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1.
Yin DF  Huang YF  He QH 《中华眼科杂志》2005,41(3):252-256
目的研究兔眶内植入甲基丙烯酸(MMA)改性甲基丙烯酸β羟乙酯(PHEMA)水凝胶义眼台的生物相容性和纤维血管化情况,为其临床应用奠定实验基础。方法将直径为14 mm的MMA改性PHEMA水凝胶义眼台分别手术植入32只兔眼眶内,分别于术后2、4、8、12及24周做单光子发射型计算机体层摄影术(SPECT)检查,并在不同时间点(2、4、8、12及24周)取出植入物进行光镜、免疫组化(Actin、Vimentin、CD34)及电镜观察。结果 SPECT检查改性PHEMA植入物在在体情况下随时间延长,同位素示踪剂在局部逐渐浓集。光镜、免疫组化、电镜检查结果显示2周时纤维血管组织从植入物外周长入,4~8周孔隙内胶原纤维逐渐致密,至12周全部纤维血管化。32例中仅1例术后出现结膜裂开、义眼台暴露,经二次手术修补愈后好。结论经改性的PHEMA水凝胶义眼台组织相容性好、血管化快,手术操作简单,并发症少,是一种安全、实用的新型眶内植入材料。  相似文献   

2.
保留角膜的巩膜在MMA改性PHEMA水凝胶义眼台中的应用   总被引:1,自引:0,他引:1  
目的:探讨MMA改型的PHEMA水凝胶义眼台植入时采用保留角膜的巩膜作为包裹材料的新型手术方法的术后效果,并进行相应病理研究.方法:新西兰白兔15只,右眼为手术眼,行眼内容剜除、保留角膜的巩膜包裹水凝胶义眼台植入术.术后0.5,1,2,3,6mo做单光子发射型计算机断层(SPECT)及病理检查.结果:SPECT及病理检查均显示植入物在2wk时有组织生长,12wk时达90%,24wk时完成血管化.15只兔中仅1眼在术后1wk出现结膜裂开,其余14只兔结膜愈合好,并发症的发生率为6.7%.结论:保留角膜的巩膜包裹水凝胶义眼台植入的手术方法,操作简单,组织损伤小,保证眼外肌正常解剖位置,避免义眼台移位,有利于义眼台的运动.  相似文献   

3.
目的:观察电纺丝(electrospinning)和异体巩膜作为水凝胶(hydrogel)义眼台包裹材料,用于实验兔眼的临床表现及病理组织学变化观察。方法:纯种新西兰兔20只,随机平均分为电纺丝包裹组和巩膜包裹组,行右眼眼球摘除术后。于肌锥内分别置入由电纺丝及异体巩膜包裹的水凝胶义眼台。术后观察眼部表现,于2,4,8,12wk,连同电纺丝或异体巩膜取出义眼台,光镜下观察包裹材料与义眼台的组织病理学改变,包括炎症反应及血管化情况;扫描电镜观察上述组织的超微结构改变。结果:所有动物均完成实验,20只大白兔均进入结果分析。光镜显示,术后2,4,8,12wk时两组植入物纤维血管生长速度基本一致,炎症及异物反应程度类似。电镜显示,早期电纺丝与水凝胶义眼台结合牢固程度强于异体巩膜组。结论:电纺丝结构特殊,纤维间结合较弱,有利于细胞拓展空间,提高了材料的细胞渗透性,作为义眼台包裹材料,较巩膜致密结缔组织更有利于血管化进程。电纺丝有望成为义眼台包裹材料的替代物。  相似文献   

4.
羟基磷灰石义眼台植入术后切口裂开的修复   总被引:3,自引:0,他引:3  
羟基磷灰石义眼台眶内植入是矫治眼球摘除或球内容物剜出术后眼窝凹陷及改善义眼活动度的较好方法,目前国内已广泛开展,实验研究表明羟基磷灰石植入眶内后能很好地与眶组织相容,使眼眶的纤维血管长进植入物,最终达到与眶组织形成一体化.义眼台植入方法简单,但常见而棘手的并发症为切口裂开,本文报道9例义眼台植入术后切口裂开的修复,探讨切口裂开的原因和修复的方法.  相似文献   

