Shah Sanket U, Shields Carol L, Lally Sara E, Shields Jerry A
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
Ophthalmic Plast Reconstr Surg. 2015 Mar-Apr;31(2):108-14. doi: 10.1097/IOP.0000000000000207.
To evaluate the features and long-term outcomes of hydroxyapatite (HA) orbital implant following enucleation in pediatric patients.
A retrospective review was performed on clinical records of patients ≤18 years of age , managed with enucleation and HA implant placement. Recorded outcomes included implant-related complications, implant and prosthesis motility, and patient cosmetic satisfaction.
There were 525 children (531 sockets) with HA implant following enucleation. The mean age at HA implant placement was 3 years (median, 2 years; range, 4 days to 17 years). Indications for enucleation included retinoblastoma (n = 457, 86%), uveal melanoma (n = 17, 3%), medulloepithelioma (n = 8, 2%), and others (n = 49, 9%). The HA implant was uncoated (n = 370, 70%) or polymer coated (n = 161, 30%). For the 370 uncoated implants, wrapping was provided with scleral (n = 346, 94%) or bovine pericardium (n = 1, <1%), and 23 patients (6%) had no wrapping. The extraocular muscles were attached to the implant/polymer coat/wrap (n = 531, 100%), by suturing 4 rectus muscles (n = 349, 66%) or all 6 muscles (n = 182, 34%). Over mean follow up of 60 months, in 477 orbital implants, complications included conjunctival thinning (n = 10, 2%), implant infection (n = 6, 1%), implant exposure (n = 13, 3%), and implant migration/extrusion (n = 0, 0%). Motility for implant was judged as excellent (n = 245, 78%) and small-angle prosthesis motility was excellent (n = 196, 59%). Patient/family satisfaction with cosmetic outcome was rated as excellent in 471 implants (99%).
Following enucleation in children, long-term outcomes of the HA orbital implant are excellent with favorable patient cosmetic satisfaction and rare complication.
评估小儿患者眼球摘除术后羟基磷灰石（HA）眼眶植入物的特点及长期效果。
对年龄≤18岁、接受眼球摘除及HA植入物置入治疗的患者临床记录进行回顾性分析。记录的结果包括与植入物相关的并发症、植入物和义眼的活动度以及患者的美容满意度。
525例儿童（531个眼窝）在眼球摘除术后植入了HA植入物。HA植入时的平均年龄为3岁（中位数为2岁；范围为4天至17岁）。眼球摘除的指征包括视网膜母细胞瘤（n = 457，86%）、葡萄膜黑色素瘤（n = 17，3%）、髓上皮瘤（n = 8，2%）及其他（n = 49，9%）。HA植入物为未涂层的（n = 370，70%）或聚合物涂层的（n = 161，30%）。对于370个未涂层的植入物，采用巩膜包裹（n = 346，94%）或牛心包包裹（n = 1，<1%），23例患者（6%）未进行包裹。眼外肌通过缝合4条直肌（n = 349，66%）或全部6条肌肉（n = 182，34%）附着于植入物/聚合物涂层/包裹物上（n = 531，100%）。平均随访60个月，477个眼眶植入物的并发症包括结膜变薄（n = 10，2%）、植入物感染（n = 6，1%）、植入物暴露（n = 13，3%）以及植入物迁移/挤出（n = 0，0%）。植入物的活动度被判定为优秀（n = 245，78%），小角度义眼的活动度为优秀（n = 196，59%）。471个植入物（99%）的患者/家属对美容效果的满意度被评为优秀。
小儿眼球摘除术后，HA眼眶植入物的长期效果良好，患者美容满意度高，并发症罕见。
