羟基磷灰石义眼台眶内植入术后结膜脓性肉芽肿形成的原因分析(英文)

目的:分析羟基磷灰石(hydroxyapatite,HA)义眼台眶内植入术后结膜脓性肉芽肿形成的原因。方法:回顾性分析我院眶内植入HA义眼台250例(钻孔及栓钉置入68例),随诊18mo~10a,脓性肉芽肿形成后首先药物保守治疗,无效后采用手术治疗。结果:植入HA义眼台250例中发生脓性肉芽肿10例,其中9例在钻孔及栓钉置入术4~7a后发生,1例发生时羟基磷灰石义眼台未钻孔。9例保守治疗效果均欠佳,行HA义眼台取出术,1例拒绝眼台取出而继续保守治疗。结论:脓性肉芽肿是严重的义眼台植入术后并发症,发生原因可能与义眼台植入后血管化不足,义眼台暴露与继发感染,异体材料包被,义眼台钻孔及栓钉置入等因素有关,而与栓钉的材料无关。脓性肉芽肿的发生意味着义眼台可能发生了感染,最终需行义眼台取出术。     

义眼台植入术后脓性肉芽肿形成原因的探讨

目的探讨珊瑚多孔羟基磷灰石义眼台植入术后脓性肉芽肿形成的原因。方法回顾性分析我院羟基磷灰石义眼台植入250例,及外院手术者1例,共251例(251眼),对其中发生脓性肉芽肿的病例、分析其发生的原因。随诊4月~9年。结果251例中发生脓性肉芽肿4例(包括外院1例),其中1例脓性肉芽肿形成时,义眼台尚未钻孔,3例在钻孔及栓钉置入术4~7年后脓性肉芽肿形成。4例保守治疗效果欠佳,3例最终行义眼台取出术,1例拒绝手术。结论脓性肉芽肿形成是羟基磷灰石义眼台眶内植入较少见的并发症,发生原因与义眼台暴露,义眼台血管纤维化不足,义眼台钻孔及栓钉置入等有关。脓性肉芽肿的形成预示义眼台发生了感染,致病菌以厌氧性革兰氏染色阳性球菌为主。义眼台取出术是治疗的关键。     

羟基磷灰石义眼台钻孔及栓钉置入术

目的 观察羟基磷灰石义眼台植入后钻孔及栓钉置入术的效果和并发平。方法 ４５例植入羟基磷灰石义眼台的患者,于术后０．５ａ左右行义眼台钻孔及栓钉置入。正确定位后用电钻或手工钻孔,拧入 孔螺钉,将平头钉插入螺钉孔内,结膜水肿消退后换圆头钉,配装活动性义眼。平均随访１３．６ｍｏ。结果 一次手术成功率为８２．２％。并发症有钻孔偏位、偏斜、孔浅钻孔处慢性肉芽肿、感染等,发生率为２２．２％。经治疗后不影响活动性义眼片安装。结论 羟基磷灰石义眼台钻孔及栓钉置入术改善义眼外观。钻孔及栓钉置入术的时机定位和钻孔准确是手术成功的关键。     

带预置缝线的羟基磷灰石义眼座眶内植入术疗效观察

目的探讨带预置缝线的羟基磷灰石义眼座(hydroxyapatite,HA)直接植入眶内的手术效果。方法22例(22只眼)行带预置缝线的羟基磷灰石义眼座直接植入眶内手术,术后随访3~17月。结果22只眼术后均有眼睑轻度肿胀,球结膜水肿,眼眶区胀痛,2只眼球结膜切口裂开,经保守治疗后愈合。未发生义眼座暴露、脱出及感染等并发症。结论带预置缝线的羟基磷灰石义眼座眶内植入术方便易行、疗效可靠。     

