273例眼球摘除和眼内容摘除的临床评价

回顾了我院1983年1月～1993年1月10年间眼球摘除和眼内容摘除273例,并对其主要病因、治疗进行了分析评价.报告如下:一般资料:10年间共行眼球摘除、眼内容摘出273例,占同期眼科住院病例5205例的5%.其中男184例,占67%,女89例,占33%.年龄最小15个月,最大75岁,平均34岁.右眼158例,左眼115例.术前无光感156例占57%,光感手动及眼前指数64眼占23%,0.01～1.0者25眼占9%,不明者28眼占11%.病因:本组病例中眼外伤为最多,有152眼占56%,而眼外伤中又以眼球破裂伤占首位,计89眼占眼外伤的59%.眼肿瘤为第2位,有76眼占28%,其中以视网膜母细胞瘤为主,计68眼占眼肿瘤组的 89%(表 1).     

眼球摘除及眼内容剜除174例临床分析

眼球摘除及眼内容剜除１７４例临床分析扬州医学院附属医院眼科庄朝荣，王晶本文分析了我院近１０年１７４例眼球摘除病例，现报道如下。１７４例均为单眼，右眼８１例，左眼９３例；女性７８例，男性９６例；年龄最小１岁，最大１０３岁。眼球摘除的病因：绝对期青光眼３...     

眼球摘除188例原因分析及义眼台植入的效果

目的对188例眼球摘除的原因进行分析，评价义眼台植入的效果。方法采用回顾性研究的方法，分析了眼球摘除的原因，并对眼球摘除的适应证及其并发症进行了讨论。结果眼球摘除的188例中，眼外伤93例，占49．47％；恶性肿瘤41例，占22．81％；失明伴眼痛、眼球萎缩及眼内炎等其他原因54例，占28．72％。其中义眼台植入76例，出现并发症者5例，包括2例结膜息肉，3例义眼台暴露。结论眼外伤是眼球摘除占首位的原因。眼球摘除后义眼台的及时植入，能改善外观，手术并发症少。     

22例眼内容剜出的原因及病理学分析

目的分析眼内容剜出的病理学分类以进一步探讨眼内容剜出的原因。方法对本院2001年1月至2007年8月眼病理室存档的22例（22只眼）眼内容剜出病例进行临床分析及组织病理学分析。结果感染性眼内炎12例（54．55％）,其中真菌性眼内炎7例;眼球萎缩7例（31．82％）;角巩膜葡萄肿2例（9．09％）;绝对期青光眼1例（4．55％）。结论感染性眼内炎尤其是真菌性眼内炎是眼内容剜出的首要原因,早期正确的诊治可避免眼内容剜出。     

眼球摘除义眼台植入术患者的心理疏导

目的 评价心理疏导对眼球摘除并义眼台植入术患者心理的积极作用.方法 对126位眼球摘除并义眼台植入术患者,在术前、术中及术后进行个性化心理疏导：术前建立互信,帮助患者树立信心,降低患者的期望值;术中语言安慰,适当抚触;术后鼓励患者快乐的情绪表达,调动自身积极因素,克服矫正长期形成的对体像的消极心态,重塑人格,提高自信心,提高患者对手术的满意度.结果 94.4％的患者达到了满意的心理预期值.结论 通过心理疏导以及降低患者的期望值,可以使患者达到“手术成功”的预期目的,提高心理素质和心理健康水平.     

眼球摘除及眼（眶）内容摘除81例临床分析

目的 眼球摘除及眼(眶)内容摘除属一种破坏性、毁容性手术,不能轻易实施.现对81例行此手术者探讨其适应症.方法 我院收治的各种眼外伤、眼肿瘤及其它相关眼病506例,其中81例施行眼球摘除或眼(眶)内容物摘除.结果 通过客观及相关仪器检查并积极处治后,对最终确认无法拯救视力及眼球的重度眼外伤、难以控制的眼内炎、跟恶性肿瘤等才能采取眼球摘除或眼(眶)内容物摘除术.结论对积极治疗最终不能挽救的患眼应在征求本人及家属意见并审报院上级同意备案后,方可施行手术眼球摘除或眼(眶)内容摘除.     

眼外伤致眼球摘除及眼内容剜除术53例临床分析

我院1991年6月至2004年6月行眼摘术125例,其中因眼外伤53例,占眼球摘除及眼内容剜除术的42.4%,居首位.现总结分析如下.     

