自体中薄皮瓣移植治疗义眼台暴露1例

病例介绍 患者男38岁,因“右眼义眼台1期植入术后5年暴露1年”入院.病程中在外院三次行右眼义眼台暴露结膜切口对位缝合术、羊膜修补术及唇黏膜修补术,结果均失败.体检:右眼睑无红肿,右眼义眼台暴露约6mm×8mm,周围球结膜轻度充血,表面少量粘性物覆盖,眼台运动基本正常,余未见明显异常.完善各项检查后拟局麻下行义眼台暴露自体中薄皮瓣移植修复术.     

异体巩膜羊膜移植治疗义眼台暴露

目的：探讨以异体巩膜联合羊膜移植治疗羟基磷灰石义眼台植入后义眼台暴露的方法。方法：用钻磨器将暴露的羟基磷灰石义眼台打磨平滑，用异体巩膜和羊膜覆盖义眼台的暴露区。治疗10例，术后进行随访观察5－19月。结果：10例中9例术后8周结膜完全愈合，安装义眼后外观满意；1例后1周巩膜羊膜植片融解脱落，2周后取出义眼台。结论：异体巩膜联合羊膜移植治疗羟基磷灰石义眼台植入后暴露是效果良好的治疗方法。     

甘油长期冷冻保存巩膜及羊膜治疗义眼座暴露

目的:了解甘油长期冷冻保存的巩膜及羊膜在治疗羟基磷灰石义眼座暴露中的效果。方法:羟基磷灰石义眼座植入术后暴露的患者13例13眼,对暴露区清创后以甘油长期冷冻保存的巩膜及羊膜进行修补,术后随访6～12mo,观察巩膜血管化及羊膜上皮化时间。结果:羊膜植片在术后1wk内上皮化13例13眼,巩膜植片在术后10d左右出现血管化,无结膜囊狭窄及义眼座再暴露。结论:甘油长期冷冻保存的巩膜及羊膜用于修补羟基磷灰石义眼座暴露成功率高,修复快,效果较好。     

新鲜羊膜移植治疗义眼台暴露

目的评价新鲜羊膜移植冶疗羟基磷灰石义眼座暴露的临床疗效。方法彻底分离眼球筋膜囊缝合深埋或用异体巩膜覆盖暴露的义眼座,新鲜羊膜移植修补结膜囊缺损区。结果12例（12眼）羊膜植片生长良好,无感染,无融解。2月后结膜上皮覆盖羊膜表面,结膜囊愈合,全部安装义眼片。结论羊膜作为一种生物膜可以减轻炎症反应,阻止巩膜融解,有利于促进结膜上皮的爬行修复,用新鲜羊膜移植治疗义眼座暴露效果良好。     

自体眼球筋膜联合唇黏膜移植治疗义眼台暴露

目的探讨自体眼球筋膜联合唇黏膜移植治疗羟基磷灰石义眼台植人后暴露的临床应用。方法回顾分析我院义眼台暴露15例（15眼）,暴露时间术后2周一4个月。暴露范围4．10mm。围手术期进行抗感染药物治疗,术中将暴露区边缘眼球筋膜转位遮盖于暴露义眼台表面,将唇黏膜间断固定缝合于筋膜表面。术后涂抗生素眼膏加压包术眼3d。随访至术后6个月。结果所有15例于术后6～8周唇黏膜愈合良好,结膜囊形成良好,安装义眼后外观满意。随访期间未见义眼台再暴露。结论自体眼球筋膜联合唇黏膜移植是治疗义眼台暴露的有效方法,避免了应用异体组织修补排斥反应的发生,对治疗该并发症有临床意义。     

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。     

羊膜加巩膜前部覆盖防治羟基磷灰石义眼座眶内植入暴露的临床分析

目的:探讨羊膜加前部巩膜覆盖对防治羟基磷灰石(HA)义眼座植入暴露的临床效果。方法:采用羊膜联合自体或异体巩膜为加固物对13例(13眼)行Ⅰ、Ⅱ期HA义眼座植入,随访12～20mo。结果:13例均获得了较好的疗效,未见其他并发症。结论:在行HA义眼座植入时采用羊膜联合前部自体或异体巩膜覆盖加固有利于结膜创口的愈合,预防创口裂开,减少义眼座暴露。     

