改良式羟基磷灰石义眼台I期植入临床分析

目的观察改良式羟基磷灰石义眼台植入的临床效果。方法20例（20眼）眼内容摘除后应用自体巩膜花瓣状成形、球内视神经剪断的方法包裹义眼台I期植人,交叉重叠缝合义眼台前的4瓣巩膜,后方巩膜敞开,分层缝合眼球筋膜囊及结膜。术后随访3～18月。结果所有患眼术后上睑饱满,与对侧眼相比无明显差异,切口I期愈合,义眼台活动良好,未发现义眼台暴露等并发症。结论改良式羟基磷灰石义眼台植入术安全可靠,并发症少,疗效良好。     

羟基磷灰石义眼台植入的手术体会

目的比较巩膜包裹羟基磷灰石(hydmxypatite，HA)义眼台植入法与带线HA义眼台直接植入法的疗效。方法眶内植入HA义眼台共58眼，用自体或异体巩膜包裹义眼台后眶内植入40眼，用带线义眼台直接植入眼眶18眼，随访3月-4年。结果义眼台暴露7眼12％(7／58)，Ⅰ期1眼，Ⅱ期6眼；6眼采用巩膜包裹植入法15％(6／40)，1眼采用带线义眼台直接植入法5．6％(1／18)。结膜囊狭窄1眼。结论HA义眼台植入术后主要并发症是义眼台暴露，用带线义眼台直接植入发生这种并发症的机率变小。     

Late infection of hydroxyapatite orbital implants

BACKGROUND: Exposure and minor complications of hydroxyapatite orbital implants are common. Infection appears to be rare and fibrovascular ingrowth into hydroxyapatite implants may make infection and extrusion less likely than with other types of orbital implant. METHODS: We describe three cases of chronic low-grade infection of hydroxyapatite implants, occurring late after apparently uncomplicated surgery, with tiny or inapparent areas of conjunctival loss or exposure. RESULTS: Two of the three cases grew Staphylococcus oureus on culture. All three implants ultimately needed to be removed. A characteristic histological pattern was seen, with abrupt transition between vascularized and abscessed implant. CONCLUSIONS: Chronic infection of hydroxyapatite implants can occur late, in the absence of large conjunctival defects, or other obvious risk factors.While exposure of the implant to pathogens through a breach in the conjunctiva may have been a factor, it appeared that the infection may have arisen in an avascular portion of the implant prior to the conjunctival breakdown in one or more of these cases.     

珊瑚羟基磷灰石Ⅱ期眶内植入

目的：观察眼球摘除后羟基磷灰石眼座二期眶内植入的修复疗效。方法：用珊瑚多孔羟基磷灰石作为二期眶内植入物共253例。结果：随访6个月-15个月均获得良好的效果。并发症少,未发现眶内感染,植入物排出移位现象,结论：珊瑚羟基磷灰石并发症少,是目前眼球摘除后的良好眶内充填材料。     

Complications of hydroxyapatite orbital implants in children: a series of 105 cases

PURPOSE: To describe the complications encountered using hydroxyapatite as an orbital implant in the pediatric population after enucleation, and try to define the risk factors for their occurrence. MATERIAL: and methods: Retrospective review of charts of children who underwent enucleation with placement of an hydroxyapatite implant between January 1991 and 1998. Complications and their type (conjunctival, extrusion, eyelids complications) have been specifically looked for. A statistical analysis trying to isolate the risks factors was performed. RESULTS: 105 implants have been used during this period with 26.7% of complications appearing during a median followup of 22 months. Extrusion of the implant was observed in 1.9% of the cases, a chronic conjunctival erosion in 15%, a conjunctival lesion without erosion in 4.75% and no eyelid lesion could be seen. Treatment (medical or surgical) achieved 75% good results. No risk factor could be found. CONCLUSION: Hydroxyapatite orbital implants were initially thought to have no or few complications. More recently, chronic erosions in particular were described. Little data exists on the pediatric population. Our series confirms that complications occur and that they are comparable to the adult population. Nevertheless the hydroxyapatite orbital implant seems better tolerated than other porous or non porous implants and warrants its use.     

