巩膜成形在义眼台植入术的应用

目的 观察巩膜成形在IOI羟基磷灰石义眼台植入术后的疗效。方法 行球内容物（扌宛）除术后先剪除视神经乳头，巩膜成形后再一期植入IOI义眼台于巩膜腔及肌锥内各1／2。结果 随访5月～33月，均无发生义眼台排斥暴露、感染、移位及眼球固定。结论 巩膜成形的应用减少了义眼台植入术后并发症的生产，是眼眶美容术中一种理想的方法。     

甲基丙烯酸改性甲基丙烯酸β羟乙酯水凝胶义眼台的实验研究

目的研究兔眶内植入甲基丙烯酸(MMA)改性甲基丙烯酸β羟乙酯(PHEMA)水凝胶义眼台的生物相容性和纤维血管化情况,为其临床应用奠定实验基础。方法将直径为14 mm的MMA改性PHEMA水凝胶义眼台分别手术植入32只兔眼眶内,分别于术后2、4、8、12及24周做单光子发射型计算机体层摄影术(SPECT)检查,并在不同时间点(2、4、8、12及24周)取出植入物进行光镜、免疫组化(Actin、Vimentin、CD34)及电镜观察。结果 SPECT检查改性PHEMA植入物在在体情况下随时间延长,同位素示踪剂在局部逐渐浓集。光镜、免疫组化、电镜检查结果显示2周时纤维血管组织从植入物外周长入,4～8周孔隙内胶原纤维逐渐致密,至12周全部纤维血管化。32例中仅1例术后出现结膜裂开、义眼台暴露,经二次手术修补愈后好。结论经改性的PHEMA水凝胶义眼台组织相容性好、血管化快,手术操作简单,并发症少,是一种安全、实用的新型眶内植入材料。     

巩膜腔前后花瓣样切开羟基磷灰石义眼台植入术的应用

由于眼球外伤等原因致不可恢复视功能而须摘除伤眼者，因术后眼眶凹陷畸形使外观不雅，致心理创伤，是患者渴望解决的重要问题。当前羟基磷灰石义眼台具多种植入术式，尤其二期植入病例，须先备有已常规处理后的异体眼球巩膜，将2种植入物同时行眼眶内植入术，术程复杂，常同时造成眼外肌过度牵拉影响眼外肌肉的功能，从而影响术后义眼的活动或因术中对眶内脂肪的破坏，造成不同程度的植入物移位及并发术后眶内容凹陷畸形。我院于2002年2月～2004年8月，对7例需眼球摘除患者在许可的前提下，改行眼球内容挖出术加巩膜腔前、     

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。     

脱细胞真皮包裹PHEMA水凝胶义眼台的实验研究

目的:研究脱细胞真皮包裹的水凝胶义眼台复合物的制备方法,评价其生物学性能。方法:材料制备:用MMA和HEMA的聚合物单体加入NaCl成孔剂制备多孔水凝胶义眼台,750mL/L乙醇浸泡制备同种异体巩膜包裹物。动物实验:新西兰白兔32只,右眼球摘除术后,16只植入脱细胞真皮包裹的直径为12mm的水凝胶义眼台作为实验组,16只植入保存异体巩膜包裹的直径为12mm的水凝胶义眼台作为对照组,术后在不同时间点(2,4,8,12wk)取材作病理检查,比较不同包裹材料对义眼台血管化程度和义眼台植入并发症发生率影响的差别。结果:MMA和HEMA的聚合物单体体积膨胀率为1.2,孔隙率为72%,孔径大小为450～520μm,且多为通孔。不同材料包裹PHEMA多孔水凝胶义眼台植入兔眶腔术后,所有32眼无肉芽肿发生及义眼台排出。光镜结果显示纤维血管组织2wk时从植入物外周长入,4～8wk时孔隙内胶原纤维逐渐致密,12wk时完成纤维血管化,扫描电镜显示植入物孔隙内逐渐被纤维血管组织填充,2wk时纤维血管组织附壁生长,12wk时孔隙内被纤维血管组织充满且孔间相连。对各组植入物纤维血管化程度进行测量,结果进行多因素方差分析,实验组较对照组血管化速度快(P=0.01)。结论:PHEMA水凝胶义眼台和脱细胞真皮生物相容性好,是一种安全可靠的眶内植入物,符合临床应用的要求,具有潜在的实际应用价值。     

改良羟基磷灰石义眼台植入术临床观察

目的:观察改良的羟基磷灰石义眼台植入术的疗效。方法:对32例改良的义眼台植入术,其中Ⅰ期18例,Ⅱ期14例,进行回顾性分析。结果:本组改良的羟基磷灰石义眼台植入术后,义眼活动度好,与健眼同步,无脱出、眼窝凹陷或上睑下垂;其中3例义眼台暴露,重新手术修补。结论:对严重的眼球破裂伤、无光感疼痛性眼球或萎缩眼球患者行改良的羟基磷灰石义眼台植入术,是一种较安全而有效的方法。     

