Schittkowski M P, Guthoff R F
Department of Opthalmology, University of Rostock, Doberaner Strasse 140, D-18055 Rostock, Germany.
Br J Ophthalmol. 2006 Sep;90(9):1173-7. doi: 10.1136/bjo.2006.092478. Epub 2006 May 17.
BACKGROUND/AIM: Children with congenital microphthalmos are usually able to wear an eye prosthesis but the cosmetic aspect is determined by the size of the orbital volume deficiency. Instead of using a ball shaped standard hydrogel expander or a regular orbital implant, which would necessitate enucleation of the microphthalmic eye, this study investigates the feasibility of volume augmentation with injectable pellet expanders, as formerly suggested for acquired anophthalmos in adults only.
The pellet expander is made from a self inflating hydrogel that takes up water by osmosis (dry state: length 8 mm, diameter 2 mm, volume 0.025 ml; in vitro hydrated state after around 1 day: length 15 mm, diameter 4 mm, volume 0.24 ml; swelling capacity: 9.6-fold). This report concerns six patients (two girls and four boys) aged between 4 months and 42 months with unilateral microphthalmos who were treated by injection of 4-14 pellet expanders into the retrobulbar orbital tissue. Volume augmentation was 1-3.5 ml. The pellets were injected using a customised trocar and placed behind the microphthalmos directed into the intraconal space.
The increasing orbital volume was noticeable within 2 days and was confirmed by ultrasonography and magnetic resonance imaging. The final result can be anticipated by the volume augmentation effect produced by the amount of saline solution injected in the orbital apex region. All patients were fitted with an artificial eye, which was subsequently enlarged every 3-5 months. Anophthalmic enophthalmos was fully compensated with this technique. No complications have been encountered to date.
Orbital volume augmentation with injectable self inflating hydrogel expander pellets is apparently a safe, quick, and minimally invasive technique for various indications in orbital reconstructive surgery-for example, to treat an enophthalmic appearance in microphthalmos and congenital or acquired anophthalmos.
背景/目的：先天性小眼球患儿通常能够佩戴义眼，但外观效果取决于眼眶容积缺损的大小。本研究摒弃了使用球形标准水凝胶扩张器或常规眼眶植入物（这需要摘除小眼球）的方法，转而探讨可注射颗粒扩张器增加容积的可行性，此前该方法仅用于成人后天性无眼球的情况。
颗粒扩张器由一种通过渗透作用吸水的自膨胀水凝胶制成（干燥状态：长度8毫米，直径2毫米，容积0.025毫升；体外约1天后水合状态：长度15毫米，直径4毫米，容积0.24毫升；膨胀能力：9.6倍）。本报告涉及6例年龄在4个月至42个月之间的单侧小眼球患者（2名女孩和4名男孩），他们接受了将4 - 14个颗粒扩张器注射入球后眼眶组织的治疗。容积增加量为1 - 3.5毫升。使用定制的套管针注射颗粒，并将其置于小眼球后方，朝向锥内间隙。
眼眶容积在2天内明显增加，超声和磁共振成像证实了这一点。最终结果可通过眼眶尖部区域注射的盐溶液量所产生的容积增加效果来预测。所有患者均佩戴了义眼，随后每3 - 5个月更换一次更大尺寸的义眼。该技术完全补偿了无眼球性眼球内陷。迄今为止未出现并发症。
可注射自膨胀水凝胶扩张器颗粒增加眼眶容积显然是一种安全、快速且微创的技术，适用于眼眶重建手术的各种适应证，例如治疗小眼球以及先天性或后天性无眼球患者的眼球内陷外观。
