前巩膜片技术预防多孔材料义眼座植入的暴露

目的探讨在眼球摘除后多孔材料义眼座前部增加一巩膜片植入眼眶后预防暴露的有效性。方法美国Ore-gon州OHSU医学院Casey Eye Institute眼科研究所眼面部整形外科从2000年1月至2009年1月,John D Ng医生的162例（170眼）眼球摘除合并眼眶内植入有孔材料,使用前巩膜片技术（在多孔义眼座的前部缝合一7.5 mm×7.5 mm的巩膜片,并将四条直肌缝在巩膜片上）。根据病例资料,眼疾诊断,手术操作技术,先前眼科手术史,植入物的大小,随访时间,植入后并发症等,观察统计义眼暴露率及并发症。结果植入暴露发生7例,7眼（4.12%,7/170）。其中一例发生在早期（〈6个月）,6例发生在晚期（〉6个月）。这7例中1例给于抗生素及结膜切除手术,暴露得到修复;另外6例结膜撕裂较大未能得到修复,遂取出义眼座植入一新的前部缝有巩膜片的义眼座。这7例经过1a以上的随访,未出现再次暴露。结论巩膜片在移植物的前表面可以作为一种屏障,在预防暴露方面具有一定的有效性。

Prevention of exposure of porous orbital implants using anterior capping with scleral patch graft on the implant technique following enucleation

Objective To investigate effectiveness of adding a sclera patch graft on a porous orbital implant to prevent exposure following enucleation or secondary implantation. Methods Design： Retrospective chart review in one surgeon＇s practice（JDN）.A chart review of all 170 eyes（162 cases）.patients who underwent placement of porous polyethylene/bioglass orbital implants was performed.All patients received anterior capping with a sclera patch on the plant.Data included patient＇s age,gender,surgical indication,prior ocular surgery,pastmedical history,procedure performed,implant size,and postoperative complications. Results Porous polyethyelene/bioglass implants were placed in 170 sockets.Seven sockets undergoing primary enucleation and implant placement had implant exposure（4.12%）.1 patient had an early exposure and 6 had late exposures.All exposures were successfully treated with antibiotics or additional surgery. Conclusion Scleral patch graft can act as duplicate barrier between anterior surface of implants and overlying soft tissue for orbital reconstruction after primary enucleation or as a secondary implant.