羟基磷灰石眼台作为药物缓释载体以减轻术后疼痛的临床观察

目的：利用羟基磷灰石（hydroxyapatite,HA)眼台作为药物载体缓慢释放于眼窝后以减轻HA眼台眼窝内填充术后疼痛及术后反应。方法：眼窝内植入义眼台皇于眼台内注入醋酸地塞米松5mg(1ml)，盐酸妥布霉素4万U（2ml)。余步骤同经典步骤。结果：44例患者中43例（98%0无痛感或仅有轻微疼痛，29例患者（66%）有不同程度的恶心，17例（39%）还伴有呕吐。80%患者没有出现组织水肿。结论：义眼台内注入地塞米松及妥布霉素能有效地控制术后疼痛，减轻术后反应。明显地减轻患者痛苦。     

药物浸泡羟基磷灰石义眼座以减轻术后疼痛的临床观察

目的 羟基磷灰石(hydmxyapatite，HA)义眼座经药物浸泡后行义眼座眼窝内填充术，以减轻术后反应和疼痛。方法 术中用醋酸地塞米松5mg(1ml)，盐酸妥布霉素4万u(2ml)，布比卡因1ml，将义眼座充分浸泡15min再植入，其余步骤同经典步骤。结果 术后1周内，89．60k、患者没有出现组织水肿。48例(48眼)患者中46例(95．8％)无疼痛或轻微疼痛。30例患者(62．5％)出现不同程度的恶心，18例(37．5％)还伴有呕吐。结论 义眼座经地塞米松等药物浸泡后使用能有效减轻术后反应，减缓术后疼痛，明显减轻患者的痛苦。     

羟基磷灰石义眼台Ⅱ期植入术

目的 回顾和分析羟基磷灰石（HA）义眼台Ⅱ期植入术临床应用。方法 采用不同手术方式对眼球摘除术后Ⅱ期义眼台植入10例，和眼内容剜除术后Ⅱ期义眼台植入8例。结果 18例中成功植入18例，随诊6月-30月，均无发生义眼台暴露、感染、移位和义眼片固定。结论HA是一种较为理想的眼窝重建眶内植入材料，利用自体或异体巩膜多层覆盖HA义眼台眶内Ⅱ期植入，可以明显改善眼球摘除术后和眼内容剜除术后眼窝凸陷畸形和结膜囊狭窄等并发症。该方法安全简便，是眼眶美容术中一种理想方法，值得在基层医院推广。     

国产羟基磷灰石义眼台Ⅰ期植入手术技巧探讨

目的:研究眼内容剜除术后Ⅰ期植入国产羟基磷灰石(hydroxyapatite,HA)义眼台的临床疗效及手术并发症。方法:回顾性分析2004-01/2010-01在我院住院行眼内容剜除后Ⅰ期植入国产HA的患者20例20眼,其中男12例,女8例。观察患者术后疼痛程度、结膜水肿时间、结膜愈合时间以及HA暴露率。术后随访4~8(平均6)mo。结果:全部20例20眼患者均成功植入国产HA,眼眶外观饱满,眼球活动度良好,无1例发生HA排斥现象。结论:眼内容剜除术后Ⅰ期植入国产HA是临床治疗需摘除眼球患者的理想方法。     

二期活动义眼植入联合结膜囊成形术探讨

目的探讨二期HA义眼台植入联合结膜囊成形术手术效果。方法10例（10眼）因摘除眼球长期佩戴厚重义眼造成下穹窿浅及睑外翻,行二期HA义眼台植入联合下穹窿成形术。结果6例轻度下穹窿浅轻度外翻,行HA植入联合下穹窿深层埋线术;4例轻度下穹窿浅中度外翻,行行HA义眼台植入联合下穹窿深层埋线及下眼睑全层V型缩短术。随访2～12月手术效果良好。结论二期HA植入联合结膜囊成形术,术式简单,节省费用,术后效果良好。     

