露或感染等并发症,术后义眼座的活动度和外观较好.结论 眼窝凹陷合并Ⅰ、Ⅱ度结膜囊狭窄采用义眼座植入同期行羊膜移植术较安全有效.     

改良羟基磷灰石义眼台植入术临床观察

目的:观察改良的羟基磷灰石义眼台植入术的疗效。方法:对32例改良的义眼台植入术,其中Ⅰ期18例,Ⅱ期14例,进行回顾性分析。结果:本组改良的羟基磷灰石义眼台植入术后,义眼活动度好,与健眼同步,无脱出、眼窝凹陷或上睑下垂;其中3例义眼台暴露,重新手术修补。结论:对严重的眼球破裂伤、无光感疼痛性眼球或萎缩眼球患者行改良的羟基磷灰石义眼台植入术,是一种较安全而有效的方法。     

羟基磷灰石义眼台眶内植入术后结膜脓性肉芽肿形成的原因分析(英文)

目的:分析羟基磷灰石(hydroxyapatite,HA)义眼台眶内植入术后结膜脓性肉芽肿形成的原因。方法:回顾性分析我院眶内植入HA义眼台250例(钻孔及栓钉置入68例),随诊18mo~10a,脓性肉芽肿形成后首先药物保守治疗,无效后采用手术治疗。结果:植入HA义眼台250例中发生脓性肉芽肿10例,其中9例在钻孔及栓钉置入术4~7a后发生,1例发生时羟基磷灰石义眼台未钻孔。9例保守治疗效果均欠佳,行HA义眼台取出术,1例拒绝眼台取出而继续保守治疗。结论:脓性肉芽肿是严重的义眼台植入术后并发症,发生原因可能与义眼台植入后血管化不足,义眼台暴露与继发感染,异体材料包被,义眼台钻孔及栓钉置入等因素有关,而与栓钉的材料无关。脓性肉芽肿的发生意味着义眼台可能发生了感染,最终需行义眼台取出术。     

Complications of supramid orbital implants

PURPOSE: To determine the incidence and risk factors of complications associated with Supramid orbital implants. METHODS: A retrospective chart review was performed to document complications in a series of 41 patients receiving Supramid implants during orbital reconstruction or fracture repair. Implant size, duration of time between trauma and implant insertion, and history of prior orbital surgery were examined as possible risk factors for the development of complications. RESULTS: Four patients had hemorrhage within the implant capsule. An orbital abscess developed in a single patient. All but one complication appeared 7.8 to 10 years after implant insertion. Patients who had complications had a longer duration of time between trauma and implant insertion than those in whom complications did not occur (P =0.0019). Complications were more frequent among patients with larger (>600 mm2) implants and a history of orbital surgery. CONCLUSIONS: Spontaneous infection or hemorrhage may occur within the capsules of Supramid orbital implants, even many years after surgery. The insertion of larger implants in the late repair of extensive bony orbital defects may predispose patients to these complications. Implant removal and marsupialization of the implant capsule to the maxillary sinus appears to be curative without causing significant postoperative enophthalmos.     

Bovine pericardium versus homologous sclera as a wrapping for hydroxyapatite orbital implants

PURPOSE: To report our experience with bovine pericardium as a wrapping material for hydroxyapatite orbital implants after enucleation and to compare the exposure rates of the implants wrapped with bovine pericardium versus donor sclera. METHODS: We retrospectively reviewed the records of all patients who received bovine pericardium-wrapped or donor sclera-wrapped hydroxyapatite implant after primary enucleation between March 1995 and December 2001. RESULTS: Of the 26 patients who received donor sclera-wrapped implants after enucleation, 1 (3.8%) had implant exposure. Of the 26 patients who received bovine pericardium-wrapped implants after enucleation, 6 (23%) had implant exposure. The incidence of implant exposure with the use bovine pericardium wrapping material was found to be significantly higher than with sclera (P = 0.05). Six of the 7 implant exposures were noted in the first 6 months after placement of the orbital implant. Five of the 6 exposed bovine pericardium-wrapped hydroxyapatite implants were associated with socket infection. The case of exposure of the sclera-wrapped implant was treated conservatively by observation. Six patients who had exposure of bovine pericardium-wrapped implants required multiple repairs because of recurrent exposures. Four of these patients eventually required removal of the implant. CONCLUSIONS: Despite the advantages of using bovine pericardium as a wrapping material for hydroxyapatite orbital implants, we observed a significantly higher incidence of exposure with bovine pericardium compared with donor sclera in the early postoperative period. Use of bovine pericardium as a wrapping material for orbital implants should be avoided unless some future modifications of the technique can be developed to prevent such complications.     

