先天性小眼球及隐眼的眼窝畸形矫治

目的探讨先天性小眼球及隐眼眼窝畸形的最佳矫治时机与矫治方法。方法回顾性分析我院收治的14例（14眼）先天性小眼球（其中2例为隐眼）病例的临床表现、就诊时间、矫治方法及治疗效果。结果14例中的12例行小眼球摘除联合义眼座植入术，9例因小睑裂、小眼眶，同时行内、外眦延长成形术，并选用了最小号（直径18mm）的义眼座；其中3例外侧眶缘截骨术，2例术中将义眼台进行了磨削，实际直径为16～17mm。12例术后均眶腔饱满，眼睑可自然睁开和闭合，配戴义眼片后，术眼活动与健眼同步，外观逼真，达到了满意的美学效果。随访6月～6年，平均23．5个月，无感染、眼座暴露或上眶区凹陷等并发症。其余2例结膜瓣遮盖后，配戴义眼片，因眼眶发育较好，美容效果也较理想。结论由于眼眶发育与眼眶的张力即眼球的直径直接相关，且有年龄阶段性。我们认为对眼球最大直径小于10mm的小眼球宜尽早选用相对稍大的羟基磷灰石义眼座矫治眼窝畸形；对最大直径大于10mm的小眼球患者，可先配戴义眼片并不断更换较大的义眼片，到8岁以后再酌情为他们施行义眼座植入手术；对小眼球角膜直径大于7mm，眼眶、结膜囊发育接近健眼，可保留眼球，仅以定制义眼片矫治眼窝凹陷。

Treatment on congenital microphthalmia and eye socket deformity

Objective To discuss the optimal timing and corrective method of congenital microphthalmia and the eye socket deformity. Methods The clinical manifestation, consultation time, corrective method, therapeutic effect of 14 cases with congenital microphthalmia were analyzed retrospectively. Results 12 cases with primary hydroxyapatite orbital implant, 9 cases with medial canthoplasty combined with lateral canthoplasty extra, had plump orbit and excellent apparenees. After a follow up of 6 -72 months, complications, including infection, implant exposure, upper eyelid excavation,did not happen. Conclusion Because the orbit development correlate with the orbit tension witch is eyeball diameter, we suggest that eyeball diameter, age of patients must be taken into consideration when choosing the therapeutic methods.