Morax S, Hurbli T
Adv Ophthalmic Plast Reconstr Surg. 1992;9:67-80.
In patients with congenital anophthalmos and severe microphthalmos, a tiny orbit and socket exist with little eyelids, frequently preventing retention of a standard conformer or prosthesis. Socket expansion is sometimes impossible with microorbitism; the retention of a prosthesis is also difficult when malformations of the eyelids exist. The treatment of these difficult cases includes three stages. The first stage is orbital expansion that depends on the cephalometric studies of the patient: transverse osteotomy on the maxilla and the zygomatic bone with lateral bar by extracranial route, vertical osteotomy on the roof of the orbit by intracranial route. In some cases, the osteotomy includes expansion in the transverse and vertical diameter with bone grafts in the defects and on the lateral and superior rims. Simultaneously, socket expansion is performed by incision of the conjunctival sac circumferentially, with mucosal or split skin grafts on a conformer. The second stage includes eyelid reconstruction by different flaps. A third stage is frequently needed for correction of eyelid malposition on the prosthesis: ptosis, entropion surgery. Two cases of congenital anophthalmos are reported. Methods and indications of treatment are discussed.
在先天性无眼球和严重小眼球患者中，存在微小的眼眶和眼窝，眼睑也很细小，这常常导致无法保留标准的义眼座或义眼。对于小眼眶患者，有时无法进行眼窝扩张；当存在眼睑畸形时，义眼的固定也很困难。这些疑难病例的治疗包括三个阶段。第一阶段是眼眶扩张，这取决于对患者的头影测量研究：通过颅外途径对上颌骨和颧骨进行横向截骨并带有侧杆，通过颅内途径对眶顶进行垂直截骨。在某些情况下，截骨包括在缺损处以及外侧和上缘使用骨移植来扩大横向和垂直直径。同时，通过环形切开结膜囊进行眼窝扩张，并在义眼座上移植黏膜或中厚皮片。第二阶段包括使用不同的皮瓣进行眼睑重建。第三阶段通常需要矫正义眼上的眼睑位置异常：上睑下垂、睑内翻手术。报告了两例先天性无眼球病例。讨论了治疗方法和适应证。