5.
目的 观察巩膜包裹羟基磷灰石义眼台植入法的临床效果.方法 用白体或异体巩膜包裹义眼台后眶内植入.Ⅰ期用自体巩膜植入12例,Ⅱ期用异体巩膜植入6例.结果 随访3月~2年,1例结膜囊狭窄,配置仿真义眼片困难,其余义眼活动良好,配戴仿真义眼片后眼外观满意.18例均无发生义眼台感染、排斥.结论羟基磷灰石义眼台眶内植入术,是眶美容的一种理想方法,自体巩膜包裹较异体巩膜包裹义眼台的义眼活动度及外观较好,尽量行Ⅰ期植入.  相似文献   

6.
目的:探讨羟基磷灰石(hydroxyapatite,HA)义眼台植入在眼科整形美容手术中的临床应用。 方法:对52例52眼患者采用不同的手术方式行HA义眼台植入。A组:自体巩膜壳内Ⅰ期植入24例24眼;B组:双层巩膜帽覆盖义眼台肌锥内Ⅰ期植入16例16眼;C组:异体巩膜包裹义眼台Ⅱ期植入12例12眼。 结果:术后随访3~24mo,大部分患者植入义眼台后眼球饱满,并获得一定的眼球活动度(优71.2%;良19.2%;差9.6%)。 结论:HA是当前理想的眶内植入物,应用于临床可以收到满意的效果。  相似文献   

7.
目的比较巩膜包裹羟基磷灰石(hydmxypatite,HA)义眼台植入法与带线HA义眼台直接植入法的疗效。方法眶内植入HA义眼台共58眼,用自体或异体巩膜包裹义眼台后眶内植入40眼,用带线义眼台直接植入眼眶18眼,随访3月-4年。结果义眼台暴露7眼12%(7/58),Ⅰ期1眼,Ⅱ期6眼;6眼采用巩膜包裹植入法15%(6/40),1眼采用带线义眼台直接植入法5.6%(1/18)。结膜囊狭窄1眼。结论HA义眼台植入术后主要并发症是义眼台暴露,用带线义眼台直接植入发生这种并发症的机率变小。  相似文献   

8.
目的:运用B超评估受体对无眼眼眶植入凝胶聚乙烯义眼台和多孔聚乙烯义眼台的反应。方法:兔36只行单侧眼内容物剜除并凝胶聚乙烯义眼台或多孔聚乙烯义眼台植入术,术后每周进行临床检查,术后30,60,90d行B超检查。结果:植入凝胶聚乙烯义眼台的兔除1只外,义眼台全都脱出,可能是凝胶义眼台吸水后体积增大造成的。B超检查显示随访期间凝胶义眼台内部无血管。植入多孔聚乙烯义眼台的兔有5只(27.8%),术后30d发生义眼台脱出。根据B超检查,多孔聚乙烯义眼台显示结构不规则有异质性,回声与血管组织类似。结论:如何确定植入兔无眼眼眶的凝胶聚乙烯义眼台的最佳大小,还需要进一步研究。我们的研究显示,B超能有效评估无眼球眼眶植入的义眼台,为进一步的活体研究提供了有用信息,有可能取代其他评估义眼台血管化的昂贵检查。  相似文献   

9.
多孔羟磷灰石眶内植入物的临床应用   总被引:2,自引:0,他引:2  
多孔羟磷灰石眶内植入物明显矫正了无眼球眼窝凹陷并增加了义眼的活动性。手术通常分两期进行,一期是在眼球摘除或球内容剜除时将羟磷灰石球植入眼肌锥内,二期是在植入物血管化后钻孔安放义眼活动栓钉,使义眼和栓钉通过球-窝状关节相连。本文介绍了羟磷灰石眶内植入物植入术的适应证、手术方法和并发症等。  相似文献   

