义眼座感染的临床病理分析

Clinical and pathological analysis of orbital implants infection

目的:探讨义眼座感染患者的临床和病理表现,以及其治疗和转归。方法:回顾分析2004-03/2012-06因义眼座感染在深圳市眼科医院取出义眼座的12例12眼患者的临床资料。结果:义眼座感染的临床表现为结膜囊分泌物增多、眼窝疼痛、结膜充血水肿(12眼),义眼座暴露(11眼),义眼自动脱落(10眼),复发性化脓性肉芽肿(1眼)。3眼结膜囊分泌物培养出表皮葡萄球菌,3眼涂片发现真菌菌丝,6眼培养结果为阴性。组织病理学检查可见义眼座前部有炎性细胞和坏死物碎屑,无纤维血管组织;义眼座后部有浓密的纤维血管组织生长,伴随炎性细胞。12例患者均取出感染的义眼座联合全身及局部抗感染治疗,7眼行Ⅱ期义眼座植入术,5眼拒绝接受整形手术。平均随访52mo,12例12眼均未出现感染复发。结论:义眼座感染是义眼座植入术后罕见的,也是最严重的并发症,通常需要取出义眼座联合抗感染治疗。

AIM .. To report the clinical and histopathologic findings, treatment, and outcomes in patients with orbital implants infection. METHODS. Clinical data of 12 patients 12 eyes with implants infection undergoing implant removal from March 2004 to June 2012 in our hospital were reviewed. RESULTS.. The clinical manifestations were discharge and socket tenderness, conjunctiva hyperemia and edemda （12 eyes）, implants exposure （11 eyes）, the artificial eyes automatically shedding （10 eyes）, recurrent pyogenic granuloma （1 eye）. Staphylococcus epidermidis were cultured in 3 eyes, fungal hyphae were smeared in 3 eyes from discharge, but 6 eyes were negative. Histopathologic examination showed inflammatory cell infiltrates and necrosis without fibrovascular tissue in the anterior of the explanted implants, whereas inflammatory cell infiltrates with fibrovascular tissue in the posterior of the explanted implants. 12 patients underwent implant removal combination with systemic and local anti- infection therapy. 7 eyes underwent secondary orbital implantation, 5 refused plastic operation. After a mean 52 months follow- up, all eyes had no recurrence of infection. CONCLUSION. Orbital implants infection is a rare and most serious complication of orbital implantation. Implant removal combined with anti-infection therapy is usually required.