The porous polyethylene (Medpor) spherical orbital implant: a retrospective study of 136 cases

PURPOSE: To evaluate complications and risk factors associated with the placement of wrapped and unwrapped porous polyethylene (PP) spherical implants after evisceration, enucleation, or secondary implantation. METHODS: A retrospective, interventional, noncomparative case series of consecutive cases of PP implant placement after anophthalmic socket surgery performed by three surgeons over a 5-year period. A PP spherical implant was placed in 133 patients, 61 women (2 bilaterally) and 72 men (1 bilaterally). There were 91 enucleations, 30 eviscerations, and 15 secondary implant placements. Sixty-six (48.5%) implants were wrapped prior to placement. Parameters evaluated included: age, sex, prior ocular surgery or radiation treatment, indications for surgery, procedure performed, size of PP sphere, material used to wrap the implant, and complications. RESULTS: A total of 17 of 136 (12.5%) cases had documented postoperative complications, with implant exposure being the most common. In 5 patients (3.7%), implant exposure developed: 1 after evisceration and 4 after primary enucleation. Three of the five exposures were small and resolved with either observation alone or in one case with surgical revision of the socket. In two cases, the exposures were large enough that removal of the implant was indicated, one after evisceration and the other after enucleation with placement of a wrapped PP sphere. CONCLUSIONS: Our series revealed no significant difference in exposure rate between wrapped and unwrapped PP sphere implants, nor was the exposure rate affected by whether an eye was eviscerated or enucleated.     

HA眼台植入后脓性肉芽肿形成的原因分析

目的分析珊瑚多孔羟基磷灰石(HA)义眼台眶内植入术后脓性肉芽肿形成的原因,探讨其有效的治疗方法。方法回顾性分析我院眶内植入HA义眼台250例(钻孔及栓钉置入68例),外院1例,随诊18月-10年,脓性肉芽肿形成后给予药物及手术治疗。结果250例中发生脓性肉芽肿6例,其中5例在钻孔及栓钉置入术4～7年后发生,1例发生时羟基磷灰石义眼台未钻孔。6例保守治疗效果欠佳,均行HA义眼台取出术。结论脓性肉芽肿的发生原因可能与义眼台血管纤维化不足,义眼台暴露,异体巩膜包被,义眼台钻孔及栓钉置入等有关。脓性肉芽肿保守治疗效果欠佳,最终行义眼台取出术。     

Porous orbital implants, wraps, and PEG placement in the pediatric population after enucleation

PURPOSE: To investigate complications of various porous orbital implants and wrapping materials in the pediatric population after enucleation. DESIGN: A retrospective, comparative, nonrandomized study. METHODS: Between November 1992 and November 2006, patients younger than 15 years old were collected for study participation. They underwent enucleation with porous orbital implants primarily or secondarily at National Taiwan University Hospital. The authors used the hydroxyapatite (HA), Medpor, and Bioceramic orbital implant. The HA implant was wrapped with four different materials: donor sclera, Lyodura, porcine sclera, and Vicryl mesh. A part of HA implants and all bioceramic implants were wrapped with Vicryl mesh, added anteriorly with scleral patch grafts. All Medpor implants were unwrapped. RESULTS: Forty-seven cases had more than a two-year follow-up. The exposure rates according to implants and wraps were: donor sclera-wrapped HA (two of nine, 22%), porcine sclera-wrapped HA (three of three, 100%), Vicryl mesh-wrapped HA (one of five, 20%), and unwrapped Medpor (one of four, 25%). No exposure was found in four Lyodura-wrapped HA implants, and 22 Vicryl mesh-wrapped HA and Bioceramic implants with anteriorly scleral coating. The exposure rate was lower in cases with implants wrapped by our method and Lyodura than in those with implants wrapped by other materials (P < .001). Of 47 patients, 20 (42.5%) were fitted with peg-coupled prostheses and all had good prosthetic movements subjectively. CONCLUSIONS: Different types of implants and wraps resulted in various exposure rates in the pediatric population. The modified wrapping technique may prevent porous implants from exposure in children.     

