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。     

低功率半导体激光治疗羟基磷灰石义眼座暴露

目的探讨低功率半导体激光治疗羟基磷灰石义眼座暴露的疗效。方法采用JAM-II型多功能半导体激光治疗仪(激光物质为GaA1As,激光波长650nm)对22例不同程度的义眼座暴露患者进行激光照射治疗,并将结果与既往采用药物及手术治疗的20例义眼座暴露患者比较。结果激光组22例全部愈合(100%);药物及手术组中轻、中、重度的愈合率分别为83.3%,63.6%和0。经采用χ2检验之四格表精确检验法处理,2组间轻度患者的愈合率在统计学上差异无显著性意义(P=0.545),而2组间中度和重度患者的愈合率在统计学上差异有显著性意义(P<0.05)。结论低功率半导体激光治疗羟基磷灰石义眼座暴露的疗效优于药物及手术方法。可用于预防及治疗羟基磷灰石义眼座暴露。     

视网膜母细胞瘤眼球摘除、羟基磷灰石义眼座Ⅰ期植入临床观察

目的 评价视网膜母细胞瘤眼球摘除，羟基磷灰石（hydroxyopatite，HA）义眼座Ⅰ期植入术后的临床效果。方法 对27例（27眼）Rb患者行眼球摘除眶内HA义眼座Ⅰ期植入术后进行临床观察。结果 术后随访12～36个月，平均18个月。义眼座活动度良好。24例结膜创口Ⅰ期愈合，2例结膜变薄，1例结膜创口裂开，HA义眼座暴露。1例Rb复发。结论 Rb患者眶内HA义眼座Ⅰ期植入有助于眼眶发育和美容。     

羊膜移植治疗义眼座植入术后结膜裂开伴结膜囊狭窄

目的:探讨羊膜移植治疗羟基磷灰石义眼座植入术后结膜裂开伴结膜囊狭窄的临床效果。方法:羟基磷灰石义眼座植入术后结膜裂开伴结膜囊狭窄患者16例16眼,手术松解结膜张力后,行保存羊膜移植于巩膜暴露区。结果:所有患者中,15例术后结膜愈合完全遮盖巩膜,结膜囊恢复理想深度;1例失败。结论:保存羊膜移植是治疗义眼座植入术后结膜裂开、保持理想结膜囊深度的有效方法。     

两种巩膜瓣切口羟基磷灰石眼座一期植入比较

目的比较半球形巩膜瓣和花瓣样巩膜瓣羟基磷灰石（HA）眼座一期植入的手术效果。方法将43例（43眼）随机分为两组,分别采用半球形巩膜瓣（20眼）和花瓣样巩膜瓣（23眼）均为HA眼座I期植入治疗术后随访6月～1年。结果半球形巩膜瓣HA植入组1眼并发伤口裂开,经药物治疗后14d愈合;花瓣样巩膜瓣HA植入组1眼并发结膜伤口轻度裂开,药物治疗后10d愈合。半球形巩膜瓣组3眼不同程度残留上睑凹陷。花瓣形巩膜瓣组1眼出现残留上睑凹陷。结论巩膜花瓣形切口HA植入,手术方法简便,术中不破坏眼外肌正常位置及眶脂肪,保留后部巩膜,防止植入物后移、并发症少、恢复快。     

双层自体巩膜荷包缝合羟基磷灰石眼座肌锥腔内植入术临床观察

目的探讨双层自体巩膜荷包缝合羟基磷灰石（HA）眼座肌锥腔内植入手术方法的疗效。方法对39例（39只眼）眼内容物剜除术后行I期或II期HA眼座植入,剪断视神经,将眼座植入肌锥腔内,双层巩膜壳重叠后荷包缝合。结果随访1～2年,37例患者对外观及义眼活动度满意,无感染、结膜裂开和义眼座暴露等并发症,1例结膜裂开、1例眼座暴露,均通过手术修复并未再复发。结论双层自体巩膜荷包缝合HA眼座肌锥腔内植入术具有操作简单,对组织损伤小,并发症少等优点。     

