羟基磷灰石义眼台置入23例

Orbital implantation of hydroxyapatite: An analysis of 23 cases

为观察眼球摘除后羟基磷灰石义眼台置入后的疗效及对羟基磷灰石义眼台暴露的原因和预防义眼台暴露进行分析,文章对2005-01/2007-12泸州医学院附属医院眼科采用自体巩膜包裹或带肌肉缝线义眼台的23例患者进行回顾性总结分析,其中Ⅰ期置入17例,Ⅱ期置入6例。对于眼球内容物剜出有巩膜瓣的患者角膜缘处360°结膜巩膜剪开,完全清除色素膜,做巩膜放射状切口,将义眼台置入巩膜腔内,缝合前部巩膜。对于眼球摘除术或羟基磷灰石义眼台Ⅱ期置入无巩膜瓣的患者,将义眼台置入肌锥内,直肌对位缝于义眼台缝线孔处。筋膜囊严密双层错位褥式缝合,结膜间断缝合。结果显示置入后义眼活动度和稳定性良好,2例发生义眼台暴露。提示羟基磷灰石义眼台置入是无眼球患者的首选,并发症少,即使出现义眼台暴露,也能很容易的处理。

This study was designed following eyeball extirpation to evaluate the therapeutic effects of hydroxyapatite and to explore the causes and preventing from exposure during orbital implantation. A total of 23 cases with autologou sclera and muscular suture selected from Department of Ophthalmology, Affiliated Hospital of Luzhou Medical College between January 2005 and December 2007 were retrospectively summarized and analyzed. Seventeen cases were implanted initially and the other 6 cases received secondary implantation. For the implantation with scleral-wrap, a 360° peritomy, limbic sclerotomy and full keratectomy were performed with corneoscleral scissors. Uveal tissue was completely removed. Posterior sclera was radially incised, and the hydroxyapatite orbital implant was implanted. Anterior sclera was sutured completely. Other implantations without using sclera-wrap were performed with the hydroxyapatite orbital implant in muscle cone and four rectal muscles were sutured to the hole of the hydroxyapatite orbital implant. Mattress suture of fascia tissue with double staggered position was performed in all the implantations. Conjunctiva was sutured discontinuously. This implant provided satisfactory functional motility and stability. Two cases developed implant exposure, suggesting that hydroxyapatite was the implant of choice for cosmesis following surgical removal of the eyeball, or enucleation. The complication rate is low and implant exposure, if it occurs, can be easily managed.