Complications associated with pegging hydroxyapatite orbital implants

OBJECTIVE: Prior studies of hydroxyapatite orbital implant complications have primarily focused on complications of the implant itself with only occasional mention of the complications associated with the peg system. This in part may be because of a low rate of pegging and, thus, a small sample size to evaluate. Therefore, a full range of complications that can occur with pegging has not been presented. The objective of this study was to determine the complications associated with pegging and to discuss ways to manage them. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS/INTERVENTION: The authors analyzed all of the complications associated with pegging 165 of a possible 275 hydroxyapatite implants implanted by 2 surgeons over 7 years. MAIN OUTCOME MEASURES: The following data were recorded: type of surgery performed, size of implant used, type of hydroxyapatite used, peg system used, time of pegging, follow-up duration, problems encountered, and treatment. RESULTS: Sixty-two (37.5%) of the 165 patients who had pegged implants were found to have problems with their pegs. Twenty-one (33.8%) of the 62 patients with peg problems had more than 1 peg-related problem. Complications associated with pegging included discharge (37%; 23 of 62), pyogenic granulomas (30.6%; 19 of 62), peg falling out (29%; 18 of 62), poor transfer of movement (11.2%; 7 of 62), clicking (11.2%; 7 of 62), conjunctiva overgrowing peg (4.8%; 3 of 62), poor-fitting sleeve (4.8%; 3 of 62), part of sleeve shaft visible (4.8%; 3 of 62), peg drilled on an angle (4.8%; 3 of 62), hydroxyapatite visible around peg hole (3.2%; 2 of 62), peg drilled off-center (3.2%; 2 of 62), popping peg (3.2%; 2 of 62), and excess movement of peg (3.2%; 2 of 62). The most serious complication occurring in two individuals (3.2%) was implant infection requiring implant removal. CONCLUSION: There are several potential complications that can occur after pegging the hydroxyapatite implant. These problems are generally of a minor nature but often require additional patient visits that would not ordinarily have been required if the peg was not in place. The most serious peg problem is implant infection, which may necessitate implant removal. These potential peg problems should be reviewed with the patient before the procedure is performed.     

Tissue breakdown and exposure associated with orbital hydroxyapatite implants.

Tissue breakdown and exposure of a hydroxyapatite implant were observed in eight patients: in four of six patients after evisceration and in four of 31 after enucleation. The reasons for evisceration were a blind, painful eye and endophthalmitis in two patients each. The reasons for enucleation were a choroidal melanoma in two patients and endophthalmitis and irreparable traumatic damage in one patient each. The patients with endophthalmitis received the implant in a second surgical procedure after intensive antibiotic treatment. Small tissue defects healed spontaneously, whereas large defects showed little tendency to heal by secondary intention. Tissue breakdown over a hydroxyapatite implant may be related to delayed ingrowth of fibrovascular tissue, and possibly related to an inflammatory reaction incited by the hydroxyapatite. Careful case selection, facilitation of tissue penetration by drilling holes into the hydroxyapatite sphere, delayed fitting of the prosthesis, and vaulting of the posterior surface of the initial prosthesis to reduce pressure on the tissues covering the anterior pole of the implant may alleviate the problems of tissue breakdown and exposure.     

羟基磷灰石义眼台植入后义眼台暴露的处理

目的：探讨羟基磷灰石眶内义眼台植入后义眼台暴露的处理方法。方法：回顾本中心１９９４年７月至１９９８年６月期间收治的羟基磷灰石义眼台暴露４１例的治疗方法及效果。结果：义眼台暴露的发生时间为术后７天至６月,暴露范围内２ｍｍ至１５ｍｍ,有１５例义眼台暴露能自行愈合;２６例需手术修补,其中２例伴有慢性感染者需手术取出义眼台。结论：义眼台暴露的处理可根据暴露范围采用不同方法处理,义眼台暴露范围在５ｍｍ以内的     