10.
目的:对比观察眼内容除去术后生物陶瓷义眼台(法国FCI公司)及羟基磷灰石义眼台(美国IOI公司)植入的临床效果。方法:需行眼内容除去义眼台植入的患者73例73眼,随机分为A,B两组,A组35眼,B组38眼,两组患者均行眼内容除去I期义眼台植入术。A组植入生物陶瓷义眼台,B组植入羟基磷灰石义眼台。结果:术后随访6~15mo,A,B两组患者均未见义眼台暴露、移位及眶内感染,配戴义眼壳后外观满意,活动度佳。结论:眼内容除去后植入生物陶瓷义眼台安全有效,生物陶瓷义眼台是另一种可选择的眶内植入物。  相似文献   

11.
PURPOSE: We compared bovine pericardium and homologous sclera as wrapping materials for hydroxyapatite (HA) ocular implants in enucleated New Zealand white rabbits. METHODS: Eighteen rabbits were unilaterally enucleated and the sockets implanted with 10-mm HA spherical implants. Six implants were wrapped with homologous sclera, 6 with bovine pericardium, and 6 were not wrapped. The rabbits were killed 7 weeks later and the sockets were examined clinically for inflammation and implant exposure. Exenterated specimens were assessed histopathologically for inflammation and vascularization. RESULTS: No clinical evidence of implant exposure or extrusion was detected in rabbits receiving sclera or bovine pericardium wrapped implants. Histopathologically, the bovine pericardium displayed more inflammation in its outer portion, as well as more disruption of its lamellar arrangement than did the sclera. Fibrovascular in-growth was complete in all wrapped implants. CONCLUSION: Bovine pericardium behaves similar clinically to homologous sclera as a wrapping material for spherical HA ocular implants in a rabbit model, and may represent a reasonable alternative to sclera in such procedures in humans.  相似文献   

12.
PURPOSE: To compare the influence of seven currently available spherical orbital implant wraps on host fibrovascularization of a hydroxyapatite (HA) orbital implant. METHODS: Five groups of 3 (15 total) adult male New Zealand albino rabbits underwent enucleation with placement of a 12-mm HA implant wrapped in high-porosity expanded polytetrafluoroethylene (e-PTFE), processed bovine pericardium, or processed human pericardium, sclera, or fascia lata. Magnetic resonance imaging before and after the intravenous administration of gadolinium-diethylenetriamine pentaacetic acid (DTPA, 0.1 mol/kg) was performed immediately before exenteration. Five rabbits (one with each of the different implant wraps) were killed at 4, 8, and 12 weeks, and the operated socket was exenterated. Histopathologic sections of the implants were then compared with the results of our previous study using polyglactin 910 mesh and autologous sclera as HA orbital implant wraps. RESULTS: Complete fibrovascularization of all the implants occurred by 12 weeks; however, HA implants wrapped with sclera, polyglactin mesh, and e-PTFE appeared to undergo more rapid fibrovascularization than spheres wrapped with other materials. CONCLUSIONS: Although all of the implant wraps studied may be suitable substitutes for donor sclera, we prefer polyglactin mesh because it is readily available, inexpensive, and without risk of transmissible diseases.  相似文献   

13.
异形羟基磷灰石义眼台的临床应用   总被引:1,自引:0,他引:1  
张虹  李贵刚  胡军 《国际眼科杂志》2008,8(9):1863-1865
目的:观察异形羟基磷灰石义眼台植入术并发症及手术效果,探讨异形义眼台的适应证及其临床应用价值。方法:设计不同体积的异形羟基磷灰石义眼台,治疗眼球萎缩、眼内容物摘除及眼球摘除术后患者共30例。对照组植入常规圆球形羟基磷灰石义眼台共30例。异形义眼台组与对照组间性别、年龄、眼部情况相似。手术后随访时间6mo以上,观察患者义眼台植入术后球结膜愈合时间、义眼台暴露、感染等并发症、义眼台活动度、位置以及与义眼片适合程度的差异。结果:异形羟基磷灰石义眼台组没有发生义眼台暴露、感染等严重并发症,球结膜愈合时间短,义眼台植入后前表面呈圆弧形,能与义眼片很好的吻合,义眼台活动度及位置均好于对照组。对照组有2例(7%)发生早期球结膜裂开的并发症,经过治疗后均愈合。结论:异形义眼台可以降低义眼台植入后引起的并发症,可以有效适应患者眼部病变的情况,获得良好的手术效果,适应证更广,安全性更好。  相似文献   

