改良唇粘膜移植结膜囊成形联合Ⅱ期羟基磷灰石义眼座植入术

目的 探讨同期唇粘膜移植结膜囊成形联合Ⅱ期羟基磷灰石义眼座植入术的手术方法及临床效果。方法 对16例眼球摘除术后结膜囊缩窄患者行改良唇粘膜移植结膜囊成形联合Ⅱ期羟基磷灰石义眼座植入术，观察术后眼窝内陷矫正、结膜囊成形及移植唇粘膜愈合情况，义眼座有无外露、感染及活动度。结果 移植唇粘膜全部成活，眼窝内陷基本矫正，眼座无外露，患者满意。结论 改良有唇粘膜移植结膜囊成形联合Ⅱ期羟基磷灰石义眼座植入术是治疗眼球摘除术后眼窝内陷、结膜囊缩窄的理想方法。     

羟基磷灰石义眼座植入后暴露原因分析与处理

目的 探讨分析羟基磷灰石(HA)义眼座植入后暴露的原因及处理。方法 对 11例 HA义眼座植入后发生暴露的患者进行回顾性总结分析。结果 HA义眼座轻度暴露<5mm,一般不须处理,2～9个月可以愈合。中度暴露≤10mm,可药物观察治疗,也可行结膜修补术。重度暴露10～25mm,巩膜溶解HA义眼座大面积暴露,行HA义眼座取出,结膜囊修补,自体真皮脂肪瓣修补缺损区。结论 义眼座暴露为HA义眼座植入术后较严重并发症,真皮脂肪瓣,保存人羊膜都可用于结膜囊形成与修复,双层袋状巩膜缝合,置于HA义眼座前,可有效减少植入物的脱出。     

后巩膜瓣旋转覆盖义眼座巩膜腔内植入术临床分析

目的:为了达到最佳的运动和仿真效果及长期的稳定,设计后巩膜瓣旋转覆盖巩膜腔内Medpor义眼座植入术,并评价此术式的手术适应证和疗效。方法:2008-01/2011-07在深圳市眼科医院接受眼内容剜除后巩膜瓣旋转覆盖巩膜腔内Medpor义眼座植入术120例患者:眼内容摘除后制作后巩膜瓣,将义眼座植入后方开放的巩膜腔内,旋转后巩膜瓣覆盖在义眼座表面,缝线固定义眼座。随访1～3a,记录最后一次就诊时的义眼座活动度,义眼片活动度,结膜囊剩余面积,结膜囊深度,并发症发生情况。结果:义眼座活动度:115例为优,5例为良;义眼片活动度89例为优,26例为良,5例为差;平均结膜囊剩余面积为178.1±7.5mm2;平均结膜囊深度为2.7±1.1mm;2例出现义眼座暴露感染,3例出现结膜下植入性囊肿,2例出现义眼座固定缝线外露,未出现义眼座内陷、上眶区凹陷、结膜囊狭窄、下睑外翻、眼眶蜂窝织炎。结论:后巩膜瓣旋转覆盖Medpor义眼座巩膜腔内植入术对于轻中度眼球萎缩、角巩膜葡萄肿、绝对期青光眼患者具有良好的治疗效果。     

新鲜羊膜联合唇黏膜移植治疗义眼座暴露的疗效观察

目的：探讨新鲜羊膜联合唇黏膜移植治疗义眼座暴露的手术方法及临床效果。

方法：对24例义眼座植入术后义眼座暴露的患者行新鲜羊膜联合唇黏膜移植,观察术后义眼座有无外露、感染。

结果：移植唇黏膜全部成活,眼座无外露,结膜囊无缩窄,患者基本满意。

结论：新鲜羊膜联合唇黏膜移植是治疗义眼座暴露的理想方法。     

Medpor义眼座植入术矫正眼窝凹陷畸形临床观察

目的探讨多孔聚乙烯义眼座(M edpor)植入矫正眼窝凹陷畸形手术效果。方法 55例(55只眼)包括眼球萎缩、眼球摘除术后、眼内容摘除术后及合并结膜囊狭窄的患者,随机植入M edpor义眼座或羟基磷灰石义眼座,随访观察术后义眼座暴露、感染等并发症情况,比较手术疗效。结果 Medpor义眼座与羟基磷灰石义眼座能取得相同的良好的治疗效果,但前者并发症更少。结论 Medpor义眼座植入术疗效可靠,Medpor具有良好的组织相容性,是矫正眼窝凹陷畸形的理想材料。     