Exposure rates of wrapped and unwrapped orbital implants following enucleation.

PURPOSE: To compare the complication rate of porous polyethylene orbital motility implants with solid acrylic implants following enucleation and identify possible risk factors. METHODS: The authors retrospectively reviewed the charts of a total of 117 consecutive enucleations performed at the University of Illinois at Chicago between March 28, 1994, and May 28, 1999. Data obtained included patient demographics, surgical indication, implant type, attending surgeon, surgical technique, and any reported complications. The primary outcome was presence or absence of implant exposure at the final recorded visit. RESULTS: Of the 117 identified cases, 29 were eliminated due to insufficient follow-up data. Of the 88 remaining cases, 48 patients received porous implants and 40 received solid acrylic implants. Implant exposure developed in four cases. All exposures occurred in unwrapped porous polyethylene implants (n=2) or porous polyethylene implants wrapped in absorbable material (n=2). All exposures occurred in patients younger than 18 years of age, and 75% occurred early after trauma-associated enucleation surgery. CONCLUSIONS: The exposure rate of porous polyethylene implants in this study (9%) was found to be comparable to published rates for hydroxyapatite implants. There were no exposures of unwrapped solid acrylic spheres. Unwrapped porous implants in pediatric patients or following trauma-related enucleation may represent an increased risk for postoperative implant exposure. Absorbable wrapping of porous implants may carry the same risk for exposure as no wrapping. Porous implants wrapped in durable material appear to be as safe as solid acrylic spheres.     

羟基磷灰石义眼台植入术的临床观察

目的观察羟基磷灰石义眼台植入术的疗效。方法观察43例行义眼台植入术病例,其中Ⅰ期手术33例,Ⅱ期手术10例,收集各病例的临床资料、手术指征、义眼台大小、手术方式、手术疗效和术后并发症。术后随诊1—12个月。结果本组43例接受羟基磷灰石义眼台植入,全部病例均获得成功,术后随访无义眼台暴露、脱出、眼窝凹陷或上睑下垂,义眼活动度好,与健眼同步。无交感性眼炎发生。结论在严格掌握手术时机和手术指征,选择正确的手术方式和义眼台大小,正确处理术后并发症,羟基磷灰石义眼台植入术是一种安全而有效的治疗严重的眼球破裂伤、部分无光感疼痛性眼球或萎缩眼球的方法。     

Autogenous temporalis fascia patch graft for porous polyethylene (Medpor) sphere orbital implant exposure

BACKGROUND: Temporalis fascia has been recommended for hydroxyapatite sphere exposure. The aim of this study was to identify potential risk factors for exposure of porous polyethylene (Medpor) sphere implants and evaluate the use of autogenous temporalis fascia as a patch graft for exposure. METHODS: A retrospective review of consecutive cases of porous polyethylene sphere orbital implant exposure. RESULTS: Five cases presented between May 2000 and October 2001 (three males, two females; mean age 44.5 years). Three had enucleation (two with primary implants) and two had evisceration (one with primary implant). Exposure occurred in one primary, two secondary, and two replacement implants. Orbital implant diameter was 20 mm in four cases and 16 mm in one case (contracted socket). The mean time from implantation to exposure was 23 months (range 0.7-42.6). Three patients had secondary motility peg placement before exposure. The average time from last procedure (sphere implant or peg insertion) to exposure was 3 months (range 0.7-12.6). Four patients required surgical intervention, of which three needed more than one procedure. Autogenous temporalis fascia grafting successfully closed the defect without re-exposure in three of these four patients. The grafts were left bare in three patients, with a mean time to conjunctivalise of 2.4 months (range 1.6-3.2). CONCLUSIONS: Exposed porous polyethylene sphere implants were treated successfully with autogenous temporalis fascia graft in three of four patients. This technique is useful, the graft easy to harvest, and did not lead to prolonged socket inflammation, infection, or extrusion.