生物羊膜联合自体角膜缘上皮干细胞移植在难治性翼状胬肉中的疗效研究

目的探讨生物羊膜联合自体角膜缘上皮干细胞移植术在治疗难治性翼状胬肉中的疗效。方法对31例(31只眼)难治性翼状胬肉患者实施了生物羊膜联合自体角膜缘上皮干细胞移植术,术后随访3～8个月。结果植片无排斥反应发生,术后2周左右溶解吸收,角巩膜创面修复好、光滑。无1例复发。结论生物羊膜联合自体角膜缘上皮干细胞移植术对难治性翼状胬肉是一个简易、安全、有效的手术方式。     

羊膜及角膜缘上皮移植术治疗复发性翼状胬肉

目的 探讨羊膜移植联合角膜缘上皮移植术治疗复发性翼状胬肉的疗效。方法 对24例（28眼）复发性翼状胬肉患者一期实施羊膜移植联合自体角膜缘上皮移植术。结果 术后平均随访9.4月表明,羊膜植片无一例排斥反应,翼状胬肉有一例复发。结论 羊膜移植联合角膜缘上皮移植术治疗复发性翼状胬肉疗效显著。     

活动性义眼台联合自体深筋膜移植的临床观察

目的 观察活动性义眼台联合自体深筋膜移植术的临床效果.方法 将19例(19只眼)活动性义眼台联合自体深筋膜移植的病例分为两种植入方法,Ⅰ期植入术10例,Ⅱ期植入术9例;术后随访观察义眼台排斥、暴露、感染、眼球运动及义眼台血管化.结果 在19例患者中结膜均为一期愈合,未发现义排斥、暴露、感染及义眼台移位;17例眼球上、下、内、外4个方向活动良好,2例眼球运动较差,未发现眼球固定.结论 在缺乏自体巩膜包裹义眼台时,活动性义眼台联合自体深筋膜移植是减少手术并发症的一种重要方法.     

改良式肌锥内义眼台植入术

目的观察改良式肌锥内羟基磷灰石（HA）义眼台植入的临床效果。方法96例眼球摘除和眼内容摘除术后采取HA义眼台植入肌锥内,义眼台前部采用巩膜或阔筋膜完全包埋。结果术后随访3～24个月,无发生义眼台感染、暴露及脱出者,活动度达到预期目的。外观饱满,双眼对称性好。结论采取HA义眼台植入肌锥内,前部采用巩膜或阔筋膜包埋固定的方法,并发症少、疗效良好。     

Scleral fixation of posterior chamber intraocular lenses using fascia lata to cover the knots

BACKGROUND AND OBJECTIVE: To describe the use of fascia lata to cover the polypropylene knots of scleral fixated posterior chamber intraocular lenses (PCIOL). PATIENTS AND METHODS: Fascia lata was used to cover the knots of scleral fixated PCIOL in 5 eyes with significant scleral thinning. Four of the 5 eyes had the PCIOL insertion and the fascia lata patching in the same setting. The fifth eye previously had scleral fixated PCIOL with late suture erosion through a partial thickness scleral flap. RESULTS: There was no suture exposure or graft thinning throughout a follow-up period of 8 to 16 months. The eyes tolerated the fascia lata well with no early or late postoperative complications. CONCLUSION: Fascia lata provides an effective means to cover the knots of scleral fixated PCIOL, especially in aphakic patients with significant scleral thinning.     

Autogenous versus allograft fascia lata in frontal sling surgery --long-term results

PURPOSE: Either autogenous or allograft fascia lata frontal sling procedures can be used for the treatment of severe ptosis. We retrospectively evaluated the late outcomes of both approaches. METHODS: Medical records of patients who underwent frontal sling ptosis surgery between 1978 and 2000, with a follow-up of one year or more were included in the study. Success rates and the complications of the surgery for autogenous and allograft fascia lata were recorded. The results were compared statistically. RESULTS: Surgeries were performed with 82 autogenous or 43 allograft fascia lata. At last follow-up there were 71 eyes (86.6%) with good, 8 eyes (9.7%) with moderate, 3 eyes (3.7%) with poor results after autogenous fascia lata and 35 (81.4%), 3 (7%) and 5 (11.6%) after the allograft fascia lata frontal sling procedure. There was no significant difference between the two groups. Repeat surgery was carried out on three patients after autogenous and five after allograft fascia lata surgery. Two cases of preseptal cellulitis were observed, one abscess after autogenous and one lagophthalmus after allograft fascia lata sling surgery. All patients had slight edema early after surgery which resolved in a few days. Only one patient developed a hematoma at the site of the leg incision. CONCLUSIONS: Although the long-term success rate with the autogenous fascia lata is slightly higher and this remains the first choice, allograft fascia lata is a good alternative in patients in whom fascia could not be harvested.     