眶内植入带线羟基磷灰石义眼座的临床分析

目的 探讨眶内植入带线羟基磷灰石（HA）义眼座的临床效果。方法 对85例（85眼）眼球摘除者眶内植入带线HA义眼座。结果 术后随访12-36个月,平均18个月。义眼座活动度良好。82例结膜创口Ⅰ期愈合,2例结膜变薄,1例结膜创口裂开,义眼座暴露。无眶内血肿或感染等并发症。结论 眶内植入带线HA义眼座手术操作简单,术后并发症少,美容效果佳,临床效果好。     

羟基磷灰石义眼座植入术后球结膜裂开的因素

目的 探讨羟基磷灰石义眼座植入术后球结膜裂开的相关因素。方法 对57例患的病例资料及术后2.4-4.5个月的随访情况进行总结分析。结果 术后55例外观效果满意；并发症主要有球结膜裂开（18例）、义眼座暴露（9例）及自体巩膜溶解（8例）；球结膜裂开18例中17例发生于术后4周内；球结膜裂开发生率与患年龄、手术期别无关，与疾病种类、手术方法特别是有无自体巩膜包裹、手术熟练程度及HA义眼座品种有关；眼球萎缩和外伤后无眼球患的发生率（7/31）较其他病种（11/26）低，眼球除自体巩膜包裹HA义眼座植入术16例中9例发生结膜裂开（8例伴自体巩膜溶解），眼球除后无包裹HA义眼座植入术36例中7例裂开。结论 眼外伤行修补术或眼球除除术后患二期义眼座植入的手术时间应适当推后；无包裹直接植入法的术后球结膜裂开发生率低于有包裹植入法，这一方法值得推广；自体巩膜离体后的处理方法尚需进一步探讨。     

视网膜母细胞瘤眼球摘除、羟基磷灰石义眼座Ⅰ期植入临床观察

目的 评价视网膜母细胞瘤眼球摘除，羟基磷灰石（hydroxyopatite，HA）义眼座Ⅰ期植入术后的临床效果。方法 对27例（27眼）Rb患者行眼球摘除眶内HA义眼座Ⅰ期植入术后进行临床观察。结果 术后随访12～36个月，平均18个月。义眼座活动度良好。24例结膜创口Ⅰ期愈合，2例结膜变薄，1例结膜创口裂开，HA义眼座暴露。1例Rb复发。结论 Rb患者眶内HA义眼座Ⅰ期植入有助于眼眶发育和美容。     

带眼外肌的自体巩膜壳覆盖羟基磷灰石义眼台植入术

目的观察带眼外肌的自体巩膜壳覆盖羟基磷灰石（HA）义眼台植入术的临床效果。方法54例（54只眼）无视功能者行眼内容物剜除后,采用带眼外肌的自体巩膜后肌锥内HA义眼台一期植入,术后观察术眼结膜的愈合、结膜囊深浅、HA义眼台位置及活动度等。结果术后随访4个月至2年,术后效果优50只眼（92．59％）,良4只眼（7．41％）,所有术眼结膜愈合好,未出现HA义眼台或巩膜暴露、感染,无义眼台移位,安置薄型义眼片后外观逼真,转动功能良好,眼窝饱满,双眼外形基本对称。结论肌锥内带眼外肌的自体巩膜壳覆盖HA义眼台植入术保留了完整的巩膜层、眼外肌和邻近的结缔组织,可以避免或最大限度的减少HA义眼台暴露的发生,术后义眼台运动度良好。     

眼外伤后二期眼球摘除义眼台植入后自体巩膜溶解原因

目的探讨眼外伤后二期眼球摘除义眼台植入后发生自体巩膜溶解的原因。方法对行眼球摘除患者病历资料进行回顾性总结和分析,根据是否斟眼外伤后一期缝合并在不同时间二期行眼球摘除义眼台植入分成两组,组1为眼外伤后二期眼球摘除义眼台植入164例（164眼）;组2为其余原因眼球摘除义眼台植入352例（352眼）。从一期眼球破裂情况、术后眼球炎症反应、二期眼球摘除原因、术后并发症、术后效果等方面进行分析,比较两组之间发生自体巩膜溶解的差异及可能的原因。结果外伤后二期眼球摘除义眼台植入术后自体巩膜溶解的发生率（8．54％）明显高于其它原因行眼球摘除义眼台植入者（1．99％）（x^2=12．868P〈0．001）。结论推测外伤后二期眼球摘除义眼台植入术后自体巩膜溶解发生的可能原因众多：二次植入的时间、义眼台排斥、多次手术激发了超敏反应及抗原抗体反应、外伤及手术大面积扰动致使眼球筋膜囊瘢痕粘连等。提示我们适时的选择眼球摘除义眼仃植人对预防术后发生自体巩膜溶解有助。,     