羟基磷灰石义眼座植入后暴露原因分析与处理

目的 探讨分析羟基磷灰石（HA）义眼座植入后暴露的原因及处理。方法 对11例HA义眼座植入后发生暴露的患进行回顾性总结分析。结果 HA义眼座轻度暴露＜5mm，一般不须处理，2－9个月可以愈合。中度暴露≤10mm，可药物观察治疗，也可行结膜修补术。重度暴露10－25mm，巩膜溶解HA义眼座大面积暴露，行HA义眼座取出，结膜囊修补，自体真皮脂肪瓣修补损区。结论 义眼座暴露为HA义眼座植入术后较严重并发症，真皮脂肪瓣，保存人羊膜都可用于结膜囊形成与修复，双层袋状巩膜缝合，置于HA义眼座前，可有效减少植入物的脱出。     

增强核磁共振成像观察人眼羟基磷灰石义眼座的纤维血管化过程

目的:利用增强核磁共振(MRI)动态显像技术监测人眼羟基磷灰石(HA)义眼座完成纤维血管化的时间,对HA义眼座纤维血管化的MRI图像信息和量化数据进行研究,以证实MRI在评价义眼座纤维血管化程度方面的临床应用价值。方法:选择临床行眼内容物剜除术及一期HA义眼座植入术的患者15例15眼,自第1mo开始,每月1次,连续7次,每次均由放射科医师进行增强MRI的相关检查并计算MRI(VE/VHA)比值(VE为义眼座强化区体积,VHA为义眼座体积)。结果:人眼HA植入术后前6mo间依次比较MRI图像中VE/VHA比值显著增加,第6mo后不再增加。结论:核磁共振成像(MRI)可作为HA义眼座术后血管化程度监测的影像学依据。正常人眼眶内植入直径20mm的HA义眼座在6mo后完全纤维血管化。     

多孔聚乙烯义眼座植入术治疗复杂性眼窝畸形

目的探讨多孔聚乙烯义眼座植入术对复杂性眼窝畸形的手术治疗方法和临床效果.方法对30例无眼球或眼球萎缩伴眼窝塌陷畸形的患者,行高密度多孔聚乙烯(high-density porous polyethylene,MEDPOR)义眼座植入联合穹隆成形术.结果所有患者眼窝畸形均得以矫正,随访3月～2年,义眼座在眼眶内无脱出、移位或感染.装入仿真义眼片后,双眼对称,义眼活动度可达10°～20°度.结论多孔聚乙烯义眼座植入联合穹隆成形术矫治复杂性眼窝畸形在总体上取得了良好的效果.多孔聚乙烯义眼座具有良好的组织相容性,是矫正眼窝塌陷畸形的理想材料.     

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。     

羟基磷灰石义眼座两种不同术式植入的临床效果观察

目的观察两种不同术式植入羟基磷灰石(HA)义眼座的手术效果。方法对38例(38只眼)行眼球内容物剜除术的患者随机分组,A组:21例(21只眼)采用巩膜花瓣状成形义眼座植入术。B组:17例(17只眼)采用巩膜帽状扣盖义眼座植入术,观察两组术式的疗效和远期并发症,随访6~24个月。结果随访期间38例患者术后义眼座活动灵活,眼窝饱满,无义眼座暴露及感染等并发症的发生。结论对于眼内容物剜除的患者,采用巩膜花瓣状成形义眼座植入术或是巩膜帽状扣盖义眼座植入术,均能获得良好的效果。两种术式损伤均小,简便易行,术后并发症少,值得推广。     

Bovine bone xenograft as orbital implants in rabbit eyes

AIM: To assess the biocompatibility of bovine bone as orbital implants in rabbits. METHODS: Bovine bone graft was used as an ocular im- plant in rabbits to determine whether it could be successfully used in the anophthalmic socket as an alternative to the expensive synthetic alloplastics. Evisceration of eyes with and without bovine bone orbital implantation was performed in the right eyes of 12 New Zealand white rabbits. Group Y (n = 6) was eviscerated without implant, meanwhile Group X (n = 6) was eviscerated with insertion of an orbital implant using bovine bone. Observation was carried out on day 1, day 7, day 14, day 28 and day 42. Serial clinical examination was carried out based on a few fixed criteria, which included rate of infection, implant migration, evidence of wound breakdown and any restriction of intraocular movements. The implanted eyes were then enucleated on day 42. The enucleated eyes were sent for histopathological evaluation to record the type of inflammatory reaction and rate of fibrovascular ingrowth. RESULTS : Serial clinical examination showed presence of mini- mal infection in all eyes, both in Group X (implanted) and Group Y (control) on first postoperative day, which responded well with antibiotics. Infection occurred in the implanted group after first postoperative day, but there was no evidence of orbital migration or extrusion of implant, wound breakdown, restriction of extraocular movement, severe infection or any physical abnormality. Histopathological examination revealed good fibrovascular ingrowth in the implanted group, with minimal rejecting reaction of rabbit eye towards bovine bone implant. CONCLUSION: This study shows that bovine orbital implant has a good biocompatibility in rabbit eyes and its cost is acceptable.     