Complications of pegged and non-pegged hydroxyapatite orbital implants

PURPOSE: The purpose of this study is twofold: to assess the incidence and implications of complications unique to placing a freestanding polycarbonate peg in patients with hydroxyapatite implants and to compare the incidence of complications in these patients with the incidence in patients with non-pegged hydroxyapatite implants. METHODS: This is a retrospective clinical case series of 103 patients who underwent hydroxyapatite implant insertion at our institution. The incidence of postoperative complications in patients who underwent freestanding polycarbonate pegging procedures (n = 21) and those who had not (n = 82) were compared. RESULTS: One postoperative complication - infection - occurred in a significantly higher percentage of patients in the pegged group (42.9%, 9/21) compared with the non-pegged group (19.5%, 16/82), (p = 0.037). Fifteen of the 21 patients (71.4%) in the pegged group experienced complications unique to freestanding polycarbonate pegging. Overall, 95.2% (20/21) of patients in the pegged group experienced a complication compared with 58.5% (48/82) of patients in the non-pegged group, (p = 0.001). In addition, there was an average of 3.1 (66/21) complications per patient in the pegged group compared with an average of 1.9 (106/82) complications per patient in the non-pegged group (p = 0.010). CONCLUSIONS: Patients who received a freestanding polycarbonate pegged implant had a high risk of experiencing complications unique to pegging, and therefore a significantly higher rate of complications overall when compared with patients whose implant was not pegged. In addition, patients who received a pegged implant had a higher incidence of infection. However, most patients retained their pegs despite complications.     

巩膜原位覆盖羟基磷灰石义眼台植入临床观察

目的 探讨改良式巩膜内羟基磷灰石义眼台植入的临床效果.方法 22例(22眼)眼内容摘除后应用自体巩膜后开窗及前折叠包裹羟基磷灰石义眼台,术后随访3 ～ 15个月.结果 所有患者均有良好效果,无一例义眼台暴露,义眼台活动良好.结论 改良式羟基磷灰石义眼台植入术并发症少,疗效良好.     

羟基磷灰石义眼座植入不同术式的疗效分析

目的评价羟基磷灰石义眼座不同植人方法的临床效果。方法54例根据植入术式分为无包裹组和自体巩膜包裹组,观察术后一期愈合情况及义眼座暴露等并发症。随访3—18个月。结果术后眼窝饱满度、义眼座活动度良好。主要并发症为结膜囊裂开,义眼座暴露。两种植入方法的愈合及暴露情况各组之间比较差异无统计学意义。结论羟基磷灰石义眼座植入整容效果良好,不同术式羟基磷灰石义眼座植入术后并发症的发生与植入方式无明显关系。     

羟基磷灰石义眼台不同植入方法的效果评价

目的 评价羟基磷灰石义眼台不同植人方法的临床效果.方法 分为5组,分别采用一期植人、二期植入、自体及异体巩膜包裹或无巩膜包裹等不同方法植入羟基磷灰石义眼台183例183眼,随访3～24月.对其术后并发症及整容效果进行分析比较.结果 术后义眼台暴露24例,暴露面积≤5 mm者可自行愈合,暴露面积＞5 mm者多需要手术修复;各组所有病例眼窝饱满,双眼对称.一期植入术后眼球活动度优于二期植入者.结论 羟基磷灰石义眼台植入整容效果满意,术后主要并发症是义眼台暴露.条件允许的情况下首选义眼台一期植入;二期手术应尽早进行.     

羟基磷灰石义眼座植入安装活动性义眼临床应用及疗效分析

目的观察羟基磷灰石义眼座植入安装活动性义眼的临床疗效。方法共54例（57眼）。其中眼球摘除、眼内容摘除义眼座植入43例（45眼）,二期植入11例（12眼）。行义眼座植入后安装活动性义眼。追踪观察10月～4年。结果54例（57眼）术后义眼水平活动度大于20°者29眼（50.88%）,活动度在10°～20°之间者22眼（38.59%）,活动度小于10°者6眼（10.53%）,并发症少。结论羟基磷灰石义眼座植入,安装活动性义眼,术后并发症少,活动度好。     

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.     