羟基磷灰石义眼座植入术后球结膜裂开的因素

目的 探讨羟基磷灰石义眼座植入术后球结膜裂开的相关因素。方法 对57例患的病例资料及术后2.4-4.5个月的随访情况进行总结分析。结果 术后55例外观效果满意；并发症主要有球结膜裂开（18例）、义眼座暴露（9例）及自体巩膜溶解（8例）；球结膜裂开18例中17例发生于术后4周内；球结膜裂开发生率与患年龄、手术期别无关，与疾病种类、手术方法特别是有无自体巩膜包裹、手术熟练程度及HA义眼座品种有关；眼球萎缩和外伤后无眼球患的发生率（7/31）较其他病种（11/26）低，眼球除自体巩膜包裹HA义眼座植入术16例中9例发生结膜裂开（8例伴自体巩膜溶解），眼球除后无包裹HA义眼座植入术36例中7例裂开。结论 眼外伤行修补术或眼球除除术后患二期义眼座植入的手术时间应适当推后；无包裹直接植入法的术后球结膜裂开发生率低于有包裹植入法，这一方法值得推广；自体巩膜离体后的处理方法尚需进一步探讨。     

两种不同术式Ⅰ期羟基磷灰石义眼座植入术的临床研究

目的比较两种不同术式的Ⅰ期羟基磷灰石义眼座植入术的临床疗效。方法将99例有义眼座植入适应证患者分为A、B两组，A组行眼球摘除巩膜包裹法植入义眼座，B组行眼内容剜除巩膜覆盖法植入义眼座，术后观察两组患者配戴义眼后外观改善程度、术后并发症。结果两组患者外观改善程度差异无显著性，但A组结膜裂开发生率高于B组（Х^2=7.380，P〈0.01），义眼座暴露发生率也高于B组（Х^2=5.160，P〈0.05）。结论眼内容剜除巩膜覆盖法是一种较眼球摘除巩膜包裹法简单、安全、方便、疗效确切的义眼座植入手术，值得在临床推广应用。     

重度眼球萎缩患者巩膜腔内HA植入术的临床研究

目的:探讨重度眼球萎缩患者巩膜腔近原位羟基磷灰石(HA)义眼座植入的可能性。方法:眼轴直径在18mm以下的重度眼球萎缩患者76例(76眼),采用眼内容物剐除后切下直径14mm后巩膜,然后在巩膜腔内植入18～20mmHA义眼座并在眼座前覆盖切下的后巩膜,再分层缝合角巩膜瓣筋膜结膜。结果:本组76例患者74例结膜创口一期愈合,2例结膜切口裂开经保守治疗愈合,术后随访6～22mo,所有患者无感染、交感性眼炎及义眼座暴露,眼窝饱满,所配带义眼活动度好,效果满意。结论:巩膜腔近原位HA义眼座植入术仍然适合于重度眼球萎缩患者的容貌矫正。     

羟基磷灰石义眼座植入术后眼座暴露原因及处理

目的 探讨羟基磷灰石(Hydroxyapatite,HA)义眼座,植入术后暴露的原因及处理.方法 对40例义眼座植入患者进行随访分析.术后发生义眼座暴露8例(20％).针对暴露的程度及原因采取不同的治疗方法.结果 3例轻度患者经保守治疗愈合,4例中重度患者经羊膜移植愈合,1例重度患者经取出义眼座后愈合,随诊3月至3年无复发.结论 羟基磷灰石义眼座植入术后暴露的原因与多种因素有关,恰当地处理可以使之恢复.羊膜移植是治疗中重度结膜裂开、眼座暴露的有效方式.     

Exposed hydroxyapatite orbital implants. Report of six cases.

