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。     

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。     

羟基磷灰石义眼台钻孔及栓钉置入术

目的 观察羟基磷灰石义眼台植入后钻孔及栓钉置入术的效果和并发平。方法 ４５例植入羟基磷灰石义眼台的患者,于术后０．５ａ左右行义眼台钻孔及栓钉置入。正确定位后用电钻或手工钻孔,拧入 孔螺钉,将平头钉插入螺钉孔内,结膜水肿消退后换圆头钉,配装活动性义眼。平均随访１３．６ｍｏ。结果 一次手术成功率为８２．２％。并发症有钻孔偏位、偏斜、孔浅钻孔处慢性肉芽肿、感染等,发生率为２２．２％。经治疗后不影响活动性义眼片安装。结论 羟基磷灰石义眼台钻孔及栓钉置入术改善义眼外观。钻孔及栓钉置入术的时机定位和钻孔准确是手术成功的关键。     

带和不带巩膜壳羟基磷灰石义眼台植入临床观察

目的比较不带巩膜壳和带巩膜壳羟基磷灰石义眼台植入术的疗效。方法30例不带巩膜壳羟基磷灰石义眼台植入者、30例带自体巩膜壳义眼台植入者、10例改良带自体巩膜壳义跟台植入者,术后随访1～10 a,对其疗效进行比较,以评价手术效果。结果30例带自体巩膜壳义眼台植入者,术后有5例发生肉芽肿形成,其中4例行义眼台取出术,1例经保守治疗痊愈。30例不带巩膜壳义眼台植入者有1例出现义眼台暴露。10例改良带自体巩膜壳义眼台植入者,无一例出现并发症。结论肉芽肿形成是带自体巩膜壳义眼台植入术后常见并发症,包裹的巩膜壳会影响义眼台血管纤维化,并发生融解和异物反应。改良带自体巩膜壳义眼台植入术可避免这一并发症,又可获得较好的美容效果。     

羟基磷灰石义眼座植入Ⅰ期钻孔的初步效果

目的 评价羟基磷灰石义眼座植入Ⅰ期钻孔放置钛钉的疗效。方法 对31例眼球摘除患者行Ⅰ期或Ⅱ期羟基磷灰石义眼座植入同时行钻孔,钻入钛钉的螺纹套子,中间放置平头钉,3～7个月后剪开,更换为球头钉,定制义眼片。结果 随访3．0～11．0个月(平均6．9个月),所有患者对义眼外观及活动度满意,无义眼座暴露、继发感染、栓钉脱出、栓钉偏斜等并发症。结论 羟基磷灰石义眼座植入Ⅰ期钻孔手术效果好,无明显增加并发症的发生机会,是一种可供选择的手术方法。     

带和不带巩膜壳羟基磷灰石义眼台植人临床观察

目的比较不带巩膜壳和带巩膜壳羟基磷灰石义眼台植入术的疗效。方法30例不带巩膜壳羟基磷灰石义眼台植入者、30例带白体巩膜壳义眼白植入者、10例改良带白体巩膜壳义跟台植入者，术后随访1—10a，对其疗效进行比较，以评价手术效果。结果30例带自体巩膜壳义跟台植入者，术后有5例发生肉芽肿形成，其中4例行义眼台取出术，1例经保守治疗痊愈。30例不带巩膜壳义眼台植入者有1例出现义眼台暴露。10例改良带自体巩膜壳义眼台植入者，无一例出现并发症：结论肉芽肿形成是带自体巩膜壳义眼台植入术后常见并发症，包裹的巩膜壳会影响义眼台血管纤维化，并发生融解和异物反应。改良带白体巩膜壳义眼台植入术可避免这一并发症，又可获得较好的美容效果。     

二期羟基磷灰石义眼台早期植入临床观察

目的：观察眼球摘除术后二期羟基磷灰石义眼台早期植入的临床特点。

方法：回顾性分析16例16眼二期羟基磷灰石义眼台早期植入原因、植入时间、手术特点、手术效果以及并发症。术后随访6～13(平均10)mo。

结果：眼球摘除术后外院转入,严重眼外伤眼眶内组织污染,眼内炎蔓延眼球摘除术后,眼内肿瘤术后是二期羟基磷灰石义眼台早期植入主要原因。16例患者在眼球摘除术后7～15(平均12)d成功行肌锥内二期羟基磷灰石义眼台植入术。术后患者外观改善,义眼台活动度良好,未见感染、义眼台暴露、脱出、眼睑下垂等并发症,1例早期球结膜裂开,再次缝合后愈合,1例结膜囊肿形成,手术切除后无复发。