A new titanium peg system for hydroxyapatite orbital implants

PURPOSE: To evaluate a new hydroxyapatite-coated titanium sleeve and titanium peg system for HA orbital implants. METHODS: The authors followed 54 patients receiving an HA-coated titanium sleeve and peg system and analyzed the complications associated with this peg system. The following data were recorded: type of surgery performed, size of implant used, type of HA used, time of pegging, follow-up duration, problems encountered, and treatment. RESULTS: Fifty-seven patients received the HA-coated titanium peg and sleeve system. The average duration of follow-up was 15 months (range, 3-30 months). Three patients were lost to follow-up after 1 month. Complications associated with peg placement in 54 patients included: discharge (9.2%), pyogenic granulomas (14.8%), peg falling out during prosthesis removal (9.2%), poor transfer of movement (1.8%), clicking (3.7%), conjunctiva overgrowing peg (1.8%), part of sleeve shaft visible (9.2%), peg drilled on an angle (1.8%), HA visible around peg hole (3.7%), and loose sleeve (3.7%). CONCLUSION: The HA-coated titanium sleeve and titanium peg is a new peg system available for HA orbital implants. Many of the complications associated with this peg system are similar to the commonly used polycarbonate peg system. Pyogenic granulomas and discharge, however, appear to be less frequently encountered with this new system. The HA-coated titanium sleeve and titanium pegs were well tolerated and appeared quieter in the socket than most polycarbonate pegs.     

巩膜花瓣状成形羟基磷灰石义眼台植入32例分析

目的 探讨巩膜花瓣状成形羟基磷灰石义眼台植入术的手术体会.方法 对32例行巩膜花瓣状成形羟基磷灰石义眼台植入术,随访3～18月,观察术后效果.结果 32例中1例结膜囊狭窄.均未发现义眼台暴露、脱出及感染等并发症.结论 巩膜花瓣状成形羟基磷灰石义眼台植入术术后并发症少,义眼台活动好,手术方便易行、疗效较可靠.     

羟基磷灰石眶内植入物血管内皮细胞生长因子的表达

目的:探讨血管内皮细胞生长因子(vascular endothelial growth factor,VEGF)与羟基磷灰石(hydroxyapatite,HA)眶内植入物纤维血管化形成的相关性,以及地塞米松抑制羟基磷灰石植入物纤维血管化的机制。方法:家兔20只随机分为实验组与对照组,每组10只;各组均采用HA植入物植入兔眼眶。术后滴妥布霉素滴眼液4次/d,实验组术后48h起隔日球周注射地塞米松0·5mg和实验结束,并观察两组的结膜生长情况;实验组与对照组分别于术后3,7,14,21,28d摘取2只HA植入物行免疫组织化学检测VEGF阳性表达情况。结果:羟基磷灰石植入物纤维血管化与VEGF的表达存在显著的相关性。术后14d,实验组HA炎性细胞浸润明显减少,实验组VEGF表达明显低于对照组。结论:羟基磷灰石植入物纤维血管化与炎症反应密切相关,VEGF可能参与了纤维血管化形成过程,地塞米松可能通过抑制植入物的炎症反应及VEGF的表达。     

Primary placement of a titanium sleeve in hydroxyapatite orbital implants

BACKGROUND: To study a new surgical option of primary placement of a titanium sleeve into hydroxyapatite implants during enucleation or evisceration. METHODS: A standard enucleation or cornea preserved evisceration was performed, followed by preplacement of a titanium sleeve into the hydroxyapatite implant by a hand drill sleeve driver. Care must be taken to ensure that the titanium sleeve is positioned centrally when the implant is put inside the orbital socket or eviscerated shell. The Tenon capsule and conjunctiva were meticulously closed with minimal tension. Complications such as sleeve exposure, coralline exposure, and infection of the titanium sleeve were closely observed. RESULTS: In all, 30 patients were treated in the above fashion with 10 enucleation and 20 evisceration procedures. The follow-up period ranged from 9 to 24 months. Three of the sleeves were found to have exposed spontaneously at 5 and 7 weeks following original surgery. They had no further complication except one sleeve loosening. The remaining 27 sleeves that did not spontaneously expose pursued secondary exposure of the titanium sleeve and peg insertion by conjunctival cutdown procedure 3 months after original surgery. Two sleeves were found to be oblique positioned after the conjunctival cutdown procedure. Fortunately, all the 30 patients were successfully fit with a peg-coupled prosthesis with good motility. CONCLUSION: Primary placement of a titanium sleeve into hydroxyapatite implants has several advantages, including high patient acceptance, technical simplicity, and office-based conjunctival cutdown pegging procedure. By avoiding the expense of postoperative imaging study and additional prosthetic modification, a more rapid and efficient rehabilitation is possible.