Klett A, Guthoff R
Central Hospital, Department of Ophthalmology, Tallin, Estonia.
Ophthalmologe. 2003 Jun;100(6):449-52. doi: 10.1007/s00347-003-0836-9.
Orbital implants following enucleation are able beyond all doubt to compensate volume adequately and improve artificial eye motility. In recent decades progress has been made concerning implant material. Nevertheless, in most designs wrapping with homoplastic or alloplastic materials is advocated. In this report a microsurgical concept is presented to avoid wrapping material and at the same time to improve prosthesis motility in a hydroxyapatite-silicon implant. In a retrospective study two groups of patients (15 individuals each) were compared concerning prosthesis motility 6 months after surgery. In group 1 the horizontal and vertical eye muscles were sutured cross-wise in front of the implant (as done since the introduction of this type in 1989). In group 2 autologous muscle pedunculated scleral flaps were dissected microsurgically and used to cover the anterior part of the porous hydroxyapatite component of the implant. There was a highly significant better prosthesis motility and so far no complications concerning implant coverage in this second group. The authors consider the use of muscle pedunculated sclera to be a modification to improve the cosmetic outcome which may also reduce the postoperative complication rate in enucleation surgery.
眼球摘除术后的眼眶植入物无疑能够充分补偿眼眶容积并改善义眼的活动度。近几十年来，植入材料方面取得了进展。然而，在大多数设计中，仍提倡使用同种异体或异种异体材料进行包裹。在本报告中，我们提出了一种显微外科概念，以避免使用包裹材料，同时提高羟基磷灰石-硅植入物中义眼的活动度。在一项回顾性研究中，比较了两组患者（每组15例）术后6个月义眼的活动度。第1组将水平和垂直眼肌在植入物前方交叉缝合（自1989年引入这种类型以来一直如此操作）。第2组通过显微外科手术解剖带蒂自体肌巩膜瓣，并用其覆盖植入物多孔羟基磷灰石部件的前部。第2组义眼活动度明显更好，且迄今为止在植入物覆盖方面未出现并发症。作者认为使用带蒂肌巩膜瓣是一种改善美容效果的改良方法，这也可能降低眼球摘除手术的术后并发症发生率。