异体阔筋膜兜带术矫正下睑松弛及外翻

目的:探讨阔筋膜兜带术矫正下睑松弛及外翻的疗效。方法:1994～2001年采用异体阔筋膜兜带术矫正8例下睑松弛或外翻病例,术后随访6～24月。结果:8例患者下睑松弛外翻均得到矫正,无并发症发生。结论:异体阔筋膜兜带术对于麻痹性脸外翻和其他睑松弛外翻矫正术后失败者疗效良好。     

Endoscopic harvesting of autogenous fascia lata

PURPOSE: To describe a technique of endoscopic harvesting of autogenous fascia lata. METHODS: A retrospective, noncomparative clinical study to evaluate the technique of videoendoscope assistance in harvesting autogenous fascia lata was conducted during a 1-year period in 2002. A small incision approximately 2 cm long is made over the lateral aspect of the thigh, either as a low or high approach. A sheathed 4-mm rigid 0- or 30-degree endoscope is used to visualize the length of the fascia lata along both its superficial aspect and its undersurface. Standard endoscopic brow lifting instruments are then used to dissect a length of fascia under direct visualization. RESULTS: Three patients underwent harvesting of autogenous fascia lata under endoscopic visualization (2 high-thigh and 1 low-thigh technique). Adequate lengths of fascia lata, approximately 12 cm long, were harvested and no complications occurred. The endoscope was particularly useful in identifying the anatomical structures adjacent to the fascia. The technique was easy to use, but took twice as long as traditional harvesting techniques. CONCLUSIONS: Videoendoscopy allows complete visualization of anatomical structures during harvesting of autogenous fascia lata. It highlights the anatomy for teaching and provides an alternative approach to conventional harvesting methods.     

Long-term persistence of fascia lata patch graft in glaucoma drainage device surgery

PURPOSE: Conjunctival erosion in glaucoma drainage device surgery can be prevented by the use of patch grafts to cover the extraocular portion of the tube. Several materials can be used, among them human preserved fascia lata. METHODS: The authors present a case of a failed Ahmed glaucoma valve due to encapsulation of the bleb, in which the fascia lata patch placed to cover the tube was removed 32 months later, during the implantation of a second glaucoma drainage device. RESULTS: Histopathologic examination of the fascia lata patch demonstrated its persistence, without degradation or cellular infiltration. CONCLUSIONS: Human preserved fascia lata is a suitable material for tube covering in glaucoma drainage device surgery, with long-term survival.     

Surgical management of scleral defects

PURPOSE: To evaluate the results of surgical management of scleral defects using fascia lata, cornea, and sclera as graft materials. METHODS: The scleral defects of 8 patients were repaired surgically. Six had previous intraocular surgery, 1 had eye trauma, and the other had both intraocular surgery and trauma. Corneoscleral grafts were used in 3 eyes, scleral grafts in 4, and fascia lata was used in 1 eye. RESULTS: In 7 patients, we achieved the desired cosmetic and tectonic success. During the follow-up period, a recurrent defect was seen in 1 patient, and a second operation was required. CONCLUSIONS: Surgical techniques using fascia lata, corneal, and scleral grafts are effective for scleral defects.     

Processed fascia lata as an alternative implant material in evisceration

PURPOSE: To examine the use of processed fascia lata strips as an implant material in evisceration. METHODS: This is a prospective, interventional, noncomparative case series. Eight patients underwent standard evisceration of an eye with subsequent primary insertion of processed fascia lata strips in the scleral shell. They were clinically examined at regular postoperative intervals (up to 20 months) and had computed tomography and magnetic resonance imaging scans of the orbits at the 12-month interval. The development of vascularity of the scleral shell contents was assessed with the intravenous administration of a contrast-enhancing agent. RESULTS: The fascia lata strips were incorporated without significant complications in all cases. The maintenance of adequate volume and position of the eviscerated globe was confirmed by both computed tomography and magnetic resonance imaging scans. T1-weighted magnetic resonance imaging studies with intravenous administration of contrast-enhancing agent and fat-saturation sequences revealed the development of vascularity of the scleral shell contents. CONCLUSIONS: Processed fascia lata may be a useful alternative implant material in evisceration. Possible advantages of its use may include protection against extrusion, custom volume selection and easy intraoperative manipulation.