Six patients with complications of primary or secondary hydroxyapatite implants were studied. Complications included socket infection and/or conjunctival dehiscence. Complications were detected during regular follow-up examinations, and various treatment approaches were used. The hydroxyapatite implant exposure occurred 4 to 6 weeks (mean, 4.5 weeks) after implantation. Three of the six implants were wrapped in preserved donor sclera before implantation. One of the implants showed wide exposure and chronic infection and was removed. In two cases, scleral patch grafts with a conjunctival pedicle graft were performed, resulting in successful coverage of the implant without further conjunctival dehiscence. In one of the patients, a Tenon's conjunctival flap was advanced to cover the defect, and was unsuccessful with the spicules of the hydroxyapatite eroding through the vascular flap after 1 month. Three of the patients demonstrate a persistent conjunctival epithelial defect. These three patients with chronically exposed hydroxyapatite have remained stable with follow-up intervals ranging from 8 to 12 months. Early exposure of hydroxyapatite orbital implants is a potential problem despite meticulous technique. Implant coverage is difficult, although chronic exposure seems to be tolerated often in the hydroxyapatite orbital implant without migration or extrusion.     

血管内皮细胞生长因子应用于羟基磷灰石眶内植入物的研究

目的观察不同质量浓度的血管内皮生长因子（VEGF）对羟基磷灰石（HA）植入物纤维血管化的作用。方法将24只新西兰白兔随机分为A、B、C、D4组,每组6只。各组均采用自体深筋膜覆盖HA植入物植入兔眼眶。A组为对照组,B、C、D组将HA义眼台植入前分别浸泡于质量浓度为0．5、1．5、2．5g／LVEGF溶液中,术后分别点用上述不同质量浓度VEGF滴眼液,每日4次,连续28d。术后14、21、28d各组取出2个HA植入物行组织学病理学检查,比较植入物纤维血管化的情况。结果术后14d,各组间纤维血管长度的平均值差异无统计学意义（F＝34．12,P〉0．05）;术后21d,各组间纤维血管长度的平均值差异有统计学意义（F=4．21,P〈0．05）;术后28d,各组间纤维血管长度的平均值差异无统计学意义（F=27．67,P〉0．05）。术后14d,各组HA植入物纤维血管化程度级别差异无统计学意义（H=0．072,P〉0．05）;术后21d,各组HA植入物纤维血管化程度级别差异有统计学意义（H=3．684,P〈0．05）;术后28d,各组HA植入物纤维血管化程度级别差异有统计学意义（H=4．318,P〈0．05）。结论质量浓度为1．5g／L及2．5g/L的VEGF对HA植入物术后早期的纤维血管化具有促进作用。     

Problems with the hydroxyapatite orbital implant: experience with 250 consecutive cases.

The coral derived hydroxyapatite sphere is a popular, integrated orbital implant designed to provide improved motility of the ocular prosthesis following enucleation. Although the implant has rapidly become widely used by ophthalmologists, little information is available regarding the problems of this technique in a large series of cases. Experience with 250 consecutive cases of hydroxyapatite orbital implant use was reviewed and the problems of the implants and their management investigated specifically. The reasons for enucleation included uveal melanoma (157 cases), retinoblastoma (70 cases), blind painful eye (22 cases), and intraocular medulloepithelioma (one case). Earlier treatment to the eye was performed before enucleation in 47 cases and included repair of ruptured globe (17 cases), plaque radiotherapy (18 cases), external beam radiotherapy (six cases), and others (six cases). During a mean of 23 months' follow up (range 6-40 months), there have been no recognisable cases of orbital haemorrhage related to the implant, and no cases of implant extrusion or implant migration. There was one case of presumed orbital infection (culture negative) that resolved with intravenous antibiotics and the implant was retained within the orbit. Other problems included conjunctival thinning in eight cases managed by observation and prosthesis adjustment, and conjunctival erosion in four cases managed by combinations of scleral patch graft, conjunctival flap, and prosthesis adjustment. The conjunctival erosion was caused by a poorly fitting prosthesis in three cases and wound dehiscence in one case. The problem rate in eyes receiving prior radiotherapy or surgery was not increased. The hydroxyapatite integrated orbital implant is a well tolerated motility implant without the high rate of extrusion and infection seen with other motility implants. The prosthesis fit may contribute to the tolerance of the implant.     