结论：眼球摘除术后早期二期羟基磷灰石义眼台植入手术过程、效果类似一期义眼台植入。合理选择病例、良好的手术技巧基础上行早期二期羟基磷灰石义眼台植入安全有效。     

羟基磷灰石义眼台植入48例临床分析

目的:本文分析羟基磷灰石义眼台植入方式与术后义眼台暴露的注意问题。方法:对48例病例资料进行回顾性分析,全部采用自体巩膜包裹的手术方式,随访6mo～2a。结果:48例病例发生义眼台暴露仅2例,其中1例继发感染而取出。结论:羟基磷灰石义眼台植入术的最严重并发症是义眼台暴露,其原因是多方面的,但主要与手术方式关系最为密切,我们认为最好采取自体巩膜包裹的I期植入方式。     

羟基磷灰石义眼座Ⅰ期与Ⅱ期钻孔效果的比较

目的比较羟基磷灰石义眼座植入Ⅰ期钻孔与Ⅱ期钻孔放置钛钉的手术效果。方法对101例羟基磷灰石义眼座Ⅰ期钻孔及158例羟基磷灰石义眼座Ⅱ期钻孔放置钛钉者行回顾性研究。结果Ⅰ期与Ⅱ期钻孔者对其外观及活动度均满意,无义眼座暴露、继发感染或栓钉脱出等并发症。Ⅰ期钻孔101例,随访3～50月,义眼的活动度为44.8°±2.9°。Ⅱ期钻孔158例,随防6～60月,活动度为42.4°±3.8°。结论Ⅰ期和Ⅱ期钻孔手术在效果和并发症上无明显差别。     

重度眼球热烧伤Ⅰ期羟基磷灰石义眼台植入13例分析

目的 探讨重度眼球热烧伤行眼内容摘除联合Ⅰ期羟基磷灰石义眼台植入的疗效.方法 回顾性分析13例(13眼)重度热烧伤眼于眼内容摘除同时植入羟基磷灰石义眼台术后并发症.结果 术后6眼球结膜开裂,4眼义眼台暴露行再次手术修补,其中1眼义眼台感染最终取出;上睑凹陷2眼;结膜囊狭窄3眼;眼睑闭合不全2眼.结论 重度限球热烧伤Ⅰ期羟基磷灰石义眼台植入存在较多并发症,故植人手术方式和时机还有待进一步探讨.     

Pyogenic granuloma as a presenting sign of hydroxyapatite orbital implant exposure: a clinicopathologic study

PURPOSE: We report 5 unusual cases of exposed hydroxyapatite orbital implants that presented as pyogenic granulomas. We propose pathogenesis and histopathologic correlations. METHODS: A clinicopathologic study of 5 patients with hydroxyapatite implants who presented with pyogenic granuloma. RESULTS: Pyogenic granulomas were detected 1.5 to 30 months after implantation in 5 patients. The lesions were multiple but were not related to the wound margin at the exposed area and were not covered by the surface epithelium in most instances. Exposure defects were detected in all patients at the time of lesion excision. The mean exposure size in the greatest dimension was 16 mm (range, 9-20 mm). Three patients were treated successfully with simple excision of the granulomas, burring down of the anterior surface of the implants, and direct repair of the exposure defects. Explantation of the implant was performed in 2 cases. Histopathologic examination revealed chronic inflammation and microabscess formation in the explanted implants. CONCLUSIONS: Five patients with pyogenic granulomas were found to have hydroxyapatite exposure. Pyogenic granuloma should not be considered a benign lesion on a hydroxyapatite orbital implant, especially in recurrent cases. Ophthalmologists must be aware of the possibility of conjunctival dehiscence with hydroxyapatite-implant exposure beneath the lesion.     

Aspergillus mycetoma in a secondary hydroxyapatite orbital implant: a case report and literature review.

OBJECTIVE: The authors describe the first case report of a fungal abscess within a hydroxyapatite orbital implant in a patient who had undergone straightforward secondary hydroxyapatite implant surgery. DESIGN: Case report and literature review. INTERVENTION: Four months postoperatively after pegging and 17 months after original implant placement, chronic discharge and socket irritation became evident. Recurrent pyogenic granulomas were a problem, but no obvious area of dehiscence was present over the implant. The peg and sleeve were removed 31 months after pegging (44 months after original placement of the implant). The pain and discharge did not resolve, and the entire hydroxyapatite orbital implant was removed 45 months after sleeve placement and 58 months after initial implant placement. The pain and discharge settled rapidly. MAIN OUTCOME MEASURES: Cultures and histopathology. RESULTS: Results of bacterial cultures were negative. Results of histopathologic examination of the implant disclosed intertrabecular spaces with multiple clusters of organisms consistent with Aspergillus. CONCLUSIONS: Persistent orbital discomfort, discharge, and pyogenic granulomas after hydroxyapatite implantation should cause concern regarding potential implant infection. The authors have now shown that this implant infection could be bacterial or fungal in nature. This is essentially a new form of orbital Aspergillus, that of a chronic infection limited to a hydroxyapatite implant.     