Hydroxyapatite orbital implant vascularization assessed by magnetic resonance imaging

PURPOSE: To report hydroxyapatite (HA) implant enhancement patterns on magnetic resonance (MR) images at varying time intervals after implantation. METHODS: We retrospectively reviewed the records of 45 consecutive patients(from one author's practice) who underwent an MR imaging study 2 to 157 months after HA orbital implant placement. Implant fibrovascular ingrowth was assessed by analyzing the extent of implant enhancement seen on MR imaging.RESULTS Of 21 patients undergoing gadolinium-DTPA T1-weighted MR imaging 2 to 7 weeks after HA placement, 15 had enhancement limited to the implant rim (Grade I or less). Five patients had peripheral foci of enhancement (Grade II), and one patient had foci of enhancement extending to the center of the implant (Grade III). MR images obtained 9 to 15 weeks after HA insertion in all 14 patients had some degree of central enhancement (Grade III) and 11 had homogeneous enhancement throughout the implant (Grade IV or V). Seven patients in the homogeneous group were believed to have particularly intense enhancement patterns (Grade V). Of the 10 patients undergoing MR imaging from 31 to 69 weeks after surgery, 5 had Grade III enhancement and 5 had Grade IV enhancement. CONCLUSIONS: This study demonstrated consistent central HA orbital implant enhancement on MR imaging in the 9- to 15-week group and the >31-week postoperative group. HA orbital implant drilling and peg placement should be performed after central vascularization of the spherical implant has occurred. The results of this study support the principle of performing orbital implant drilling and peg placement at least 5 to 6 months after HA implant insertion.     

羟基磷灰石义眼座眶内植入139例分析

目的探讨带预置缝线的羟基磷灰石(hydroxyapatite，HA)义眼座直接植入眶内的手术效果。方法自1997年9月～2002年6月进行带预置缝线的HA义眼座直接植入眶内手术139例(139眼)，其中Ⅰ期眶内义眼座植入117眼，Ⅱ期眶内义眼座植入22眼。随访6～24月，平均11．8月。结果139眼术后出现轻微眼睑及球结膜水肿，4眼结膜切口裂开，经保守治疗自愈。2眼HA义眼座暴露，经修复后愈合。随访观察139眼义眼活动良好，眼窝饱满；Ⅰ期较Ⅱ期植入的义眼活动度大，外观更逼真。未发生义眼座脱出及感染等并发症。结论眼球摘除术后植入HA义眼座，提高了眼球运动效果和面部美观程度，效果较好。     

带预置缝线的羟基磷灰石义眼座眶内植入术疗效观察

目的探讨带预置缝线的羟基磷灰石义眼座(hydroxyapatite,HA)直接植入眶内的手术效果。方法22例(22只眼)行带预置缝线的羟基磷灰石义眼座直接植入眶内手术,术后随访3~17月。结果22只眼术后均有眼睑轻度肿胀,球结膜水肿,眼眶区胀痛,2只眼球结膜切口裂开,经保守治疗后愈合。未发生义眼座暴露、脱出及感染等并发症。结论带预置缝线的羟基磷灰石义眼座眶内植入术方便易行、疗效可靠。     

