Lin Chao-Wen, Liao Shu-Lang
Departments of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
College of Medicine, National Taiwan University, Taipei, Taiwan.
Br J Ophthalmol. 2017 May;101(5):681-685. doi: 10.1136/bjophthalmol-2016-308932. Epub 2016 Jul 29.
To analyse the long-term outcomes of different types of orbital implant and the results of dermis fat graft for the management of large-area implant exposure.
Retrospective case series. From 1994 to 2015, 256 patients who received primary implantation after enucleation or evisceration and were followed up for an average of 108.9 months were recruited. Detailed characteristics of patients, including previous surgery or trauma, surgical indications and methods, pegging procedure, and implant types were collected. The long-term outcomes were recorded. For patients with extensive implant exposure (diameter of tissue defect >2 cm), implant removal and dermis fat graft were performed.
The risk factors for implant exposure included eviscerated globes and pegged implants. The exposure rates were higher (24.7% in hydroxyapatite (HA), 23.5% in bioceramic and 76.5% in Medpor) as compared with those in previous reports. The average times to exposure were 67.4 months in HA, 52.5 months in bioceramic and 73.4 months in Medpor implants. Among the cases with implant exposure, late exposure (>2 years after operation) accounted for 67% of cases. Thirty eyes with large-area exposure were managed with dermis fat grafts. Twenty-four cases were successfully treated with single surgery. The other six cases developed fornix loss and required additional reconstruction with full thickness skin graft.
Late exposures of porous orbital implants were noted during long-term follow-up. The causes of implant exposure may be associated with pegging procedures and evisceration. The implantation of dermis fat can be an effective procedure for the management of large-area implant exposure.
分析不同类型眼眶植入物的长期效果以及真皮脂肪移植治疗大面积植入物暴露的结果。
回顾性病例系列研究。纳入1994年至2015年期间接受眼球摘除或眼内容剜出术后初次植入且平均随访108.9个月的256例患者。收集患者的详细特征，包括既往手术或外伤史、手术适应证和方法、栓钉植入程序以及植入物类型。记录长期效果。对于植入物暴露范围广泛（组织缺损直径>2 cm）的患者，进行植入物取出和真皮脂肪移植。
植入物暴露的危险因素包括眼内容剜出眼球和栓钉植入物。与既往报道相比，暴露率更高（羟基磷灰石（HA）为24.7%，生物陶瓷为23.5%，Medpor为76.5%）。HA植入物的平均暴露时间为67.4个月，生物陶瓷为52.5个月，Medpor植入物为73.4个月。在植入物暴露的病例中，晚期暴露（术后>2年）占67%。30只大面积暴露的眼睛接受了真皮脂肪移植治疗。24例单次手术成功治疗。另外6例出现穹窿部缺失，需要额外进行全厚皮片移植重建。
在长期随访中发现多孔眼眶植入物存在晚期暴露情况。植入物暴露的原因可能与栓钉植入程序和眼内容剜出有关。真皮脂肪移植可作为治疗大面积植入物暴露的有效方法。