眼外伤所致眼球,眼内容摘除原因分析

眼外伤是致盲致残的主要原因之一,伤情严重在伤后就诊不及时或处理不当易导致伤眼失明,甚至被迫作眼球或限内容摘除,造成终生痛苦。现将我院lop－lop年收治的5568例眼外伤中102例眼球和限内容摘除原因分析报道如下。临床资料：（1）我院24年中共收治眼外伤5568例,其中眼球服内容摘除102例,占1．83％。男朋例,女22例,男女之比为3．邱：1。2－6岁9例7~20岁31例,21~50岁55例,51~68岁7例,农民54例,工人17例,学生2例,学前儿童9例。锐器伤力例,钝挫伤兀例,爆炸伤35例,化学伤2例。受伤后H小时内就诊15例,2－7天就诊22例,8天以后…     

外伤后眼内容摘除的原因和Ⅰ期义眼座植入的特点

目的：分析外伤后眼内容摘除的原因和羟基磷灰石义眼座Ⅰ期植入的手术特点。方法：住院病例分析和随访观察，结果：27例27眼，眼内容摘除的原因；严重眼球破裂伤急诊手术3例，眼内炎10例，眼外伤并发症8例，按无菌术的观点，分为污染手术，感染手术和无菌手术3个类别。结论：严重眼球破裂伤，眼内炎和眼球外伤并发症是外伤后眼球丧失的主要原因。Ⅰ期植入义眼座手术可分为污染，感染和无菌3个类别。     

眼外伤致眼内容摘除168例临床分析

本文总结报告了本院10年间眼外伤致眼内容摘除168例，其中男性、农民、儿童发生较多。致伤物种类多达40余种，其中最多见的是树棒、铁丝、刀剪等。分析讨论了本地区发病率高的特点及适应本地区的预防措施。     

眼球摘除后二期羟基磷灰石眼座植入术

对１６例已行眼球摘除术的患者,二期植入带肌肉固定缝线的羟基磷灰石眼座,用含有眼直肌的组织瓣与其缝合固定,结果眼座活动均良好,外观较满意,本文为眼球摘除后的二期眼座植入提供了一种安全、简便及实用的方法。     

眼球摘除病因分析

本文分析１２２例眼球摘除病因。因眼肿瘤摘除５４例（４４．３％）占首位原因，第二位原因是绝对期青光眼２４例（１９．７％），第三位原因是眼球破裂伤２１例（１７．２％）。文中简单介绍减少眼球摘除手术的点滴体会。     

羟基磷灰石微粒在眼内容摘除术中的应用

目的观察羟基磷灰石微粒在眼内容摘除术中应用的手术方法和临床效果。方法对52例(52眼)严重眼球裂伤、绝对期青光眼以及眼球萎缩患者行眼内容摘除联合巩膜腔内植入羟基磷灰石微粒术。结果术后早期患眼多有不同程度的眼睑及结膜水肿,大多于术后5~7天明显减轻或消退。未见羟基磷灰石微粒暴露、脱出、感染或排异反应发生。配戴仿真义眼片后患眼外形满意。结论对严重眼球裂伤、绝对期青光眼以及眼球萎缩患者采取眼内容摘除联合巩膜腔内羟基磷灰石微粒植入术,效果良好。     

创伤导致眼球摘出49例临床分析

目的:分析因创伤导致眼球摘除的相关因素。方法:收集我院2005-07/2009-07因创伤而导致摘除眼球的所有患者资料,对其受伤时间、原因、年龄和职业等因素进行分析。结果:从受伤到住院摘除眼球时间1h~40a,平均4.9a;导致眼球摘除的首要眼病是眼球破裂伴眼内容物脱失,其次是继发性青光眼,再次是化脓性眼内炎;青光眼或白内障手术并发症是导致眼球摘除的首要原因,其次是木块和石块击伤;职业构成:占第一位的是从事农业或建筑行业人群,其次是从事个体经营和工厂工人。受伤主要年龄在41~60岁,其次是21~40岁。结论:眼外伤后应及时正确处理,应加强对特殊人群有关眼睛保护知识的培训,对基层眼科医生应该加强技能训练。     

羟基磷灰石在眼窝成形中不同术式的临床观察

目的 观察羟基磷灰石（HA）在眼窝成形中不同术式的手术效果。方法 据病眼条件采用不同术式的HA植入眼窝成形术,并对其手术效果进行比较分析。结果 不同术式的HA眼窝植入成形术手术效果有较大差异。50例中一期植入31例,随访期无显并发症,二期植入19例,其中下穹窿变浅3例,结膜切口裂开6例,义眼台裸露2例。结论 HA适于各种需行眼窝成形的患者,一期植入术,尤其是一期眼内容剜除自体巩膜囊盖HA植入术并发症少,义眼运动好。     

眶内植入羟基磷灰石义眼座的术式

羟基磷灰石(hydroxyapatite,HA)义眼台植入术,现已成为临床上广泛采用的眼球摘除或眼内容物剜除术后的主要手术方法,HA义眼台植入的并发症有结膜裂开、感染、义眼台暴露、排斥等,因此义眼台的选择,手术的方式,术后的处理至关重要,我们就手术的方式进行综述。     

Study of the indications and changing trends of enucleation and evisceration in West Malaysia