14.
Long term follow up of bone derived hydroxyapatite orbital implants   总被引:8,自引:0,他引:8       下载免费PDF全文
AIMS: To document the long term experience of bone derived hydroxyapatite orbital implants and compare results using scleral wrapped implants with those not using sclera. METHODS: This retrospective case series reviewed the long term follow up of 118 patients with 120 eyes which had undergone enucleation and bone derived hydroxyapatite orbital implant insertion at Dunedin Hospital from 1977 until 2000. Patient details were obtained from theatre records, case note review, patient interview and examination, interview of patient relatives, and family general practitioner records. RESULTS: Of the 120 eyes 84 had bone derived hydroxyapatite orbital implants with sclera and 36 without sclera. Follow up was 0.5-25 years (mean 8.9 years). 25 (19.3%) suffered minor complications of limited exposure of the implant which resolved spontaneously, with implant drilling or wound resuture. Nine (7.5%) suffered major complications requiring explantation. Major complications were more likely in cases with major tissue disruption, ischaemia, or inflammation. There were significantly fewer complications in the group where a bone derived hydroxyapatite orbital implant was implanted without a scleral covering (p<0.05). CONCLUSIONS: The placement of a bone derived hydroxyapatite orbital implant in the socket was associated with a low rate of long term complications and good cosmesis in most cases. The omission of a scleral covering over the hydroxyapatite sphere had some advantages and may prove to be the procedure of choice.  相似文献   

15.
PURPOSE: Porous coralline hydroxyapatite orbital implants have been used with great success in anophthalmic sockets. We used a substitute for donor sclera as a wrapping tissue. METHODS: Orbital implants were wrapped with polytetrafluoroethylene (PTFE) instead of homologous donor tissue in five patients after enucleation. RESULTS: The postoperative course was uneventful in three cases. Complications occurred in two cases: one with implant exposure, and one with severe implant infection leading to its eventual removal. CONCLUSIONS: PTFE is inferior to other wrapping tissue.  相似文献   

16.
PURPOSE: To examine the incidence of orbital complications in patients who underwent primary placement of a porous polyethylene implant (Medpor) after enucleation. MATERIAL AND METHOD: Prospective non randomized case series of 75 consecutive patients in whom a porous polyethylene (PP) spherical implant wrapped with homologous sclera was implanted after enucleation. RESULTS: The mean age at the time of enucleation was 42.7 years (range, 1.4 to 80 years). The histopathological diagnoses after enucleation included uveal melanoma in 28 patients, retinoblastoma in 11 patients, phthisis bulbi in 23 patients, neovascular glaucoma in 5 patients, endophthalmitis in 3 patients, ruptured traumatic globe in 2 patients, microphthalmos in two patients, and medulloepithelioma in one patient. Thirty-four patients (45%) had had prior ocular surgery. The prosthesis was fitted after a mean interval of 4.5 weeks (range, 3 to 10 weeks). After a mean follow-up of 20 months (range, 3 to 33 months), there was one case (1%) of conjunctival dehiscence with material exposure secondary to massive postoperative orbital hemorrhage 2 weeks after enucleation. There was no case of orbital cellulitis, implant extrusion, or significant inflammatory response. No PP implant was drilled for peg placement. DISCUSSION-CONCLUSIONS: The anteriorly wrapped porous polyethylene orbital (Medpor) sphere appears to be well tolerated by all age groups with no major complication in primary implantation after enucleation.  相似文献   

17.
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.  相似文献   

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