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。     

羟基磷灰石义眼台植入术并发症防治体会

目的：探讨羟基磷灰石（hydroxyapatite,HA)义眼台植入术并发症的发生原因及治疗。方法：回顾155例随访6月－6年，结果。术后并发症包括义眼台暴露9例，下穹隆狭窄6例，钻孔偏斜4例，钻孔后感染2例，上睑下垂2例，义眼台偏移1例，均经治疗后痊愈，结论：术后及术后的正确处理可以防止或减轻并发症的发生及其造成的不良后果。     

眶内二期羟基磷灰石义眼台植入术

目的探讨眶内二期羟基磷灰石义眼台植入手术的临床疗效及在不同情况下的手术方式选择。方法对33例行眼球摘除或眼内容物剜出术后的患者采用珊瑚多孔羟基磷灰石(HA)义眼台行二期眶内植入术，观察其外观修复效果。结果术后随访6～24个月，眼部外观满意度达78．8％，无感染、义眼台排出或移位等现象；并发症主要有术后球结膜裂开、义眼台部分外露等。结论眶内二期羟基磷灰石(HA)义眼台植入术，是眼球丧失后疗效较好的眼眶充填手术。     

带和不带巩膜壳羟基磷灰石义眼台植入临床观察

目的比较不带巩膜壳和带巩膜壳羟基磷灰石义眼台植入术的疗效。方法30例不带巩膜壳羟基磷灰石义眼台植入者、30例带自体巩膜壳义眼台植入者、10例改良带自体巩膜壳义跟台植入者,术后随访1～10 a,对其疗效进行比较,以评价手术效果。结果30例带自体巩膜壳义眼台植入者,术后有5例发生肉芽肿形成,其中4例行义眼台取出术,1例经保守治疗痊愈。30例不带巩膜壳义眼台植入者有1例出现义眼台暴露。10例改良带自体巩膜壳义眼台植入者,无一例出现并发症。结论肉芽肿形成是带自体巩膜壳义眼台植入术后常见并发症,包裹的巩膜壳会影响义眼台血管纤维化,并发生融解和异物反应。改良带自体巩膜壳义眼台植入术可避免这一并发症,又可获得较好的美容效果。     

带和不带巩膜壳羟基磷灰石义眼台植人临床观察

目的比较不带巩膜壳和带巩膜壳羟基磷灰石义眼台植入术的疗效。方法30例不带巩膜壳羟基磷灰石义眼台植入者、30例带白体巩膜壳义眼白植入者、10例改良带白体巩膜壳义跟台植入者，术后随访1—10a，对其疗效进行比较，以评价手术效果。结果30例带自体巩膜壳义跟台植入者，术后有5例发生肉芽肿形成，其中4例行义眼台取出术，1例经保守治疗痊愈。30例不带巩膜壳义眼台植入者有1例出现义眼台暴露。10例改良带自体巩膜壳义眼台植入者，无一例出现并发症：结论肉芽肿形成是带自体巩膜壳义眼台植入术后常见并发症，包裹的巩膜壳会影响义眼台血管纤维化，并发生融解和异物反应。改良带白体巩膜壳义眼台植入术可避免这一并发症，又可获得较好的美容效果。     

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.     