A Histopathologic Study of Orbital Implant Vascularization

Purpose: To histopathologically assess the extent and pattern of vascularization of explanted porous polyethylene (PP) and hyrdoxyapatite (HA) orbital implants. To compare the vascularization in PP implants harvested after enucleation versus after evisceration. Methods: This is a comparative case series of six orbital implants explanted between 11 months and 5 years and 4 months post implantation. The implants were subjected to histopathological examination with various stains, after complete decalcification. Results: There were 2 post evisceration, 3 post enucleation and 1 secondary implant. The size of the implants varied from 18 to 23 mm diameter. The reason for explantation was exposure in all the 6 cases with additional infection in 2 cases. Histopathology revealed complete vascularization up to the core of the implant in all the cases. There was evidence of chronic inflammation within all the explanted specimens. Acute inflammation was present at the site of exposure in four of the implants. Three of these implants had additional evidence of necrosis. Two cases with clinically evident infection had Gram positive cocci within the implant. Foreign-body type giant-cells, melanophages and haemosiderin laden macrophages were also observed. Eviscerated specimens showed scleral remodelling and thickening. Conclusion: All the implants were vascularized up to the core. There was histologic evidence of chronic inflammation in all the explanted implants possibly indicating the foreign nature of the implant material. The sclera did not impede vascularization of the implants in eviscerated specimens. We found no difference in the degree of vascularization of the implant in enucleated versus eviscerated implants.     

牛骨异种移植物作为义眼座兔眼眶内植入术

目的:评价以牛骨作为义眼座在兔眼眶内植入的生物相容性。方法:在兔眼中用牛骨作为植入物,观察其生物相容性及其能否取代昂贵的人造植入物。把12只眼球内容摘除术后的新西兰白兔按眶内有没有植入牛骨分为两组:Y组(6只)为眼球摘除术后眶内没有植入牛骨,X组(6只)为眼球摘除术后植入牛骨。对12只新西兰白兔右眼行眼球内容物摘除,其中6例作为实验组行牛骨植入,6例作为对照组不植入。术后1,7,14,28,42d连续观察术眼的感染情况,植入物的移位情况,伤口愈合情况,眼球运动是否受限。术后42d,摘除实验组眼球,行组织病理检查,检测其炎性反应类型以及纤维血管增生情况。结果:连续临床观察显示:试验组和对照组在术后1d都有轻微的炎症反应,抗生素控制有效。试验组有1例在术后1d发生感染。但没有植入物的移位和脱出,没有伤口的裂开和眼球运动受限,也没有严重的感染和畸形出现。组织病理检查显示牛骨纤维生长良好,有轻微的排斥反应。结论:实验表明在兔眼中,牛骨作为义眼座植入有良好的生物相容性,而且其成本较低,易被接受。     

Primary replacement for the management of exposed orbital implant

Purpose: We present a series of primary orbital implant replacement for cases of implant exposure to describe our experience of this one-staged surgical approach.

Methods: This study reports on a one-stage technique which involved the removal of the exposed implant or dermis fat graft (DFG) and insertion of a secondary (replacement) in the same procedure, with a variety of materials, including autologous tissue. Re-exposure in a socket where a DFG was placed was defined as a new defect in the newly epithelialized conjunctiva or dehiscence of the dermis-conjunctiva junction. All cases of primary replacement for the management of exposed orbital implant, porous and non-porous, were included, even when there were clinical signs suggestive of infection. The primary outcome was the rate of re-exposure, requiring additional surgical procedures. Infection following primary replacement was a secondary outcome.

Results: Seventy-eight patients had primary replacement for the management of an exposed orbital implant. 6.4% had re-exposure at a mean follow-up of 49.7 months (9.1% for ball implants and 4.5% for DFG). The rate of exposure was higher in those with prior signs of infection than those without (8% vs. 3.6%). Re-exposure occurred in 4.5% of cases with DFG implantation, 4.3% of cases with non-porous implants and in 20% of cases with porous implants.

Conclusion: Primary replacement for management of exposed orbital implant, porous and non-porous, has a high rate of successful outcome even in cases with presumed or confirmed infection.     

Evisceration with Primary Orbital Implant in Fulminant Endophthalmitis/Panophthalmitis

Purpose: To compare the outcome of evisceration with primary orbital implant in blind eyes with and without fulminant infection (endophthalmitis/panophthalmitis).