AIM: To study the demographic pattern and indications for enucleation and evisceration in West Malaysia, and to evaluate the changing trends of the same over the past three decades. · METHODS: In a retrospective hospital based study, case records of all patients who underwent enucleation and evisceration at University of Malaya Medical Centre over a period of 20 years (1985/2004) were reviewed. Age, gender, ethnicity of patients, indications for enucleation and evisceration were evaluated. · RESULTS: Out of 160 patients, enucleation was done in one eye in 85 patients and evisceration was done in one eye in 75 patients during the study period. The mean age of patients was 36.4 years with a range of 6 months to 90 years. In our study, panophthalmitis (26.9%) and retinoblastoma (18.8%) were the most common causes of evisceration and enucleation respectively. Infections of the eye contributed to 72.0% of eviscerations while tumors contributed to 51.8% of enucleations. There was a significant decrease in the removal of eyes over the past three decades in our hospital. The number of removal of eyes for glaucoma and trauma-related causes significantly reduced while removal for infection- related causes and painful blind eyes significantly increased when compared to the figures reported three decades ago from our hospital. · CONCLUSION: Panophthalmitis and intraocular tumors are the major indications for the removal of eyes. Although the frequency of removal of eye has significantly decreased over time in our country, the indications for the same suggest that there is a need of further improvement of eye care services in Malaysia.     

Autologous dermis graft at the time of evisceration or enucleation

Aim

To present a new technique using autologous dermis graft at the time of enucleation or evisceration to replace the ocular surface area lost when the corneal scleral button is excised.

Methods

A retrospective, interventional, non‐comparative case series of patients who had an autologous dermis graft placed to assist in closure of Tenon''s capsule and conjunctiva at the time of enucleation or evisceration. Medical records were reviewed and the following variables were recorded: age, sex, history of previous ocular surgery or radiation treatment, indication for surgery, type of surgery, laterality, type of orbital implant, size of implant, length of follow up, and complications.

Results

Nine patients were identified (three male, six female) Five had enucleation with implant placement and four had evisceration with implant placement. Four individuals received unwrapped porous polyethylene spherical implants, three received silicone implants, and two received hydroxylapatite implants. Follow up ranged from 30 to 112 weeks (mean (SD), 61 (28) weeks). No operative or early complications were observed. One patient who had enucleation after two rounds of brachytherapy for uveal melanoma developed subsequent late exposure of the implant. There were no complications involving the graft donor site.

Conclusions

This small series shows that the use of a dermis graft is a safe and effective new technique to facilitate orbital rehabilitation. It is hypothesised that the extra surface area produced with a dermis graft preserves the fornices and allows a larger implant. It may also allow the implant to be placed more anteriorly which assists with both implant and prosthesis motility.     

马来西亚西部眼球摘除术和眼内容摘除术的手术适应证及其变化趋势

目的:通过研究近30a马来西亚西部地区眼球摘除术和眼内容物摘除术的数据统计和手术适应证,观察其近30a的动态变化趋势.方法:通过回顾研究20a(1985/2004)在马来亚大学医学中心接受眼球摘除术和眼球内容摘除术病例资料,对患者的年龄、性别、种族及其手术适应证进行分析.结果:在全部160名患者中,85例单眼行眼球摘除术,75例单眼行眼内容摘除术,患者平均36.4岁(6mo～90岁).全眼球炎(26.9%)和视网膜母细胞瘤(18.8%)是眼球摘除术和眼球内容摘除术共同的病因,72.0%因眼部感染行眼球摘除术,51.8%因眼部肿瘤行眼内容摘除术.与30a前的统计数据相比较,我们医院近30a的眼球摘除率显著降低,因青光眼和眼创伤疾病导致眼球摘除的数量显著减少,而因感染和疼痛性盲眼导致的眼球摘除数量则有显著增加.结论:全眼球炎和眼内肿瘤是眼球摘除术的主要手术适应证,尽管现在在我国需要行眼球摘除术的病例数量较以前有显著降低,但手术适应证比例的变化提示我们,在马来群岛眼部的护理仍需要很大的改进.     

Enucleation and evisceration:indications, complications and clinicopathological correlations

AIM:To assess main indications, postoperative complications and clinicopathological correlation of ocular enucleation-evisceration.METHODS: A total of 107 subjects who underwent enucleation and/or evisceration and received hydroxyapatite implants (Scleral wrap or mesh) were assessed. For each patient clinicopathological data was collected which included demographic information, clinical history, primary clinical diagnosis, main cause of ophthalmic surgery (traumatic, non-traumatic), type of surgical procedure (enucleation, evisceration) and pathological report. Patients’ postoperative clinical visits were checked for procedure-related complications during first year after surgery.RESULTS:One hundred and seven patients (male:65.4%; mean age:26y) underwent enucleation (n=100) or evisceration (n=7) due to traumatic (n=41) and non-traumatic (n=66) causes. Disfiguring painful blind eye was the most common indication of surgery (66.4%), followed by leukocoria (19.6%) and endophthalmitis (4.7%). The main types of injury included ?recracker, traf?c and work accidents, and sharp object perforating injury. In 53 (80.3%) subjects in non-traumatic group the initial clinical diagnosis matched the histopathological results. Malignant tumors (retinoblastoma:47.5%, malignant melanoma:27.3%) were the most common pathological diagnoses followed by phthisis bulbi (25.8%). The most common procedure-related complications were major eye discharge (39.6%), and implant exposure and discharge (20.8%).CONCLUSION: Trauma and malignant tumors are the leading causes of enucleation-evisceration. Despite developing new techniques and materials, enucleation is still associated with considerable postoperative complications.