未成年人摘除眼球后眼眶的发育

目的探讨未成年人摘除眼球未植入义眼台的眼眶发育情况。设计回顾性病例系列。研究对象41例未成年时行单眼眼球摘除患者。方法回顾分析患者冠状位眼眶CT扫描影像资料,测量患侧及健侧的眼眶入口面积。主要指标眼眶入口面积。结果摘除眼球侧和健侧眼眶入口面积分别为(10.67±1.41)mm2和(12.03±1.41)mm2(P=0.000)。0~6岁摘除眼球组和7~12岁摘除眼球组两侧眼眶入口面积的差别均有统计学意义(P=0.000、0.018),13~18岁摘除眼球组二者的差别无统计学意义(P=0.09)。配戴义眼片组和未配戴义眼片组无眼球侧眼眶入口面积与健侧眼眶入口面积差存在统计学差异(P=0.004)。结论未成年人摘除眼球后影响该侧眼眶生长发育,摘除眼球时的年龄越小影响越大。摘除眼球后配戴义眼片可改善眼眶的发育。     

眼球摘除对眼眶发育的影响及其防治研究进展

在眼科手术中，平均眼球除率为2．8／10万。在成人眼球除后，常导致眼球除后综合征。在儿童除眼球后，不仅会导致眼球除综合征，而且导致眶骨发育迟缓，严重造成颜面畸形。为此，本就眼球除适应证、眼球除综合征发生机制和防治，以及眶内植入对眶骨发育影响等方面的系统研究加以综述。     

RB眼球摘除及外放疗后晚期眼眶畸形的治疗进展

视网膜母细胞瘤患儿眼球除，继之以外放疗，成年后患侧会出现眶颞区皮肤、肌肉、骨骼发育不良，以致眶颞区凹陷和眼窝缩窄，面部不对称，严重影响患外貌。此类患的眼眶畸形十分复杂，如何进行整形手术一直是临床上的难点，本就其手术治疗进展进行综述。     

眼台Ⅱ期植入对眼眶发育影响的实验研究

目的：探讨不同时间眼球摘除后对眼框发育的影响及眼球摘除眼台Ⅱ期植入对眼框发育的影响。方法：将18只同龄幼兔,随机分成两组,一组分别在不同兔龄行单侧眼球摘除术,另一组则均在相同兔龄行单侧眼球摘除术,并在眼球摘除后不同时间人别行Ⅱ期HA植入。两组兔均在4月龄时处死,直接解剖测量术眼和健眼的眶容积并进行对比研究。结果：眼的眶容积与术眼的眶的容积差值百分比与眼球摘除时间之间有密切的负相关（r=-0.988);健眼眶容积与眼台植入组眶容积差值百分比与眼台植入时间之间有密切的正相关（r= 0.978)。结论：在生长发育期,眼球摘除越早期眼眶发育越差;眼球摘除后眼台植入越早眼框的发育越好;眼球在眶骨发育过程中起到一种“生骨诱导中心”的作用,眼台也卢到一定的“生骨诱导中心”作用。     

285例眼球摘除术后眼窝畸形整复的分析

２８５例眼球摘除术后眼窝畸形整复的分析陈守宁，宋玉英，周美英，尹茶仙，诸荷琴，琚红云眼球摘除后装配义眼，如果双眼饱满程度相仿，义眼活动度＞２５°，则可以减轻患者因毁容而产生的心理压力。关于摘除眼球后一期植入自体组织、异体组织或人造材料填充物等已有较多...     