Coralline hydroxyapatite orbital implant (bio-eye): experience with 158 patients

PURPOSE: To assess the problems seen in 158 patients with coralline hydroxyapatite (HA) orbital implants (Bio-Eye). METHODS: A consecutive case series of 170 patients receiving coralline HA implanted by two surgeons over a 5-year period were reviewed. The authors analyzed age, type of surgery, implant size, peg system, follow-up duration, time of pegging, problems encountered, and treatment. RESULTS: Twelve patients were lost to follow-up after 5 months, leaving 158 patients who were followed from 6 to 130 months (average, 39 months). Problems in unpegged implants occurred in 36 (22.8%) patients. Discharge occurred in 18 (11.4%) patients, implant exposure in 12 (7.6%), socket discomfort in 1 (0.6%), conjunctival thinning in 3 (1.9%), chronic conjunctival swelling in 2 (1.3%), and implant infection in 3 (1.9%). Problems after pegging occurred in 68 (50.7%) of 134 patients: discharge in 27 (20.1%), pyogenic granuloma in 24 (17.9%), conjunctiva overgrowing the peg in 4 (3.0%), implant exposure around the sleeve in 5 (3.7%), clicking in 6 (4.5%), peg on an angle in 2 (1.5%), loose sleeve in 1 (0.7%), peg falling out in 18 (13.4%), popping peg in 1 (0.7%), poor transfer of movement in 3 (2.2%), pain with movement in 1 (0.7%), and implant infection in 2 (1.5%). CONCLUSIONS: The Bio-Eye orbital implant represents a porous orbital implant that is biocompatible with orbital tissues and allows fibrovascular ingrowth and improved motility when coupled to the overlying artificial eye. It is more expensive than other commercially available porous orbital implants, such as synthetic FCI3 HA, porous polyethylene (Medpor), and aluminum oxide (Bioceramic) implant. Problems encountered with its use are similar to those problems seen in patients with the synthetic FCI3 hydroxyapatite and aluminum oxide orbital implants.     

Problems after evisceration surgery with porous orbital implants: experience with 86 patients

PURPOSE: To assess the problems associated with the use of 4 types of porous orbital implant (Bio-Eye coralline hydroxyapatite, FCI3 synthetic hydroxyapatite, aluminium oxide [Bioceramic], and porous polyethylene [Medpor]) after evisceration surgery. METHODS: A retrospective analysis was made of all cases of evisceration with placement of one of four types of porous orbital implants performed between 1991 and 2002 by one surgeon (n = 86). Patient age, implant type and size, surgery type (standard evisceration or evisceration with posterior sclerotomies), peg system used, follow-up duration, time of pegging, problems before and after pegging, and treatment were recorded. RESULTS: Eight patients had less than 6 months of follow-up. The other 78 patients were followed for 6 to 107 months (average, 31 months). The following problems were noted before peg placement: discharge, 8 patients (10.2%); implant exposure, 6 patients (7.7%); implant fracture at the time of surgery, 1 patient (1.3%); persistent pain, 1 patient (1.3%). Of the 29 patients who had pegging, problems including discharge, exposure, pyogenic granuloma, infection, and peg sleeve problems occurred in 23 (79.3%). Sixteen (55.2%) of the 29 patients required at least 1 additional surgical procedure, 4 required 3 additional procedures, and 2 required 5 additional procedures, including implant removal. CONCLUSIONS: Although primary evisceration with posterior sclerotomies and placement of a porous orbital implant is an accepted technique for treating a variety of end-stage eye diseases, patients should be cautioned about an increased likelihood of problems and potential need for additional surgeries if pegging is considered.     

义眼座感染的临床病理分析

目的:探讨义眼座感染患者的临床和病理表现,以及其治疗和转归。方法:回顾分析2004-03/2012-06因义眼座感染在深圳市眼科医院取出义眼座的12例12眼患者的临床资料。结果:义眼座感染的临床表现为结膜囊分泌物增多、眼窝疼痛、结膜充血水肿(12眼),义眼座暴露(11眼),义眼自动脱落(10眼),复发性化脓性肉芽肿(1眼)。3眼结膜囊分泌物培养出表皮葡萄球菌,3眼涂片发现真菌菌丝,6眼培养结果为阴性。组织病理学检查可见义眼座前部有炎性细胞和坏死物碎屑,无纤维血管组织;义眼座后部有浓密的纤维血管组织生长,伴随炎性细胞。12例患者均取出感染的义眼座联合全身及局部抗感染治疗,7眼行Ⅱ期义眼座植入术,5眼拒绝接受整形手术。平均随访52mo,12例12眼均未出现感染复发。结论:义眼座感染是义眼座植入术后罕见的,也是最严重的并发症,通常需要取出义眼座联合抗感染治疗。     