Problems after evisceration surgery with porous orbital implants: experience with 86 patients

PURPOSE: To assess the problems associated with the use of 4 types of porous orbital implant (Bio-Eye coralline hydroxyapatite, FCI3 synthetic hydroxyapatite, aluminium oxide [Bioceramic], and porous polyethylene [Medpor]) after evisceration surgery. METHODS: A retrospective analysis was made of all cases of evisceration with placement of one of four types of porous orbital implants performed between 1991 and 2002 by one surgeon (n = 86). Patient age, implant type and size, surgery type (standard evisceration or evisceration with posterior sclerotomies), peg system used, follow-up duration, time of pegging, problems before and after pegging, and treatment were recorded. RESULTS: Eight patients had less than 6 months of follow-up. The other 78 patients were followed for 6 to 107 months (average, 31 months). The following problems were noted before peg placement: discharge, 8 patients (10.2%); implant exposure, 6 patients (7.7%); implant fracture at the time of surgery, 1 patient (1.3%); persistent pain, 1 patient (1.3%). Of the 29 patients who had pegging, problems including discharge, exposure, pyogenic granuloma, infection, and peg sleeve problems occurred in 23 (79.3%). Sixteen (55.2%) of the 29 patients required at least 1 additional surgical procedure, 4 required 3 additional procedures, and 2 required 5 additional procedures, including implant removal. CONCLUSIONS: Although primary evisceration with posterior sclerotomies and placement of a porous orbital implant is an accepted technique for treating a variety of end-stage eye diseases, patients should be cautioned about an increased likelihood of problems and potential need for additional surgeries if pegging is considered.     

Experience with 120 synthetic hydroxyapatite implants (FCI3)

PURPOSE: To assess the problems and/or complications associated with the use of a synthetic hydroxyapatite implant (FCI, Cedex, France). METHODS: The authors analyzed all of the problems and/or complications associated with the use of a third-generation synthetic hydroxyapatite implant (FCI3) in 120 patients by one surgeon over 4 years. The following data were recorded: age, type of surgery performed, size of implant used, peg system used, follow-up duration, time of pegging, problems and/or complications encountered, and treatment. RESULTS: Thirteen patients were lost to follow-up after 3 months, leaving 107 patients who were followed up from 4 to 48 months (average, 29 months). Discharge occurred in 21 (19.6%) patients, implant exposure in 3 (2.8%), socket discomfort in 2 (1.9%), trochleitis in 2 (1.9%), conjunctival thinning in 1 (0.93%), and pyogenic granuloma in 1 (0.93%). Peg problems occurred in 24 (35.2%) of 68 patients. Problems encountered with the peg were discharge in 10 (14.7%) patients, pyogenic granuloma in 9 (13.2%), conjunctiva overgrowing the peg in 4 (5.8%), hydroxyapatite exposure around the sleeve in 3 (4.4%), loose sleeve in 3 (4.4%), peg drilled on an angle in 1 (1.5%), implant infection in 1 (1.5%), and peg falling out in 1 (1.5%). CONCLUSIONS: The FCI3 synthetic hydroxyapatite is a less costly alternative form of hydroxyapatite currently in use in many parts of the world. Problems and complications encountered with its use are similar to those seen with the Bio-Eye Integrated Orbital Implants, Inc., San Diego, CA, U.S.A. The incidence of exposure associated with the synthetic hydroxyapatite implant is lower than several other reports on the Bio-Eye. The synthetic hydroxyapatite implant is slightly softer than the Bio-Eye and fractured under extreme pressure in one case.     

