后巩膜瓣旋转覆盖义眼座巩膜腔内植入术临床分析

目的:为了达到最佳的运动和仿真效果及长期的稳定,设计后巩膜瓣旋转覆盖巩膜腔内Medpor义眼座植入术,并评价此术式的手术适应证和疗效。方法:2008-01/2011-07在深圳市眼科医院接受眼内容剜除后巩膜瓣旋转覆盖巩膜腔内Medpor义眼座植入术120例患者:眼内容摘除后制作后巩膜瓣,将义眼座植入后方开放的巩膜腔内,旋转后巩膜瓣覆盖在义眼座表面,缝线固定义眼座。随访1～3a,记录最后一次就诊时的义眼座活动度,义眼片活动度,结膜囊剩余面积,结膜囊深度,并发症发生情况。结果:义眼座活动度:115例为优,5例为良;义眼片活动度89例为优,26例为良,5例为差;平均结膜囊剩余面积为178.1±7.5mm2;平均结膜囊深度为2.7±1.1mm;2例出现义眼座暴露感染,3例出现结膜下植入性囊肿,2例出现义眼座固定缝线外露,未出现义眼座内陷、上眶区凹陷、结膜囊狭窄、下睑外翻、眼眶蜂窝织炎。结论:后巩膜瓣旋转覆盖Medpor义眼座巩膜腔内植入术对于轻中度眼球萎缩、角巩膜葡萄肿、绝对期青光眼患者具有良好的治疗效果。

Clinical analysis of 120 patients with posterior sclera flap rotating and covering porous polyethylene implantation

AIM: To propose and evaluate a modified evisceration and implantation technique that aiming to improve the motility and simulation and long-term stabilization of the implant.

METHODS: From January 2008 to July 2011, 120 patients underwent the primary evisceration and implantation of a porous polyethylene in our hospital using the modified technique, which included secting posterior sclera flap, inserting porous polyethylene sphere into sclera cavity, the posterior sclera flap on the surface of the implant. They underwent artificial eye installation about one to two months postoperatively. Main outcome measures were mobility of the implants, mobility of the artificial eyes, conjunctiva surplus square, conjunctiva sac depth, and complications.

RESULTS: In a mean 1.5 years follow-up period(range, 1 to 3 years), mobility of the implants were excellent in 115 cases, and good in 5 cases; mobility of the artificiaI eyes were excellent in 89 cases, and good in 26 cases, and poor in 5 cases; the mean conjunctiva surplus square was 178.1±7.5mm²; the mean conjunctiva sac depth was 2.7±1.1mm; there was 2 cases of implant exposure and infection, 3 cases of subconjunctival implantation cysts, 2 cases of implant fixation sutures exposure, no case of significant enophthalmos, superior sulcus deformity, conjunctiva sac narrow, lower eyelid ectropion, or orbital cellulitis.

CONCLUSION: This technique appears to be an excellent modification for an ophthalmic socket reconstruction.