同种异体脱细胞真皮用于羟基磷灰石眼台覆材料的临床观察

目的比较同种异体脱细胞真皮与同种异体巩膜作为眼球摘除并羟基磷灰石(HA)义眼台植入的覆盖材料术后效果,探讨同种异体脱细胞真皮的临床应用价值。设计回顾性病例系列。研究对象北京同仁医院2003年5月至2005年3月收治的眼球萎缩患者行眼球摘除并HA眼台植入手术患者112例。方法临床观察112例112眼,眼球摘除并HA眼台植入覆盖同种异体巩膜者为异体巩膜组(56眼),覆盖同种脱细胞真皮者为脱细胞真皮组(56眼)。两组在手术后1天、3天、1周、1个月及6个月进行随诊,严密观察结膜伤口愈合情况及有无HA眼台的暴露。主要指标结膜伤口愈合情况、HA眼台暴露情况。结果异体巩膜组中有1眼结膜伤口裂开但无HA眼台暴露。脱细胞真皮组中5眼术后结膜伤口裂开,其中2眼HA眼台暴露。经再次手术治疗后痊愈,但与异体巩膜组比较两组差异无统计学意义。两组均无其他手术并发症出现。结论同种异体脱细胞真皮作为HA眼台的覆盖材料应用于临床其价值得到初步肯定,与同种异体巩膜相同,无术后严重并发症。不易作为传染源的载体及容易获得为其优点,应用这种材料需手术操作更为细心及熟练。(眼科,2007,16:378-381)     

The use of vicryl mesh in 200 porous orbital implants: a technique with few exposures

PURPOSE: To report the results of a wrapping technique for porous orbital implants by using polyglactin 910 (Vicryl) mesh (Ethicon Inc., Somerville, NJ, U.S.A.). METHODS: We retrospectively reviewed the records of 200 consecutive patients from one author's practice who received a polyglactin 910 mesh-wrapped porous orbital implant after enucleation or as a secondary implant between October 1, 1996, and April 15, 2001. We recorded potential problems that might be attributed to polyglactin 910 mesh both before pegging (excessive inflammatory response to the material, conjunctival thinning, and implant exposure) and after pegging (exposure of the implant around the sleeve, conjunctival thinning, and implant exposure other than adjacent to the peg). RESULTS: One hundred twenty-two men and 78 women underwent placement of a polyglactin 910 mesh-wrapped porous orbital implant. The average age at the time of implantation was 48.9 years (range, 11 to 85 years). The average follow-up interval in the 200 patients was 19.4 months (range, 2 to 80 months). Thirteen of the 200 patients had less than 6 months of follow-up, leaving 187 patients with an average follow-up of 20.5 months (range, 6 to 80 months). There were 76 primary enucleations and 124 secondary orbital implants. Thirty-seven patients received a Bio-Eye hydroxyapatite implant (HA) (Integrated Orbital Implants, San Diego, Calif), 97 received a synthetic FCI hydroxyapatite implant (FCI, Issy-Les-Moulineaux, France), and 66 received a Bioceramic implant (aluminum oxide-Al2O3) (FCI, Issy-Les-Moulineaux, France). One hundred fourteen patients (57%) underwent peg placement. The average time to pegging was 9.9 months (range, 6 to 16 months). Before pegging, 4 of 187 patients (2.1%) had implant exposure. Three of these exposures followed secondary orbital implant placement (2 Bio-Eye HA, 1 synthetic FCI3 HA) and one followed an enucleation (synthetic FCI3 HA). Two patients required a temporalis fascia graft and one required a scleral patch; the remaining defect closed spontaneously. One patient had conjunctival thinning 6 months after orbital implantation, which remained stable with no frank exposure for 36 months. No patient had excess socket inflammation. After peg placement, 3 additional patients had exposure of the implant around the peg site. There were no cases of conjunctival thinning or exposure of the implant other than adjacent to the peg site. CONCLUSIONS: Polyglactin 910 mesh is an excellent option as a wrapping material for porous orbital implants. It is simple to use, readily available, eliminates the need for donor tissue, does not require a second operative site, and it is less expensive than other currently available wrapping materials. We attribute our high success rate to our technique, which emphasizes proper placement of the implant within the Tenon space, suturing the extraocular muscles anterior to their normal anatomic sites, and meticulous closure of the Tenon capsule and conjunctiva in separate layers.     

