Bovine hydroxyapatite orbital implant: a preliminary report

PURPOSE: To determine the safety and efficacy of bovine hydroxyapatite as an orbital implant material. METHODS: Prospective, consecutive case series of patients undergoing enucleation, evisceration, or secondary orbital implantation. A motility peg was placed in all consenting candidates. Patients were followed 1 week, 1 month, and several months after surgery for signs of inflammation, infection, extrusion, or other complication. RESULTS: Twenty-seven patients received a bovine hydroxyapatite orbital implant. Magnetic resonance imaging was obtained in 3 patients (3 orbits) approximately 4 weeks after surgery and showed signs of peripheral fibrovascular ingrowth in all three cases. Magnetic resonance imaging was obtained in 9 patients (9 orbits) 4 to 12 months after surgery and showed signs of incomplete fibrovascular ingrowth in 1 of 9 (11%) cases, subtotal fibrovascular ingrowth in 2 of 9 (22%) cases, and complete fibrovascular ingrowth in 6 of 9 (67%) of cases. Complications included postoperative chemosis in 3 cases (11%) and exposure requiring reoperation in 2 cases (7%). Motility peg placement was performed successfully in 5 patients (5 orbits). CONCLUSIONS: Bovine hydroxyapatite appears to be a safe and effective orbital implant material. The material appears to be biocompatible and nonallergenic. Bovine hydroxyapatite allows for fibrovascular integration and motility peg placement.     

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。     

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.     

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.     

羟基磷灰石眼座眶内植入的临床研究

目的 观察眼球摘出后羟基磷灰石眼座眶内植入的疗效。方法 采用巩膜或硬脑膜包裹羟基磷灰石作为眶内植入物,观察１２７例的疗效。其中６６例摘出眼球或眼内容后１期植入,６１例２期植入。术后半年钻孔７４例。结果 随访１～３６月５例,出现眼座暴露,未见半年钻孔７４例。结论 羟基磷灰石眼座眶内植入并发症少,植入后外观,眼片活动度佳,能达到仿真效果。     

Polytetrafluoroethylene as a wrapping material for a hydroxyapatite orbital implant

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.     

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。     

Culture-proven Aspergillus fumigatus infection in a primary hydroxyapatite orbital implant

Hydroxyapatite orbital implants are widely used in enucleation surgery. Infection in this setting is an uncommon but severe complication. Herein a patient with a 3-year history of chronic socket discharge, orbital discomfort, conjunctival breakdown and implant exposure after enucleation and implantation of a hydroxyapatite sphere 7 years previously is reported. Repeated attempts at covering the exposed implant failed. Eventually the implant was removed, and Aspergillus fumigatus was cultured from the explanted material. This is the second reported case of Aspergillus infection of a hydroxyapatite orbital implant, and the first case where fungal cultures were positive.     

羟基磷灰石义眼座眶内植入139例分析

目的探讨带预置缝线的羟基磷灰石(hydroxyapatite，HA)义眼座直接植入眶内的手术效果。方法自1997年9月～2002年6月进行带预置缝线的HA义眼座直接植入眶内手术139例(139眼)，其中Ⅰ期眶内义眼座植入117眼，Ⅱ期眶内义眼座植入22眼。随访6～24月，平均11．8月。结果139眼术后出现轻微眼睑及球结膜水肿，4眼结膜切口裂开，经保守治疗自愈。2眼HA义眼座暴露，经修复后愈合。随访观察139眼义眼活动良好，眼窝饱满；Ⅰ期较Ⅱ期植入的义眼活动度大，外观更逼真。未发生义眼座脱出及感染等并发症。结论眼球摘除术后植入HA义眼座，提高了眼球运动效果和面部美观程度，效果较好。     

羟基磷灰石义眼台Ⅱ期眶内植入术术式的探讨

目的 探讨羟基磷灰石义眼台Ⅱ期眶内植入术的最佳手术方式。方法 对18例(18眼)眼球摘除(或眼内容摘除)术后1周至33年的患者采用羟基磷灰石义眼台Ⅱ期眶内植入，观察其疗效。其中无自体巩膜者15例中的7例采用异体巩膜包裹义眼台植入肌锥内；另8例不用异体巩膜包裹而直接将义眼台植入肌锥内。有自体巩膜者3例，在剪断外直肌及视神经后，将义眼台从颞侧植入肌锥内(巩膜壳后)。结果 术后眼眶及眼睑外观满意，义眼活动度良好，义眼台眶内固定，术后随访5～36月，除异体巩膜包裹的1例发生排斥反应而取出义眼台外，其余无发生义眼台移位、脱出或眶内感染者。结论 Ⅱ期羟基磷灰石义眼台直接植入眶内，比用异体巩膜包裹植入眶内，操作简便、术后无排斥反应、效果更好。     

