Use of bovine pericardium as a wrapping material for hydroxyapatite orbital implants

AIM: To present the results of 27 patients who had enucleation for malignant melanoma of the choroid with hydroxyapatite implant wrapped in bovine pericardium. METHOD: A retrospective study was performed on 27 patients, 12 males and 15 females, who had enucleation as a primary treatment for their choroidal melanomas. The patients were followed up at 1 week, 1 month, 3 months, and then every 6 months. A conformer was fitted at 1 week and an artificial eye at 1 month. The average follow up was 1.7 years. RESULTS: No patient had extrusion of the implant. One patient needed repair of the wound, two patients required a lateral tarsal strip, and one patient developed a conjunctival granuloma, which did not need excision. In one patient there was shallowing of the inferior fornix. The cosmetic results and ocular movement were satisfactory in all but one patient. CONCLUSION: Use of bovine pericardium as wrapping material for the hydroxyapatite implants has shown promising results with minimal extrusion rates providing an effective alternative for sclera, eliminating the potential risks of CJD.     

Bovine pericardium versus homologous sclera as a wrapping for hydroxyapatite orbital implants

PURPOSE: To report our experience with bovine pericardium as a wrapping material for hydroxyapatite orbital implants after enucleation and to compare the exposure rates of the implants wrapped with bovine pericardium versus donor sclera. METHODS: We retrospectively reviewed the records of all patients who received bovine pericardium-wrapped or donor sclera-wrapped hydroxyapatite implant after primary enucleation between March 1995 and December 2001. RESULTS: Of the 26 patients who received donor sclera-wrapped implants after enucleation, 1 (3.8%) had implant exposure. Of the 26 patients who received bovine pericardium-wrapped implants after enucleation, 6 (23%) had implant exposure. The incidence of implant exposure with the use bovine pericardium wrapping material was found to be significantly higher than with sclera (P = 0.05). Six of the 7 implant exposures were noted in the first 6 months after placement of the orbital implant. Five of the 6 exposed bovine pericardium-wrapped hydroxyapatite implants were associated with socket infection. The case of exposure of the sclera-wrapped implant was treated conservatively by observation. Six patients who had exposure of bovine pericardium-wrapped implants required multiple repairs because of recurrent exposures. Four of these patients eventually required removal of the implant. CONCLUSIONS: Despite the advantages of using bovine pericardium as a wrapping material for hydroxyapatite orbital implants, we observed a significantly higher incidence of exposure with bovine pericardium compared with donor sclera in the early postoperative period. Use of bovine pericardium as a wrapping material for orbital implants should be avoided unless some future modifications of the technique can be developed to prevent such complications.     

Auricular cartilage versus donor sclera as a wrapping of hydroxyapatite orbital implants

AIM: To retrospectively compare postoperative outcomes after primary enucleation and placement of a hydroxyapatite(HA) implant without wrapping, wrapped with auricular cartilage or donor sclera. METHODS: Medical records of patients presented as intraocular tumor or severe ocular injury were identified from the electronic medical record system. Cases underwent enucleation and HA orbital implantation were enrolled in this study and were divided into 3 groups according to the wrapping material of HA implant. Cases with autogenous cartilage caps were enrolled in group A(n=11), with donor sclera caps in group B(n=12), and without any wrapping material in group C(n=9). Follow-ups were set at 1, 2 wk, 1, 3, 6, and 12 mo after surgery.RESULTS: Altogether 32 cases finished the followup and were enrolled in this study. Three cases(27.27%) in group A, 4 cases(33.33%) in group B, and 4 cases(44.44%) in group C developed one complication each after surgery. In group A, no HA exposure occurred, but conjunctival inclusion cyst occurred in one and severe conjunctive chemosis in two cases. In group B, one HA exposure occurred, conjunctive inclusion cysts occurred in one, severe conjunctive chemosis occurred in one, and conjunctival granuloma occurred in one case. In group C, one HA exposure occurred, severe conjunctive chemosis occurred in two cases, and conjunctival granuloma occurred in one case. The case of exposure of none-wrapped implant was noted in the first 6 mo after placement of the orbital implant. The case of exposure of donor sclerawrapped implant was noted at the 12 mo after placement of the orbital implant. Both exposure cases were treated successfully with conservative treatment.CONCLUSION: With low incidence of implant exposure and mild complications, auricular cartilage can be a good choice of alternative wrapping material of orbit implant with satisfied outcome.     

兔眼应用聚氨酯电纺丝作为水凝胶义眼台包裹的效果

目的:观察电纺丝(electrospinning)和异体巩膜作为水凝胶(hydrogel)义眼台包裹材料,用于实验兔眼的临床表现及病理组织学变化观察。方法:纯种新西兰兔20只,随机平均分为电纺丝包裹组和巩膜包裹组,行右眼眼球摘除术后。于肌锥内分别置入由电纺丝及异体巩膜包裹的水凝胶义眼台。术后观察眼部表现,于2,4,8,12wk,连同电纺丝或异体巩膜取出义眼台,光镜下观察包裹材料与义眼台的组织病理学改变,包括炎症反应及血管化情况;扫描电镜观察上述组织的超微结构改变。结果:所有动物均完成实验,20只大白兔均进入结果分析。光镜显示,术后2,4,8,12wk时两组植入物纤维血管生长速度基本一致,炎症及异物反应程度类似。电镜显示,早期电纺丝与水凝胶义眼台结合牢固程度强于异体巩膜组。结论:电纺丝结构特殊,纤维间结合较弱,有利于细胞拓展空间,提高了材料的细胞渗透性,作为义眼台包裹材料,较巩膜致密结缔组织更有利于血管化进程。电纺丝有望成为义眼台包裹材料的替代物。     