The use of vicryl mesh in 200 porous orbital implants: a technique with few exposures

PURPOSE: To report the results of a wrapping technique for porous orbital implants by using polyglactin 910 (Vicryl) mesh (Ethicon Inc., Somerville, NJ, U.S.A.). METHODS: We retrospectively reviewed the records of 200 consecutive patients from one author's practice who received a polyglactin 910 mesh-wrapped porous orbital implant after enucleation or as a secondary implant between October 1, 1996, and April 15, 2001. We recorded potential problems that might be attributed to polyglactin 910 mesh both before pegging (excessive inflammatory response to the material, conjunctival thinning, and implant exposure) and after pegging (exposure of the implant around the sleeve, conjunctival thinning, and implant exposure other than adjacent to the peg). RESULTS: One hundred twenty-two men and 78 women underwent placement of a polyglactin 910 mesh-wrapped porous orbital implant. The average age at the time of implantation was 48.9 years (range, 11 to 85 years). The average follow-up interval in the 200 patients was 19.4 months (range, 2 to 80 months). Thirteen of the 200 patients had less than 6 months of follow-up, leaving 187 patients with an average follow-up of 20.5 months (range, 6 to 80 months). There were 76 primary enucleations and 124 secondary orbital implants. Thirty-seven patients received a Bio-Eye hydroxyapatite implant (HA) (Integrated Orbital Implants, San Diego, Calif), 97 received a synthetic FCI hydroxyapatite implant (FCI, Issy-Les-Moulineaux, France), and 66 received a Bioceramic implant (aluminum oxide-Al2O3) (FCI, Issy-Les-Moulineaux, France). One hundred fourteen patients (57%) underwent peg placement. The average time to pegging was 9.9 months (range, 6 to 16 months). Before pegging, 4 of 187 patients (2.1%) had implant exposure. Three of these exposures followed secondary orbital implant placement (2 Bio-Eye HA, 1 synthetic FCI3 HA) and one followed an enucleation (synthetic FCI3 HA). Two patients required a temporalis fascia graft and one required a scleral patch; the remaining defect closed spontaneously. One patient had conjunctival thinning 6 months after orbital implantation, which remained stable with no frank exposure for 36 months. No patient had excess socket inflammation. After peg placement, 3 additional patients had exposure of the implant around the peg site. There were no cases of conjunctival thinning or exposure of the implant other than adjacent to the peg site. CONCLUSIONS: Polyglactin 910 mesh is an excellent option as a wrapping material for porous orbital implants. It is simple to use, readily available, eliminates the need for donor tissue, does not require a second operative site, and it is less expensive than other currently available wrapping materials. We attribute our high success rate to our technique, which emphasizes proper placement of the implant within the Tenon space, suturing the extraocular muscles anterior to their normal anatomic sites, and meticulous closure of the Tenon capsule and conjunctiva in separate layers.     

Exposure of expanded polytetrafluoroethylene-wrapped hydroxyapatite orbital implant: a report of two patients

PURPOSE: Hydroxyapatite (HA) spheres used to replace volume after an enucleation are often wrapped with autologous tissue before orbital implantation. Man-made materials are less expensive and pose no risk for viral transmission. The use of expanded polytetrafluoroethylene (ePTFE) to wrap HA spheres was evaluated. METHODS: The medical records of 2 consecutive patients who underwent uncomplicated implantation of an HA sphere wrapped in ePTFE were reviewed. RESULTS: An unusual reaction to the ePTFE material that was nonresponsive to topical or systemic antibiotic therapy developed in these 2 patients. Eventual wound erosion and bacterial infection of the implant necessitated its removal. CONCLUSIONS: Although well tolerated in other surgeries, ePTFE, when used to wrap HA spheres and placed into the orbit, may cause persistent conjunctival discharge, pyogenic granuloma formation, and eventual wound erosion. Therefore, the use of this material to wrap HA spheres is not recommended.     

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.