Coralline hydroxyapatite orbital implant (bio-eye): experience with 158 patients

PURPOSE: To assess the problems seen in 158 patients with coralline hydroxyapatite (HA) orbital implants (Bio-Eye). METHODS: A consecutive case series of 170 patients receiving coralline HA implanted by two surgeons over a 5-year period were reviewed. The authors analyzed age, type of surgery, implant size, peg system, follow-up duration, time of pegging, problems encountered, and treatment. RESULTS: Twelve patients were lost to follow-up after 5 months, leaving 158 patients who were followed from 6 to 130 months (average, 39 months). Problems in unpegged implants occurred in 36 (22.8%) patients. Discharge occurred in 18 (11.4%) patients, implant exposure in 12 (7.6%), socket discomfort in 1 (0.6%), conjunctival thinning in 3 (1.9%), chronic conjunctival swelling in 2 (1.3%), and implant infection in 3 (1.9%). Problems after pegging occurred in 68 (50.7%) of 134 patients: discharge in 27 (20.1%), pyogenic granuloma in 24 (17.9%), conjunctiva overgrowing the peg in 4 (3.0%), implant exposure around the sleeve in 5 (3.7%), clicking in 6 (4.5%), peg on an angle in 2 (1.5%), loose sleeve in 1 (0.7%), peg falling out in 18 (13.4%), popping peg in 1 (0.7%), poor transfer of movement in 3 (2.2%), pain with movement in 1 (0.7%), and implant infection in 2 (1.5%). CONCLUSIONS: The Bio-Eye orbital implant represents a porous orbital implant that is biocompatible with orbital tissues and allows fibrovascular ingrowth and improved motility when coupled to the overlying artificial eye. It is more expensive than other commercially available porous orbital implants, such as synthetic FCI3 HA, porous polyethylene (Medpor), and aluminum oxide (Bioceramic) implant. Problems encountered with its use are similar to those problems seen in patients with the synthetic FCI3 hydroxyapatite and aluminum oxide orbital implants.     

Clinicopathologic analysis of 15 explanted hydroxyapatite implants

PURPOSE: To report the clinical findings, treatment, outcomes, and histopathologic findings in patients with suspected orbital implant infection requiring implant removal. METHODS: Retrospective, observational case series of 14 patients (15 hydroxyapatite orbital implants) undergoing implant removal from September 1994 through December 2002. Patient age, type of surgery, implant type, symptoms, treatment, histopathology of implant, and follow-up course were analyzed. RESULTS: Of the 14 patients, 7 were female and 7 were male. The mean age at explantation was 42 years. The most common symptoms were discharge and socket tenderness. The most common signs were conjunctival inflammation (edema, hyperemia), discharge, and recurrent pyogenic granuloma. Clinical evidence of infection was documented in 13 patients. Histopathologic assessment of the 15 explanted implants showed acute inflammation and necrosis (abscess) with identification of microorganisms (5 patients), acute inflammation and necrosis without identification of microorganisms (4 patients), chronic inflammation with identification of microorganisms (1 patient), chronic inflammation without identification of microorganisms (3 patients), and a predominant foreign body granulomatous response without identification of microorganisms (2 patients). Osseous metaplasia was seen in 10 implants. Prompt resolution of symptoms and signs occurred in all but one case. CONCLUSIONS: The clinical course of porous orbital implant infection may be prolonged, and the early symptom of recurrent discharge, a common problem for implant recipients, may delay diagnosis. Implant infection should be suspected when there is persistent conjunctival inflammation and discharge after implant placement despite antibiotic therapy, discomfort on implant palpation, and recurrent pyogenic granuloma (indicative of implant exposure). Implant removal is usually required in these cases. If orbital pain (not necessarily related to implant palpation) is the main complaint, without signs of conjunctival inflammation and with or without discharge, one should consider other reasons for the symptoms.     

Six cases of bacterial infection in porous orbital implants

BACKGROUND: We present 6 cases of bacterial infection that developed after porous orbital implant surgery. CASES: Five patients with hydroxyapatite implants showed lid swelling, discharge, and suppurative granuloma 14 days to 3 years after surgery. The hydroxyapatite implants were removed 14 days to 41 months postoperatively, and synthetic porous polyethylene orbital implants were inserted. Thick discharge and conjunctival melting was noted 14 months after primary Medpor implant surgery in the sixth patient, and the infection was controlled by medical therapy. OBSERVATIONS: The culture of specimens removed with swabs from the conjunctiva of patients and from the hydroxyapatite implants showed growth of Staphylococcus aureus, Staphylococcus epidermidis, alpha-hemolytic streptococcus and peptostreptococcus in 4 patients, whereas Streptococcus pyogenes were cultured from the conjunctiva in the Medpor implant patient. Culture for the remaining patient was negative .CONCLUSIONS: If there is continuous pain, injection, and discharge after porous implant insertion, bacterial infection in the implant should be considered immediately. Systemic antibiotics and topical eye drops should be administered without delay. If no improvement is observed, the implant should be removed and a different approach must be considered.