Methods: Retrospective nonrandomized comparative interventional case series. Patients with a minimum postoperative follow-up of 6 months were considered for inclusion. Thirty-four eyes of 34 patients were included. Sixteen eyes were infective and 18 noninfective. Nonporous silicone implants were used for all cases and the main outcome measure was successful retention of the primary implant. Major and minor complications and successful prosthesis fitting were also noted.

Results: All except 3 cases were able to retain the primary implant successfully and all but 2 patients underwent successful prosthesis fitting. Major complications included implant extrusion in 3 cases (2 infective, 1 noninfective) and implant exposure in 1 case (noninfective). The difference in major complications between the groups was not statistically significant (p?=?0.66, Fisher exact test).

Conclusion: Our data suggest that evisceration with primary orbital implant is a feasible option in fulminant endophthalmitis/panophthalmitis and provides a good postoperative cosmetic outcome to the anophthalmic socket at an economical cost.     

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.     

羟基磷灰石义眼台眶内植入术并发症的相关分析和预防处理

目的:探讨羟基磷灰石义眼台植入后义眼台暴露的原因处理方法及相关预防。方法:对本院2000/2003年收治的62眼(A组),2004/2007年收治的65眼(B组)I期羟基磷灰石义眼台植入术患者的治疗方法、效果及并发症分别进行回顾性分析。结果:手术的主要并发症为义眼台暴露,共12例,A组10例(16.1%),B组2例(3.1%)。发生时间为术后3~15d,义眼台暴露范围为3~14mm,能自行愈合者4眼,手术修补8眼,术后随访。结论:义眼台暴露的原因与手术方法和技巧、手术时机、炎症、术后感染等因素有关。其处理可根据范围不同采用不同方法。     

Mycobacterium Abscessus Infection in a Case of Recurrent Orbital Implant Exposure

Exposure is one of the most frequent complications of porous orbital implants, while infection is rarely observed. Atypical mycobacteria are ubiquitous germs of mostly variable pathogenicity. A patient with recurrent orbital implant exposure is described, in whom a final diagnosis of Mycobacterium abscessus infection was made on culture of the orbital implant remnant at its removal.

In orbital implant exposure, infection with unexpected organisms should be considered and in these cases only the complete removal of the implant may allow the socket to settle.     

兔眶内植入国产珊瑚羟基磷灰石的实验研究

目的：探讨国产珊瑚羟基磷灰石（ＨＡ）眶内植入物的生物相容性以及植入兔眶内后纤维血管化情况。方法：在１８只兔眶内植入国产珊瑚ＨＡ,于术后定期取出植入物作光镜与透射电镜检查,结果：１８例中有２例出现植入物暴露,无发生植入物暴露的组织学改变显示;术后６周时植入物已全部纤维血管化,公有少许为症细胞;发生植入物暴露的组织学改变显示;植入物外围少许纤维血管长进,内围大量炎症细胞浸润。结论：①国产珊瑚ＡＨ具有良     

Postcontrast magnetic resonance imaging assessment of porous polyethylene orbital implant (Medpor)

OBJECTIVE: To evaluate the fibrovascular ingrowth progression within the porous polyethylene orbital implant (Medpor) with serial magnetic resonance imaging (MRI). DESIGN: Prospective, nonrandomized, comparative (self-controlled) trial. PARTICIPANTS: Ten patients who underwent enucleation and implantation of a 20-mm porous polyethylene implant wrapped with heterologous sclera. METHODS: Serial precontrast and postcontrast T1-weighted MRI were obtained at 1.5, 3, 6, and 12 months after implantation. The percentage area of enhancement was calculated by use of manual planimetric contouring unenhanced areas at the equator of each sphere on axial and coronal planes. RESULTS: All the implants showed enhancing areas as early as 1.5 months after enucleation. In 8 of the 10 patients, the areas of enhancement at the equator of the implant consistently showed similar centripetal progression primarily during the first 6 months after enucleation. The presence of fibrovascular tissue at the equator was associated in all cases with enhancing zones at the anterior portion of the implant. None of the implants showed diffuse complete enhancement after 12 months. Two patients failed to demonstrate further enhancement progression 1.5 months after implantation. No histopathologic study to equate with the MRI findings was performed in this series. CONCLUSIONS: Postcontrast magnetic resonance studies seem to be the best-suited imaging modality for assessing the fibrovascular tissue progression into porous polyethylene spheres after enucleation and for identifying patients in whom failure of vascularization occurs. Incomplete vascularization at the equator of the porous polyethylene sphere does not prove an absence of fibrovascular ingrowth in the anterior region. Prior ocular surgery and coexisting arterial hypertension may slow the progression of fibrovascular ingrowth.