异体巩膜的眼库处理及在眼座植入术中的应用

目的　改良一种人异体巩膜的眼库处理方法,比较异体巩膜和自体巩膜在眼座植入术中应用的临床效果。方法　人异体巩膜的处理包括去除其它眼组织、灭菌、脱水、低温保存、复水等步骤。比较33 例用异体巩膜包裹羟基磷灰石眼座植入术与35 例自体巩膜包裹者和2 例自体加异体巩膜包裹者的临床效果、并发症。结果　异体巩膜包裹的眼座植入后的临床效果及并发症与自体巩膜组相似。结论　异体巩膜处理方法简单,临床使用安全,效果好     

自体髂骨义眼座植入术

目的研究自体髂骨义眼座植入的手术方法，评估其临床效果。方法于髂前上嵴处手术截取自体髂骨，制作一与眼窝相适应的球形义眼座，按常规方法植入眼眶内。结果34例均一次性取骨制成类圆形骨性义眼座，植入眼窝后无一例结膜裂开或义眼座脱出，镶配义眼片后美容效果良好。结论自体髂骨适合于其他材料义眼座植入后发生排斥反应或不能承受其他材料义眼座费用的患者。     

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.     

Warfarin-associated delayed orbital hemorrhage after orbital fracture repair with smooth nylon foil implant

The authors describe the first report in the literature of delayed orbital hemorrhage that may be partly caused by supratherapeutic anticoagulation. A 52-year-old man with supratherapeutic international normalized ratio (INR) presented with acute proptosis, orbital pain and diplopia 9 months after the floor and medial orbital wall fracture repair using nylon foil implant. He was found to have hemorrhaged into the capsule surrounding the orbital implant. Three weeks later, the patient underwent implant removal after warfarin was discontinued for 5 days and INR was normalized. His symptoms resolved postoperatively. This case describes a unique risk factor of delayed orbital hemorrhage in patients with previous orbital fracture repair, and highlights that coagulopathy should be investigated in patients presenting with acute proptosis with a history of orbital fracture repair. The authors also provide a comprehensive and up-to-date literature review on previously reported cases with delayed hemorrhagic complications from alloplastic orbital implants.     

二期羟基磷灰石义眼台早期植入临床观察

目的：观察眼球摘除术后二期羟基磷灰石义眼台早期植入的临床特点。

方法：回顾性分析16例16眼二期羟基磷灰石义眼台早期植入原因、植入时间、手术特点、手术效果以及并发症。术后随访6～13(平均10)mo。

结果：眼球摘除术后外院转入,严重眼外伤眼眶内组织污染,眼内炎蔓延眼球摘除术后,眼内肿瘤术后是二期羟基磷灰石义眼台早期植入主要原因。16例患者在眼球摘除术后7～15(平均12)d成功行肌锥内二期羟基磷灰石义眼台植入术。术后患者外观改善,义眼台活动度良好,未见感染、义眼台暴露、脱出、眼睑下垂等并发症,1例早期球结膜裂开,再次缝合后愈合,1例结膜囊肿形成,手术切除后无复发。

结论：眼球摘除术后早期二期羟基磷灰石义眼台植入手术过程、效果类似一期义眼台植入。合理选择病例、良好的手术技巧基础上行早期二期羟基磷灰石义眼台植入安全有效。     

生物陶瓷中空义眼座的设计和临床应用

目的 观察作者设计的生物陶瓷中空八孔义眼座的临床应用效果。方法 对112例眼球摘除术后采用生物陶瓷带有八个孔的中空义眼座作为填充物,观察其效果。结果 112例中108例眼窝塌陷得到满意矫正,义眼活动度15°～20°。3例因下穹隆过浅而未装入义眼,1例因感染取出义眼座。结论 生物陶瓷八孔中空义眼座生物相容性好,手术方法简便,美容效果满意。     

聚甲基丙烯酸甲酯义眼台的肌锥内植入

目的探讨聚甲基丙烯酸甲酯义眼台肌圆锥内植入的可行性及其美容效果。方法用化学固化型义齿基托材料制做义眼台。52例行眼内容物摘除术。术中将巩膜壳剪成两半并剪断视神经,义眼台放于肌圆锥内。5-0线间断缝合巩膜壳的两部分,并在巩膜壁上剪2个2 mm×3 mm大小的小孔做引流用。间断缝合眼球筋膜,连续缝合球结膜。结膜囊填油纱条,加压包扎。3 d后选配仿真义眼片植入结膜囊,5 d拆除结膜缝线。随访观察最少半年。结果义眼台植入后,眼部外观良好,义眼有一定的活动度。无义眼台脱出、外露等并发症。结论聚甲基丙烯酸甲酯义眼台肌锥内植入能够达到良好的美容效果,并且费用低、操作方便、并发症少。