临时结膜瓣对真菌性角膜溃疡愈合及新生血管形成影响的研究

目的观察临时结膜瓣对真菌性角膜溃疡愈合和角膜新生血管形成的影响。方法采用随机对照的方法,将真菌性角膜溃疡86例（86眼）分为两组。A组：临时结膜瓣移植组,51例;B组：常规结膜瓣移植组,35例。观察并比较A、B两组的治愈率、治愈时间及角膜新生血管形成率。随访6个月。结果两组间治愈率差异及治愈时间差异均无统计学意义（P〉0.05）,角膜新生血管形成率两组间差异有统计学意义,A组角膜新生血管形成率明显低于B组（P〈0.01）。结论临时结膜瓣能促进真菌性角膜溃疡愈合,并能减少角膜新生血管形成,其疗效优于常规结膜瓣。     

翼状胬肉撕除联合球结膜移植及丝裂霉素C的临床效果观察

目的观察翼状胬肉撕除联合球结膜移植及丝裂霉素C治疗翼状胬肉的效果。方法将69例（69眼）患者随机分为三组,A组行单纯翼状胬肉撕除术;B组为翼状胬肉撕除联合应用丝裂霉素C;C组为翼状胬肉撕除联合应用丝裂霉素C及球结膜移植术。术后观察角膜创面、移植片情况、术后并发症及胬肉复发情况。结果 A组23眼有6只眼复发（26.09%）;B组23眼有3只眼复发（13.04%）;C组23眼有1只眼复发（4.35%）复发率。C组与A组、B组比较,差异均具有统计学意义（P〈0.05）。角膜创面愈合三组差异无统计学意义（P〉0.05）。结论翼状胬肉撕除联合球结膜移植及丝裂霉素C是一种安全有效的治疗翼状胬肉的方法,且复发率低。     

巴曲酶治疗听力曲线为平坦型突发性聋33例

目的 探讨巴曲酶治疗听力曲线为平坦型突发性聋的疗效.方法 对68例听力曲线为平坦型突发性聋患者分为2组.均给予口服磺酸倍他司丁和泼尼松,同时静脉滴注6%低分子右旋糖酐500 mL,治疗组在对照组治疗的基础上加用巴曲酶.两组均以10 d为1个疗程.结果 治疗后,两组听力水平差异有统计学意义(t=5.42,P<0.05),治疗组优于对照组.两组眩晕消失时间:巴曲酶组(3.09±0.24)d,对照组(3.38±0.21)d,差异无统计学意义(t=8.34,P>0.05).巴曲酶组总有效率(66%)高于对照组总有效率(43%),差异有统计学意义(χ2=10.49,P<0.05).结论 巴曲酶治疗听力曲线为平坦型突发性聋有效.     

义眼座植入联合皮片移植术治疗眼窝凹陷Ⅲ度结膜囊狭窄

目的:为观察义眼座植入同时联合皮片移植术矫正眼窝凹陷并Ⅲ度结膜囊狭窄的疗效。方法:对32例(32眼)Ⅲ度结膜囊狭窄行义眼座植入同时联合皮片移植结膜囊成形术。结果:术后32眼Ⅲ度结膜囊狭窄全部治愈,均无义眼座暴露、感染、皮片坏死、伤口裂开等并发症,术后义眼座的活动度和外观较好,配戴义眼后患者满意,眼窝凹陷全部矫正。结论:眼窝凹陷合并Ⅲ度结膜囊狭窄采用义眼座植入同时联合皮片移植安全有效。     

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.