眼眶骨折眼球内陷的动物模型建立及发生机制研究

探讨眼眶骨折眼球内陷的发生机制,为其临床手术治疗提供依据。方法应用手术方法造成４０只成年猫眶壁骨折和缺损,术后进行眼眶ＣＴ扫描和眼球内陷测量。结果眶内侧壁缺损组的２０只猫中,１７只猫发生眼球同陷;后部眶底缺损的１０只猫中,４只猫发生眼球内陷;前部眶底缺损的１０只猫中,仅１只猫发生眼球内陷。     

眼球摘除的病因分析

眼球摘除是各种眼病中最不幸的结局，无论病人或医生都应持十分慎重的态度。现将我院l四1年元至IM年2月收住院的34例眼球摘除作一临床分析。临床资料：34例中，男工例，女问例；右眼14例，左眼to例。年龄最大邱岁，最小4月，其中以对一eq岁为最多。农民日例占五．3％，工人8例占23．5％，学龄前儿童7例占及对叽，学生火例占11．乃叽，干部3例占9．82％。导致眼球摘除的主要原因是眼外伤为17例，占to％；其次是视网膜母细胞瘤5例，占14．7％，均为学龄前儿童。病程最长班年，最短回小时（附表1）。典型病例：马X，男，4月，住院号34351。左…     

先天性小眼球患儿眼睑和眼眶发育的形态测量学研究

目的 探讨先天性小眼球患儿的眼睑、眼眶发育情况.设计 前瞻性病例系列.研究对象 6～78个月的先天性小眼球患儿23例(23眼).方法 测量患儿的睑裂横径、垂直径,采用CT影像和计算机软件辅助技术相结合的方法测量眼球前后径和眼眶容积,分析眼球前后径、年龄分别与睑裂横径、垂直径及眼眶容积的关系,评价眼睑和眼眶发育的影响因素.主要指标 睑裂横径、垂直径、眼球前后径和眼眶容积.结果 睑裂横径、垂直径、眼球前后径和眼眶容积分别为(16.44+3.24)mm、(2.47±1.48)mm、(11.99±3.33)mm、(14.19±2.37)ml,均明显小于健侧(P均=0.000).眼眶容积分别与眼球前后径、年龄呈正相关(r=0.62,0.63;P=0.037,0.035).睑裂横径、垂直径与眼球前后径呈正相关(r=0.54,0.53;P=0.030,0.034).而均与年龄无关.眼球前后径≤12mm组(10例)和＞12 mm组(13例)的睑裂横径、垂直径和眼眶容积分别为(13.50±1.97)mm、(1.08±0.66)mm;(12.73±0.95)ml、(18.20±2.49)mm;(3.30±1.16)mm、(15.05±2.57)ml(P=0.001,0.003,0.024).结论 先天性小眼球患儿的眼睑和眼眶发育明显迟滞.眼球越小,对眼睑和眼眶发育的影响越大.尽可能早期干预治疗是促进眼睑和眼眶发育,预防和减轻眶发育畸形的根本方法.     

眶内植入物对眼眶畸形发育防治机制的研究

目的 探讨眶内植入物在眼眶畸形发育防治中的作用机制.方法 新西兰幼兔21只,随机分为眼球摘除组、眶内植入物组和正常对照组.1月龄时对眼球摘除组和眶内植入物组的兔分别行左侧眼球摘除、眼球摘除联合眶内植入物植入术,正常对照组左侧眼眶作为对照.2月龄时处死全部兔子,取左侧颧骨脱钙后制成石蜡切片.对比观察3组的眶骨组织学改变,并测量其骨吸收参数N.Oc/B.Pm.结果 眼球摘除组较其余两组的皮质骨表面边缘不规整,骨吸收现象明显,骨板排列不整齐,粘合线明显紊乱.眼球摘除组骨吸收参数N.Oc/B.Pm明显高于其余两组(P＜0 01),眶内植入物组和正常对照组N.Oc/B.Pm差异无统计学意义(P ＞0 05).结论 眼球摘除后眶骨骨吸收增强参与了眼眶畸形的发育过程,眶内植入物防治眼球摘除后眼眶畸形发育的作用至少部分是通过减弱骨吸收来实现的.     