Bovine pericardium as a wrapping for orbital implants

PURPOSE: We report the use of bovine pericardium as an alternative wrapping for porous orbital implants after enucleation. METHODS: We retrospectively reviewed the records of all patients who received a bovine pericardium-wrapped orbital implant after enucleation by the authors between August 1, 1996, and December 1, 1999. RESULTS: Eighty patients underwent placement of bovine pericardium-wrapped orbital implants. The average age at the time of implantation was 49.3 years (range, 5 years to 83 years). The mean follow-up interval was 11.8 months (range, 2 to 41 months). There were no intraoperative complications. No patient had secondary systemic infection or showed evidence of rejection. There was no clinical evidence to suggest that vascularization of the porous implant was unusually delayed, and there were no complications after secondary drilling and placement of a coupling post. Four (5%) of 80 patients had complications requiring removal of the spherical implant. All 4 patients had hydroxyapatite implants. Two patients had significant exposure requiring removal of the implant at 2 months after surgery; 1 patient had a chronic fistulous tract with secondary infection 3 years after surgery: and 1 patient had chronic orbital pain requiring removal of the implant at 1 year after surgery. CONCLUSIONS: The incidence of implant exposure was less than 4%. This compares favorably to the incidence of exposure of 9% to 21% reported in recent literature. Other complications were few and of minimal clinical significance. The authors conclude that bovine pericardium is a viable option to sclera as a wrapping for porous orbital implants.     

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.     

Mersilene mesh versus sclera in wrapping hydroxyapatite orbital implants

PURPOSE: To compare Mersilene mesh versus sclera in wrapping hydroxyapatite orbital implants used in primary enucleation. METHODS: In a prospective, randomized, interventional comparative case series, 60 eyes from 60 consecutive patients were included and randomly allocated for primary enucleation and either Mersilene mesh-wrapped hydroxyapatite (MHA) orbital implant (30 cases, 50%) or sclera-wrapped hydroxyapatite (SHA) orbital implant (30 cases, 50%) under general anesthesia. Complete socket examination was performed at 1 week, 1 month, and then every 3 months after surgery. RESULTS: Mean age was not significantly different (P = 0.08) between patients with MHA (36.43 years) and SHA (28.50 years) orbital implants. The most common cause of enucleation was trauma in both groups (P = 0.09). Patients with MHA had significantly (P = 0.005) longer follow-up time (mean, 11.40 months) than those with SHA (mean, 9.40 months). No exposure was found at last follow-up in the MHA group, but one patient in the SHA group had a small exposure (1 x 1 mm) 1 month after surgery that was conservatively treated. There were no significant postoperative soft tissue complications in either group. CONCLUSIONS: Sclera and Mersilene mesh could be used as a wrapping material for hydroxyapatite orbital implants without significant complications. Absence of disease transmission, low cost, and availability are the main advantages of Mersilene mesh.     

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。     

在爆裂性眼眶骨折修复中羟基磷灰石复合体应用的意义

目的评价羟基磷灰石（HA）复合体修复眼眶爆裂性骨折的安全性和有效性。方法采用HA复合体修复眼眶爆裂性骨折13例（13眼）,观察比较术前术后眼球突出度、眼外肌运动、复视及视力等情况。结果所有病例均获得不同程度外观的改善及复视的好转或消失,手术未影响视力,术后随访期间无植入物感染、排出或移位等并发症。结论临床表现明显的眼眶爆裂性骨折应及早行眶壁骨折修复手术,应用HA复合体作植入物安全有效,是目前重建眶壁较理想的生物材料之一。     

Amniotic membrane for repair of exposed hydroxyapatite orbital implant

Exposure of a hydroxyapatite orbital implant measuring 10 x 3 mm developed in a 25-year-old man. The exposure was repaired with an amniotic membrane graft. Follow-up examinations at 5 days, 2 weeks, 2.5 months, and 5 months after surgery demonstrated closure of the conjunctival defect. The author concludes that amniotic membrane may be useful for the treatment of hydroxyapatite orbital implant exposures.     

羟基磷灰石义眼台植入26例的临床观察

目的:观察羟基磷灰石(hydroxyapatite,HA)义眼台两种植入手术方法的治疗效果.方法:回顾性分析我院2007-06/2011-06植入HA义眼台26例26眼患者资料,分别采用直接肌锥内植入法、巩膜后肌锥内植入法2种手术方法.术后随访3～24(平均13)mo.结果:所有患者中有15例手术后整形效果良好,出现结膜囊狭窄、肉芽肿、上眶区凹陷6例,义眼活动不良3例,仅有2例发生义眼台脱出.HA义眼台植入后义眼活动度和稳定性好.结论:HA义眼台植入术是无眼球患者的首选,而巩膜后肌锥内植入法能明显降低手术后义眼台暴露率.     

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。     

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.     

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。     

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。