HA眼台植入后脓性肉芽肿形成的原因分析

目的分析珊瑚多孔羟基磷灰石(HA)义眼台眶内植入术后脓性肉芽肿形成的原因,探讨其有效的治疗方法。方法回顾性分析我院眶内植入HA义眼台250例(钻孔及栓钉置入68例),外院1例,随诊18月-10年,脓性肉芽肿形成后给予药物及手术治疗。结果250例中发生脓性肉芽肿6例,其中5例在钻孔及栓钉置入术4～7年后发生,1例发生时羟基磷灰石义眼台未钻孔。6例保守治疗效果欠佳,均行HA义眼台取出术。结论脓性肉芽肿的发生原因可能与义眼台血管纤维化不足,义眼台暴露,异体巩膜包被,义眼台钻孔及栓钉置入等有关。脓性肉芽肿保守治疗效果欠佳,最终行义眼台取出术。     

Clinical Application of Artificial Orbital Implantation with a Turning Implantation Method in 46 Cases

 Purpose: To analyze and summarize the application of turning implantation method in artificial orbital implantation. Methods: Artificial orbital implants were implanted into 46 patients who were willing to accept artificial orbital implantation with turning implantation method. Results: After the implantation, 46 cases (46 eyes) with HA orbital implants were healed with plump orbits. No ptosis appearance deformity or rejection was observed. The implants were qualified in appearance and flexibility. Two cases presented with chemosis and eye grinding pain during early postoperative, but recovered after effective treatment. After 6-24 months of follow-up, none of them had artificial implant exposure or abnormal orbital stimulation. Conclusion:Turning implantation method acts as a good artificial orbital implantation.     

异形羟基磷灰石义眼台的临床应用

目的:观察异形羟基磷灰石义眼台植入术并发症及手术效果,探讨异形义眼台的适应证及其临床应用价值。方法:设计不同体积的异形羟基磷灰石义眼台,治疗眼球萎缩、眼内容物摘除及眼球摘除术后患者共30例。对照组植入常规圆球形羟基磷灰石义眼台共30例。异形义眼台组与对照组间性别、年龄、眼部情况相似。手术后随访时间6mo以上,观察患者义眼台植入术后球结膜愈合时间、义眼台暴露、感染等并发症、义眼台活动度、位置以及与义眼片适合程度的差异。结果:异形羟基磷灰石义眼台组没有发生义眼台暴露、感染等严重并发症,球结膜愈合时间短,义眼台植入后前表面呈圆弧形,能与义眼片很好的吻合,义眼台活动度及位置均好于对照组。对照组有2例(7%)发生早期球结膜裂开的并发症,经过治疗后均愈合。结论:异形义眼台可以降低义眼台植入后引起的并发症,可以有效适应患者眼部病变的情况,获得良好的手术效果,适应证更广,安全性更好。     

Hydroxyapatite orbital implants Experience with 100 cases

Background: The hydroxyapatite (HA) intraorbital implant is a relatively new implant made from the porous skeleton of a coral species which allows fibrovascular ingrowth and therefore tissue integration. After fibrovascular ingrowth, a hole can be drilled in the implant and a motility peg inserted to increase movements of the prosthesis by coupling the implant to the prosthesis. Method: The records of the first 100 cases of HA intraorbital implants inserted by the one surgeon were analysed for complications, pain and nausea postoperatively, length of hospital stay, and further surgical procedures required. A series of acrylic implants inserted by the same surgeon was used for comparison. Results: Twenty-five primary and 75 secondary HA implants were performed in patients ranging from six to 74 years of age. All were covered in donor sclera. Follow-up was three to 34 months (mean 16.9, median 17.0). Complications occurred in 15 patients and included too large an implant (seven cases) requiring surgical reduction, scleral exposure in three (repair required in one), an early small exposure of the coral in one case, late thinning of the conjunctiva and later exposure of the implant in one, and shallowing of the inferior fornix requiring mucous membrane grafting in three. No implants migrated, extruded or became infected. Of 80 patients beyond six months follow-up, 28 (35%) had insertion of motility pegs, and six (7.5%) of these suffered minor complications related to the peg. Compared to patients having acrylic implants, the postoperative analgesic requirements and length of hospital stay were significantly greater for the HA patients. Conclusions: Hydroxyapatite intraorbital implants represent a significant advance over other implants and offer a more stable, safe alternative. They also offer the possibility of improved prosthesis motility. The additional cost of the implant, prolonged hospital stay and postoperative pain, should be considered in recommending such implants to patients either as primary or secondary implants.