眶内植入带线羟基磷灰石义眼座的临床分析

目的 探讨眶内植入带线羟基磷灰石（HA）义眼座的临床效果。方法 对85例（85眼）眼球摘除者眶内植入带线HA义眼座。结果 术后随访12-36个月,平均18个月。义眼座活动度良好。82例结膜创口Ⅰ期愈合,2例结膜变薄,1例结膜创口裂开,义眼座暴露。无眶内血肿或感染等并发症。结论 眶内植入带线HA义眼座手术操作简单,术后并发症少,美容效果佳,临床效果好。     

羟基磷灰石义眼台纤维血管化的实验研究

目的 研究手术方式对兔眼窝植入羟基磷灰石义眼台纤维血管化的影响。方法 将36只新西兰大白兔随机分为4组，分别对其左眼实施半巩膜壳内(A组)、多孔巩膜壳内(B组)、全巩膜壳内(C组)或巩膜瓣遮盖肌锥内(D组)4种不同术式义眼台植入术。不同时间采用Tc-99MDP显像或病理检查法检测各组义眼台纤维血管化程度。结果 第1、2周及第8周，各组间平均L／R值差异无显著性意义；第4周(F=7．482，P=0．009)和第6周(F=6．676，P=0．034)，C组低于其他3组，而A、B、D组间比较差异无显著性意义。第8周病理检查各组义眼台纤维血管化程度差异无显著性意义。结论 半巩膜壳内或多孔巩膜壳内植入义眼台效果最佳。     

羟基磷灰石眼座植入后上睑沟凹陷的处理

目的 评价羟基磷灰石或高密度聚乙烯作为填充物矫正眼座植入后上睑沟凹陷的疗效。方法 对34例患者行羟基磷灰石骨板或高密度聚乙烯垫入眼座下矫正上睑沟凹陷，用眼球突出计测量凹陷程度。结果 术后观察3－32月，平均10.3月，无1例继发感染，无排异，治愈率为85.3%，总有效率达到97.1%。结论 羟基磷灰石或高密度聚乙烯生物相容性好，作为填充物矫正效果确切。     

羟基磷灰石植入物眼窝成形术

目的观察眼球摘除后羟基磷灰石植入物眼窝成形术的疗效。方法采用巩膜包埋羟基磷灰石植入物作为眼球摘除（或眼内容剜除）术后眼窝成形的填充物，观察５０例眼窝成形术的效果，其中自体巩膜包裹羟基磷灰石球一期植入术４１例，异体巩膜包裹二期植入术９例。结果患者均获得良好的义眼运动。随访７～２３个月（平均１５．６个月），未发现眶内感染、植入物排出和移位现象。术后并发症少，效果满意。结论羟基磷灰石适合于任何需要眶内植入的患者。     

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。     

羟基磷灰石眼座植入后钻孔的临床研究

目的评价羟基磷灰石眼座植入后钻孔手术的疗效。方法146例HA植入6个月后行钻孔手术。用弧形视野计测量术前、术后义眼的活动度。结果义眼的活动幅度从术前的18.7±3.8度提高到42.3±3.7度。随访1～40个月无继发感染等并发症。结论钻孔手术放置栓钉后不仅义眼的活动幅度增加,而且大大提高其活动灵敏度,改善患者外观。     

羟基磷灰石义眼座Ⅱ期植入术中寻找眼外肌的手术体会

目的探讨羟基磷灰石（HA）义眼座Ⅱ期植入术中寻找眼外肌的方法,以减少并发症的发生。方法选择近5年来我科住院行HA义眼座Ⅱ期植入的其中73例（73只眼）患者,年龄5—74岁,男性多于女性,病因多样,以眼外伤最多见。手术方法：运用肌鞘-直肌法在内、外、上、下四个方位内寻找4直肌,选择相应大小的HA义眼座植入肌锥腔内,将4直肌固定于眼座表面,分层严密缝合筋膜组织、结膜。结果73例中有62例的四条眼外肌都可找到,其中包括视网膜母细胞瘤眼球摘除术后合并放疗的、眼座取出需再植入的、合并眶骨折的。其余11例中有3例视网膜母细胞瘤眼球摘除术后合并放疗的患眼找到3条直肌,2例眼座取出需再植入者找到2条直肌,5例严重眼外伤的找到3条直肌,仅1例患者只找到1条确切的直肌。植入后无1例发生眼座暴露,术后有5例发生上睑下垂,可能在寻找上直肌时损伤了提上睑肌所致,已通过手术予以矫正。结论循着肌鞘寻找眼外肌的方法不仅提高了手术成功率、减少了术后并发症的发生,而且防止了眼座的前移。此法适用于各种状况下的Ⅱ期眼座植入术。     

Osteogenesis in a human hydroxyapatite orbital implant 5.5 years after implantation

PURPOSE: We report the histological findings of a hydroxyapatite orbital implant 5.5 years after implantation. METHODS: The hydroxyapatite orbital implant was excised from the left orbit of a 17-year-old female, and it was decalcified and processed for routine light microscopic evaluation. RESULTS: The implant showed complete fibrovascularization with nearly complete osteogenesis with hematopoiesis. CONCLUSION: Bone may biointegrate throughout the pores of hydroxyapatite orbital implants.