1609例眼球摘除原因分析

本文对１６０９例眼球摘除原因进行分析。其中因眼外伤９７６例；眼内肿瘤３３０例；其它原因２５７例；另有４６例随同眶内容剜出摘除眼球。原因以眼外伤占首位，多为青壮年，男性多于女性，多因眼球严重破裂伤及眼内感染合并眼球萎缩而摘除眼球。眼内肿瘤以视网膜母细胞瘤为最多，２３４例；脉络膜黑色素瘤占第二位，８１例。提示对眼外伤的预防很重要。提高基层医疗水平，及时有效的治疗眼外伤也是降低眼球摘除率的关键。对于眼内     

眼球摘除188例原因分析及义眼台植入的效果

目的对188例眼球摘除的原因进行分析，评价义眼台植入的效果。方法采用回顾性研究的方法，分析了眼球摘除的原因，并对眼球摘除的适应证及其并发症进行了讨论。结果眼球摘除的188例中，眼外伤93例，占49．47％；恶性肿瘤41例，占22．81％；失明伴眼痛、眼球萎缩及眼内炎等其他原因54例，占28．72％。其中义眼台植入76例，出现并发症者5例，包括2例结膜息肉，3例义眼台暴露。结论眼外伤是眼球摘除占首位的原因。眼球摘除后义眼台的及时植入，能改善外观，手术并发症少。     

Perspective on orbital enucleation implants

The philosophy and design of orbital enucleation implants have evolved significantly over the past 50 years. Animal studies and improved imaging techniques have changed our understanding about the physiology and anatomy of the post-enucleation orbit. Changes in implant design and biomaterials have reduced complication rates. It is our impression that for many ophthalmic professionals in training, the rational behind the current thinking in implant design and biomaterials is unclear. This is in part related to the older literature on orbital enucleation implants, which is scattered and at times contradictory. This review aims to present the historical information in a coherent and concise form; provide evidence based review of changes in the practice patterns of enucleation; identify areas of continuing controversy; and highlight gaps in the scientific literature about orbital implants, in particular, the poor understanding of implant and prosthesis motility.     

Effects of dexmedetomidine for retrobulbar anesthesia in orbital ball implants after enucleation surgery

Background:Dexmedetomidine (DEX) can prolong the duration of local anesthetics, but the use of retrobulbar DEX has not been fully elucidated. This study was designed to determine the effects of adding DEX to lidocaine-bupivacaine for retrobulbar block in orbital ball implants after enucleation surgery.Results:Duration of analgesia was prolonged in the DEX, compared with the control group ([258.35 ± 66.82 min] as [130.75 ± 29.52 min], [P < 0.05]). The median number of postoperative analgesic requests per patient during the first 24 h was decreased in the DEX group (P < 0.05). In the first 24 postoperative hours, DEX group consumed significantly less dezocine (P < 0.05). BIS values and mean arterial pressure remained lower in the DEX group, but within the safe range (P < 0.05). The side effect profile was similar between the two groups. Patients and surgeon satisfaction were higher in the DEX group (P < 0.05). Demographic characteristics were comparable in both groups (P > 0.05).Conclusion:Retrobulbar DEX reduces consumption of rescue analgesic, prolonged the duration of retrobulbar block, improved postoperative pain, provided better sedation effects, and increased patient and surgeon satisfaction after orbital ball implants after enucleation surgery.     

眼球摘除病因分析

本文分析１２２例眼球摘除病因。因眼肿瘤摘除５４例（４４．３％）占首位原因，第二位原因是绝对期青光眼２４例（１９．７％），第三位原因是眼球破裂伤２１例（１７．２％）。文中简单介绍减少眼球摘除手术的点滴体会。     

Autologous dermis graft at the time of evisceration or enucleation

Aim

To present a new technique using autologous dermis graft at the time of enucleation or evisceration to replace the ocular surface area lost when the corneal scleral button is excised.

