改良自体巩膜义眼座固定简易手术

Simple fixation of hydroxyapatite artificial eye mount of auto sclera

目的:探讨自体巩膜固定羟基磷灰石义眼座更简易、更合理的手术方法。方法:对各种原因引起失明的患者23例23眼,在施行眼内容物剜出术时不切断眼外肌,自鼻上、鼻下、颞上、颞下放射状剪开巩膜6～8mm,环绕视乳头剪开后极部巩膜约6mm,再于上、下、内、外放射状剪开后巩膜5～6mm,十字交叉钝性扩张后筋膜囊,将义眼座植入后肌锥及巩膜腔,巩膜瓣对位交叉缝合,对HA义眼座起双层加固作用。结果:患者23例23眼植入的HA义眼座固定稳固,眼窝成形饱满,安装义眼片后两眼基本对称,义眼具有较好的活动度。随访中无1例发生义眼座移位、外露及脱出等并发症。结论:改良自体巩膜义眼座固定简易手术,能使义眼座更加牢固地固定在原眼球位置上,保持原来的运动状态,且操作更为简单,安装义眼片后效果逼真。

AIM：To explore a simple and more reasonable fixation of hydroxyapatite （HA） artificial eye mount of auto sclera. METHODS：Fixation was done in 23 cases of blindness with unknown causes. Eye contents enucleation was performed without cutting off extrinsic eyeball muscles. Episclera was sheared radially into 4 parts from nasal superior, inferonasal, subtemporal and supratemporal parts. Posterior sclera was scissored about 6mm around the optic nerve head, again downward, upward, internally and externally. Posterior sclera was sheared about radially the length of 5-6mm.Tenon capsule was dilated right-angle crossed and passively. After artificial eye mount was implanted into orbital muscle cone and sclera cavity, the 4 flaps of the sclera were cross-stitched, performing a double reinforcement effect to HA artificial eye mount RESULTS：All the HA artificial eye mounts implanted into 23 cases presented solid fixations, and full of orbital formations. After artificial eye pad was fixed, by and large, eyes were symmetrical, and artificial eye mount had a good range of motion. The follow-up studies showed none of artificial eye mount occurred to shift, expose, prolapse or other complications. CONCLUSION：The modified simple fixation of artificial eye mount of auto sclera makes it more solid for artificial eye mount to be fixed in the original eye position, and remain the original state of motion, and the operation is simple. After the fixation, it presents a very lifelike effect.