Methods

A retrospective, interventional, non‐comparative case series of patients who had an autologous dermis graft placed to assist in closure of Tenon''s capsule and conjunctiva at the time of enucleation or evisceration. Medical records were reviewed and the following variables were recorded: age, sex, history of previous ocular surgery or radiation treatment, indication for surgery, type of surgery, laterality, type of orbital implant, size of implant, length of follow up, and complications.

Results

Nine patients were identified (three male, six female) Five had enucleation with implant placement and four had evisceration with implant placement. Four individuals received unwrapped porous polyethylene spherical implants, three received silicone implants, and two received hydroxylapatite implants. Follow up ranged from 30 to 112 weeks (mean (SD), 61 (28) weeks). No operative or early complications were observed. One patient who had enucleation after two rounds of brachytherapy for uveal melanoma developed subsequent late exposure of the implant. There were no complications involving the graft donor site.

Conclusions

This small series shows that the use of a dermis graft is a safe and effective new technique to facilitate orbital rehabilitation. It is hypothesised that the extra surface area produced with a dermis graft preserves the fornices and allows a larger implant. It may also allow the implant to be placed more anteriorly which assists with both implant and prosthesis motility.     

Autologous fat graft in irradiated orbit postenucleation for retinoblastoma

Autologous fat grafting has been extensively and successfully adopted in a number of pathologic conditions in regenerative surgery especially on irradiated fields in order to improve pain symptoms and tissue trophism promoting scar release. In the present study, we report our experience with autologous fat grafting for the treatment of postirradiation fibrosis and pain on three consecutive patients undergoing orbital enucleation for locally advanced retinoblastoma (RB) and subsequent radiotherapy. We selected three consecutive patients who underwent orbital enucleation for locally advanced RB and subsequent local radiotherapy showing severe reduction in orbital volume and eyelid length and retraction due to fibrosis, spontaneous local pain exacerbated after digital pressure with no possibility to place an ocular implant. They underwent autologous fat grafting in the orbital cavity and results were evaluated by clinical examination at 5 and 14 days, and 1, 3, 6 months, and 1 year after surgery. A significant release of scar retraction, reduction of fibrosis and orbital rim contraction together with an important improvement of pain symptoms was observed in all patients. The local changes observed enabled an ease placement of an ocular prosthetic implant (implant). No local or systemic complication occurred. Fat grafting is a promising treatment for patients showing radiotherapy related complication in the orbital area and it should be adopted by all oculoplastic surgeon in order to improve pain syndrome creating the ideal local conditions for the placement of an ocular prosthetic implant.     

61例眶内容摘出术临床回顾

对61例眶内容摘出术进行回顾性分析。40例眼眶恶性肿瘤大多数行完全眶内容摘出，21例良性肿瘤则行部分眶内容摘出术。手术一般保留眼睑，眼窝重建采取上下睑皮肤复盖眶骨面，让创面缓慢生长愈合。全部2－3月达到Ⅱ期愈合。作者认为该术式操作简单、方便，术后眼窝稍浅，有利美观。但术中要注意出血，损伤脑膜和发现鼻窦肿瘤的情况。     

Amputation neuroma of the orbit. Report of two cases and review of the literature

Two patients developed proptosis and a slowly enlarging mass with increasing discomfort in the orbital socket 17 and 25 years following enucleation. Preoperative CT scans revealed a single cystic structure within the orbits of each case with distinct soft tissue tumors adjacent to the cysts. The cystic structures and the adjacent solid masses were removed en bloc necessitating reconstruction of the orbits with a dermal fat pad (case 1) and a mucous membrane graft (case 2). Postoperatively the patients were free of complaints. Microscopically, the cystic structures were identified as conjunctival inclusion cysts while the soft tissue masses were traumatic neuromas with irregular tangles and whorls composed of proliferated axons, Schwann cells and connective tissue. Only seven amputation neuromas of the orbit have been reported. Pain related to the neuroma is rarely encountered and is probably caused by mechanical irritation of the amputation neuroma, by retracting scar tissue, or compression from an adjacent cystic mass as in one of our cases.